CoChat
Sign Up
Cited by 340Consumer Attitudes and Food LabelingNutritional Studies and DietGlobal Public Health Policies and Epidemiology

The DOI matches its Crossref record; 222 of the 222 references it cites were found in a registry or an index; 6 of the 86 sources its claims cite were checked for support.

Ultra-processed foods and human health: the main thesis and the evidence

Open access
Monteiro, Carlos A, Louzada, Maria LC, Steele-Martinez, Euridice, Cannon, Geoffrey, Andrade, Giovanna C, Baker, Phillip, Bes-Rastrollo, Maira, Bonaccio, Marialaura, Gearhardt, Ashley N, Khandpur, Neha, Kolby, Marit, Levy, Renata B, Machado, Priscila P, Moubarac, Jean-Claude, Rezende, Leandro F M, Rivera, Juan A, Scrinis, Gyorgy, Srour, Bernard, Swinburn, Boyd, Touvier, Mathilde·2025·The Lancet
DOI 10.1016/s0140-6736(25)01565-x
Open this paper in CoChat — free accountOpen PDF

Abstract

This first paper in a three-part Lancet Series combines narrative and systematic reviews with original analyses and meta-analyses to assess three hypotheses concerning a dietary pattern based on ultra-processed foods. The first hypothesis-that this pattern is globally displacing long-established diets centred on whole foods and their culinary preparation as dishes and meals-is supported by decades of national food intake and purchase surveys, and recent global sales data. The second-that this pattern results in deterioration of diet quality, especially in relation to chronic disease prevention-is confirmed by national food intake surveys, large cohorts, and interventional studies showing gross nutrient imbalances; overeating driven by high energy density, hyper-palatability, soft texture, and disrupted food matrices; reduced intake of health-protective phytochemicals; and increased intake of toxic compounds, endocrine disruptors, and potentially harmful classes and mixtures of food additives. The third and final hypothesis-that this pattern increases the risk of multiple diet-related chronic diseases through various mechanisms-is substantiated by more than 100 prospective studies, meta-analyses, randomised controlled trials, and mechanistic studies, covering adverse outcomes across nearly all organ systems. The totality of the evidence supports the thesis that displacement of long-established dietary patterns by ultra-processed foods is a key driver of the escalating global burden of multiple diet-related chronic diseases. Two companion papers in this Series specify policy actions and wider public health strategies to promote, protect, and support diets based on fresh and minimally processed foods and prevent their displacement by ultra-processed foods.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This Lancet Series paper combines narrative and systematic reviews, original analyses, and meta-analyses to argue that ultra-processed foods (UPFs) are displacing long-established diets, degrading diet quality, and increasing risk of multiple chronic diseases. It concludes the totality of evidence supports UPF displacement as a key driver of the global chronic disease burden, while calling for public health action despite remaining research gaps.

Key findings

  • Across 36 countries, the dietary share of UPFs ranged from 9% (Iran) to 60% (USA) of total energy and correlated with national wealth (r=0.45, 95% CI 0.20–0.70). Repeated surveys showed increases in 8 of 9 countries; e.g., Spain rose from 11.0% to 31.7% over three decades and Canada from 24.4% to 54.9% over eight decades. Euromonitor 2007–22 data showed per capita UPF sales rose 60% in Uganda (20.3 to 32.2 kg), 40% in lower-middle-income countries (45.3 to 63.3 kg), nearly 20% in upper-middle-income countries (104.0 to 121.6 kg), and remained stable at about 200 kg in high-income countries.
  • A 13-country meta-analysis found higher UPF energy share associated with higher free sugars, total fat, and saturated fat, and lower fibre, protein, potassium, zinc, magnesium, and several vitamins; it predicted a 34.7 kcal/day increase per 10% higher UPF share. Reducing UPF intake to the lowest quintile would reduce inadequate diets by 69.4% (Canada) to 92.1% (USA). At 15% UPF energy, fruits, vegetables, and legumes contributed 12.4% of energy; at 75%, this fell to 4%. In NutriNet-Santé (n=110,925), the highest versus lowest UPF quintile had two-fold higher emulsifiers, three-fold flavour enhancers, five-fold non-sugar sweeteners, and 15-fold colourings.
  • The systematic review included 104 prospective adult studies; 92 reported increased risk of one or more chronic disease outcomes and 78 reported statistically significant linear trends. Meta-analyses found high versus low UPF exposure associated with 12 outcomes, with effect sizes from 1.14 (95% CI 1.06–1.23) for cerebrovascular disease or mortality to 1.90 (1.40–2.59) for Crohn’s disease; no associations were found for all-cancer mortality, ulcerative colitis, or colorectal cancer. In RCTs, the US NIH trial (20 adults) found the UPF diet led to +0.9 kg bodyweight and +0.4 kg fat mass versus −0.9 kg and −0.3 kg on the non-UPF diet; the Tokyo trial (9 adults) found +2.2 kg and +0.7 kg fat mass versus +1.1 kg and −0.4 kg; the Drexel pilot (14 adults) reported a 3.5 kg weight reduction after an 8-week intervention to reduce UPF intake.
  • The paper states the evidence fulfils seven of nine Bradford Hill criteria for causality and cites an eight-country study estimating UPFs account for 4% (Colombia) to 14% (USA and UK) of premature all-cause mortality.

Methods

  • Design: first paper in a three-part Lancet Series; combines narrative and systematic reviews with original analyses and meta-analyses to assess three hypotheses about the ultra-processed dietary pattern.
  • Systematic review: registered with PROSPERO (CRD42022351111) and conducted per PRISMA and MOOSE; searched PubMed/MEDLINE, Scielo, LILACS, Web of Science, Scopus, and Embase from inception to July 4, 2024; included prospective studies in adults using Nova; 104 studies met inclusion criteria; random-effects meta-analyses were done for outcomes with ≥4 studies; quality assessed with the Newcastle-Ottawa Scale.
  • Original analyses: national food intake surveys across 36 countries; Euromonitor International food sales data from 93 countries (2007–22); NutriNet-Santé cohort (n=110,925) for additive intake; narrative review of interventional and mechanistic studies.

Limitations

  • Stated: observational evidence cannot definitively establish causality; residual confounding and non-differential misclassification of exposure are possible; few RCTs exist; biological mechanisms are not fully established; data from low-income countries are scarce; Nova classification can be challenging without training and may introduce subjectivity or classification bias; UPFs vary in nutrient composition, so within-group heterogeneity may obscure health-relevant distinctions; subgroup analyses face confounding, multicollinearity, low variability, and multiple testing; the systematic review focused on adults because few child and adolescent studies were available; the Crohn’s disease association became statistically non-significant after excluding low-quality studies; no associations were found for all-cancer mortality, ulcerative colitis, or colorectal cancer.
  • Evident from the text: several authors developed the Nova classification system, and the Series was funded by Bloomberg Philanthropies; only one included study stated industry funding; some sales analyses rely on Euromonitor International proprietary data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/s0140-6736(25)01565-x

Cites

222 of 222 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

6 of 86 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    The two crossover RCTs on ad libitum UPF and non-UPF diets matched for presented calories and macronutrients and the pilot behavioural intervention study found significant effects of the ultra-processed dietary pattern on weight changes.

    “However, the two crossover RCTs on ad libitum UPF and non-UPF diets matched for presented calories and macronutrients and the pilot behavioural intervention study aforementioned found significant effects of the ultra-processed dietary pattern on weight changes.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [56] Hall, 2019, Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake, Cell Metab source

      The Abstract (page not provided) describes one randomized crossover trial with ad libitum ultra-processed and unprocessed diets matched for presented calories and macronutrients. It reports significant weight gain during the ultra-processed diet and weight loss during the unprocessed diet. This paper does not establish the results of the second crossover RCT or the pilot behavioural intervention study named in the sentence. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [58] Hamano, 2024, Ultra-processed foods cause weight gain and increased energy intake associated with reduced chewing frequency: a randomized, open-label, crossover study, Diabetes Obes Metab source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [55] Hagerman, 2024, A pilot study of a novel dietary intervention targeting ultra-processed food intake, Obes Sci Pract source

      Checked before — its earlier verdict is held back until a new check runs.

  • Findingcitation

    Post-hoc analyses linked the differences in energy intake and eating rate to the increased energy density of non-beverages and the greater content of hyperpalatable foods in the ultra-processed diet.

    “Post-hoc analyses linked these differences to the increased energy density of non-beverages and the greater content of hyperpalatable foods in the ultra-processed diet.57”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [57] Fazzino, 2023, Ad libitum meal energy intake is positively influenced by energy density, eating rate and hyper-palatable food across four dietary patterns, Nat Food source

      Checked before — its earlier verdict is held back until a new check runs.

  • Findingcitation

    In the Drexel pilot study with 14 participants, the 8-week behavioural intervention designed to reduce UPF consumption led to a bodyweight reduction of 3•5 kg (1•8-5•2).

    “In the Drexel pilot study with 14 participants, the 8-week behavioural intervention designed to reduce UPF consumption led to a bodyweight reduction of 3•5 kg (1•8-5•2).55”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [55] Hagerman, 2024, A pilot study of a novel dietary intervention targeting ultra-processed food intake, Obes Sci Pract source

      Checked before — its earlier verdict is held back until a new check runs.

  • Findingcitation

    Nationally representative studies from the USA found higher urinary concentrations of PFAS in people with increased UPF intake.

    “Nationally representative studies from the USA found higher urinary concentrations of PFAS in people with increased UPF intake.72,73”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [72] Martínez Steele, 2020, Association between dietary contribution of ultra-processed foods and urinary concentrations of phthalates and bisphenol in a nationally representative sample of the US population aged 6 years and older, PLoS One source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [73] Buckley, 2019, Ultra-processed food consumption and exposure to phthalates and bisphenols in the US National Health and Nutrition Examination Survey, 2013–2014, Environ Int source

      Checked before — its earlier verdict is held back until a new check runs.

  • Findingown data

    Effect sizes ranged from 1.14 (95% CI 1.06-1.23) for cerebrovascular disease or mortality, to 1.90 (1.40-2.59) for Crohn's disease.

    “Effect sizes ranged from 1•14 (95% CI 1•06-1•23) for cerebrovascular disease or mortality, to 1•90 (1•40-2•59) for Crohn's disease.”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one. 48
  • Probably not a substantial claim. 17
  • The quote only partly states this claim. 3

  • It may state two separate claims as one.

    Findingcitation

    The 13-country meta-analysis predicted that when UPFs represented 15% of total energy intake, the dietary energy share of fruits, vegetables, and legumes was 12.4%; when UPFs represented 75% of total energy intake, that share dropped to 4%.

    “The aforementioned 13-country meta-analysis predicted that when UPFs represented 15% of total energy intake, the dietary energy share of fruits, vegetables, and legumes (ie, sources of health-protective phytochemicals) was 12•4%.When UPFs represented 75% of total energy intake, that share dropped to 4%. 46”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [46] Martini, 2021, Ultra-processed foods and nutritional dietary profile: a meta-analysis of nationally representative samples, Nutrients source

      The Methods (section 2.3) say the meta-analysis estimated dietary shares at 15% and 75% of energy from UPFs, and the Discussion (section 4) reports lower fruit, vegetable, and legume consumption with higher UPF consumption. The passages in our copy do not give a combined fruit–vegetable–legume energy share of 12.4% or 4%, so the quoted figures cannot be verified. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Studies on all-cause mortality were included because 75% of global deaths result from chronic diseases.

    “Studies on all-cause mortality were included, as 75% of global deaths result from chronic diseases.97”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [97] Vos, 2020, Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019, Lancet source

      The Results (Global trends) and Discussion (Main findings) describe substantial burdens from chronic conditions, but neither gives the share of global deaths caused by them. Searches for “75% of global deaths” and equivalent non-communicable-disease mortality terms found no passage supporting the cited percentage. The decision to include all-cause mortality studies is the citing authors’ own method, not a finding attributed to this source. (LLM, conf=0.74)

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Findingcitation

    Nationally representative US studies found linear inverse associations between UPF quintiles and flavonoid intake, and urinary concentrations of phytoestrogens.

    “Furthermore, nationally representative US studies found linear inverse associations between UPF quintiles and flavonoid intake, 66 and urinary concentrations of phytoestrogens.67”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [66] Leitão, 2024, Association between ultra-processed food and flavonoid intakes in a nationally representative sample of the US population, Br J Nutr source
    • cites [67] Martínez Steele, 2017, Association between dietary share of ultra-processed foods and urinary concentrations of phytoestrogens in the US, Nutrients source

      Methods §2.1 identifies the data as nationally representative US NHANES data. Results §3.2 reports an inverse linear trend across UPF-share quintiles for urinary enterodiol and enterolactone, but no significant linear trend for the four urinary isoflavones. Thus, the citation supports the urinary-concentration part of the sentence only for some phytoestrogens; the flavonoid-intake finding is attached to a different citation. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Interpretationreasoning

    Other plausible factors linking UPF consumption to harm include hyper-palatability, high nonbeverage energy density, disrupted food structures, soft texture, low content of health-protective phytochemicals, toxic contaminants created during processing or released from packaging materials, and potentially harmful classes and mixtures of additives.

    “As discussed in hypothesis 2, other plausible factors include hyper-palatability, high nonbeverage energy density, disrupted food structures, soft texture, low content of health-protective phytochemicals, toxic contaminants created during processing or released from packaging materials, and potentially harmful classes and mixtures of additives.[57][58][59][60][61][62]”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [57] Fazzino, 2023, Ad libitum meal energy intake is positively influenced by energy density, eating rate and hyper-palatable food across four dietary patterns, Nat Food source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [58] Hamano, 2024, Ultra-processed foods cause weight gain and increased energy intake associated with reduced chewing frequency: a randomized, open-label, crossover study, Diabetes Obes Metab source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [59] Krop, 2018, Influence of oral processing on appetite and food intake—a systematic review and meta-analysis, Appetite source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Findingcitation

    In the 1-week Tokyo trial with 9 participants, the UPF diet led to a gain of 2•2 kg (1•8-2•6) in bodyweight and 0•7 kg (0•3-1•1) in fat mass, while the non-UPF diet led to a gain of 1•1 kg (0•5-1•6) in bodyweight and a reduction of 0•4 kg (0•0-0•8) in fat mass.

    “In the 1-week Tokyo trial with 9 participants, the UPF diet led to a gain of 2•2 kg (1•8-2•6) in bodyweight and 0•7 kg (0•3-1•1) in fat mass, while the non-UPF diet led to a gain of of 1•1 kg (0•5-1•6) in bodyweight and a reduction of 0•4 kg (0•0-0•8) in fat mass.58”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [58] Hamano, 2024, Ultra-processed foods cause weight gain and increased energy intake associated with reduced chewing frequency: a randomized, open-label, crossover study, Diabetes Obes Metab source

      Checked before — its earlier verdict is held back until a new check runs.

  • It may state two separate claims as one.

    Findingcitation

    In the 2-week US NIH trial with 20 participants, the UPF diet led to a gain of 0•9 kg (95% CI 0•9-1•5) in bodyweight and 0•4 kg (0•2-0•6) in fat mass, while the non-UPF diet led to a reduction of 0•9 kg (0•3-1•5) in bodyweight and 0•3 kg (0•1-0•5) in fat mass.

    “In the 2-week US NIH trial with 20 participants, the UPF diet led to a gain of 0•9 kg (95% CI 0•9-1•5) in bodyweight and 0•4 kg (0•2-0•6) in fat mass, while the non-UPF diet led to a reduction of 0•9 kg (0•3-1•5) in bodyweight and 0•3 kg (0•1-0•5) in fat mass.56”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [56] Hall, 2019, Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake, Cell Metab source

  • It may state two separate claims as one.

    Findingcitation

    National surveys of children and adolescents in Argentina, Australia, Brazil, Chile, Colombia, Mexico, the UK, and the USA showed that the energy share of UPFs correlated positively with energy density and free sugars, and inversely with fibre.

    “National surveys of children and adolescents in Argentina, Australia, Brazil, Chile, Colombia, Mexico, the UK, and the USA showed that the energy share of UPFs correlated positively with energy density and free sugars, and inversely with fibre.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    The dietary share of UPFs correlates with national wealth (r=0.45; 95% CI 0.20-0.70), but is also influenced by cultural and other food systems factors.

    “The analysis also reveals that this share correlates with national wealth (r=0•45; 95% CI 0•20-0•70), but is also influenced by cultural and other food systems factors.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    In 2007-22, annual per capita overall sales and sales of the ten UPF subgroups increased in south Asia, southeast Asia, sub-Saharan Africa, central Europe, eastern Europe, Latin America and the Caribbean, central Asia, eastern Asia, north Africa, and the Middle East.

    “In the same 2007-22 period, annual per capita overall sales and sales of the ten UPF subgroups increased in south Asia, southeast Asia, and sub-Saharan Africa (starting <100 kg), as well as in central Europe, eastern Europe, Latin America and the Caribbean, central Asia, eastern Asia, north Africa, and the Middle East (starting between 100 kg and 150 kg).”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one. The quote only partly states this claim.

    Findingcitation

    The energy contribution of UPFs to total household food purchases increased in Spain, Canada, Mexico, Brazil, Argentina, China, South Korea, the USA, and the UK over recent decades.

    “The energy contribution of UPFs to total household food purchases nearly tripled in Spain 39 over three decades (11•0% to 31•7%), more than doubled in Canada 40 over eight decades (24•4% to 54•9%), and increased from 10% to 23% in Mexico 41 and Brazil 42 over four decades (figure 1).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [39] Latasa, 2018, Added sugars and ultra-processed foods in Spanish households (1990–2010), Eur J Clin Nutr source
    • cites [40] Moubarac, 2014, Processed and ultra-processed food products: consumption trends in Canada from 1938 to 2011, Can J Diet Pract Res source
    • cites [41] Marrón-Ponce, 2018, Trends in ultra-processed food purchases from 1984 to 2016 in Mexican households, Nutrients source

      Checked before — its earlier verdict is held back until a new check runs.

  • It may state two separate claims as one.

    Findingcitation

    UPF intake was associated with elevated circulating concentrations of acrylamide biomarkers in the USA and industrial trans-fatty acids in Europe.

    “UPF intake was associated with elevated circulating concentrations of acrylamide biomarkers in the USA 69 and industrial trans-fatty acids in Europe.70”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [69] Martínez Steele, 2023, Ultra-processed food consumption and exposure to acrylamide in a nationally representative sample of the US population aged 6 years and older, Prev Med source
    • cites [70] Huybrechts, 2022, Characterization of the degree of food processing in the European Prospective Investigation into Cancer and Nutrition: application of the Nova classification and validation using selected biomarkers of food processing, Front Nutr source

      Checked before — its earlier verdict is held back until a new check runs.

  • It may state two separate claims as one. The quote only partly states this claim.

    Findingown data

    Of the 104 prospective studies, 92 reported associations between exposure to the ultra-processed dietary pattern and increased risk of one or more chronic disease outcomes, and 78 of these reported statistically significant linear trend associations.

    “Of the 104 studies, 92 reported associations between exposure to the ultra-processed dietary pattern and increased risk of one or more chronic disease outcomes, including all-cause mortality; cancer-related, cardiovascular-related, or cerebrovascular-related morbidity and mortality; and gastrointestinal, respiratory, kidney, liver, gallbladder, joint, metabolic, and mental illnesses.Of these 92”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingcitation

    During pregnancy, an increased UPF intake was associated with greater maternal concentrations of phthalates and umbilical cord PFAS.

    “During pregnancy, an increased UPF intake was associated with greater maternal concentrations of phthalates 74 and umbilical cord PFAS.75”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [74] Baker, 2024, Ultra-processed and fast food consumption, exposure to phthalates during pregnancy, and socioeconomic disparities in phthalate exposures, Environ Int source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [75] Naspolini, 2021, Maternal consumption of ultra-processed foods and newborn exposure to perfluoroalkyl substances (PFAS), Cad Saude Publica source

  • It may state two separate claims as one.

    Findingcitation

    A US study at Drexel University assessed 14 adults in an 8-week pilot behavioural intervention designed to reduce UPF intake, and reported statistically significant reductions in daily energy intake (2561 kcal to 1949 kcal), the number of UPFs consumed (11.5 per day to 6.2 per day), and the energy from UPFs (1944 kcal/day to 993 kcal/day).

    “Three 24 h dietary recalls before and after the intervention were used, and statistically significant reductions in daily energy intake (2561 kcal to 1949 kcal), the number of UPFs consumed (11•5 per day to 6•2 per day), and the energy from UPFs (1944 kcal/day to 993 kcal/day) were reported.55”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] Hagerman, 2024, A pilot study of a novel dietary intervention targeting ultra-processed food intake, Obes Sci Pract source

      Checked before — its earlier verdict is held back until a new check runs.

  • It may state two separate claims as one.

    Findingown data

    From 2007 to 2022, annual per capita sales of UPFs increased by 60% in Uganda, by 40% in lower-middle-income countries, and by nearly 20% in upper-middle-income countries.

    “From 2007 to 2022, annual per capita sales of UPFs increased by 60% (20•3 kg to 32•2 kg) in Uganda, the only low-income country assessed by Euromonitor; by 40% (45•3 kg to 63•3 kg) in lower-middle-income countries (n=22); and by nearly 20% (104•0 kg to 121•6 kg) in upper-middle-income countries (n=26; figure 2).”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingcitation

    Reducing UPF intake to the lowest quintile would substantially decrease the prevalence of diets with insufficient fibre intake or with excessive energy density, free sugars, or saturated fat, and would reduce the percentage of diets inadequate in all four parameters by 69.4% (Canada) to 92.1% (USA).

    “Further analysis of eight of the 13 countries showed that reducing UPF intake to the lowest quintile would substantially decrease the prevalence of diets with insufficient fibre intake or with excessive energy density, free sugars, or saturated fat, and would reduce the percentage of diets inadequate in all four parameters by 69•4% (in Canada) to 92•1% (in the USA).”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingcitation

    Diets with higher UPF energy shares had higher contents of nutrients directly associated with chronic disease risk (free sugars, total fat, saturated fat), and lower contents of nutrients inversely associated with chronic disease risk (fibre, protein, potassium, zinc, magnesium, and several vitamins).

    “diets with higher UPF energy shares had higher contents of nutrients directly associated with chronic disease risk (ie, free sugars, total fat, and saturated fat), and lower contents of nutrients inversely associated with chronic disease risk (ie, fibre, protein, potassium, zinc, magnesium, and several vitamins).”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one. The quote only partly states this claim.

    Findingcitation

    In a 2-week crossover RCT by the US NIH, participants consuming an ultra-processed diet (~80% of energy from UPFs) consumed approximately 500 kcal more and ate faster than when consuming a diet containing no UPFs, despite equivalent nutrient profiles.

    “Participants consumed approximately 500 kcal more with the UPF diet and ate faster (with a higher energy intake rate), despite equivalent nutrient profiles.56”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [56] Hall, 2019, Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake, Cell Metab source

  • It may state two separate claims as one.

    Findingown data

    In Latin America and the Caribbean, overall UPF sales declined after 2016 due to reduced sweetened drink sales and stable trends in other subgroups.

    “In Latin America and the Caribbean, overall UPF sales declined after 2016 due to reduced sweetened drink sales and stable trends in other subgroups (figure 3).”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    In maximally adjusted models, high exposure to the ultra-processed dietary pattern was associated with a greater risk of 12 outcomes: overweight or obesity, abdominal obesity, type 2 diabetes, hypertension, dyslipidaemia, cardiovascular disease or mortality, coronary heart disease or mortality, cerebrovascular disease or mortality, chronic kidney disease, Crohn's disease, depression, and all-cause

    “In maximally adjusted models, high exposure to the ultra-processed dietary pattern was associated with a greater risk of 12 outcomes: overweight or obesity, abdominal obesity, type 2 diabetes, hypertension, dyslipidaemia, cardiovascular disease or mortality, coronary heart disease or mortality, cerebrovascular disease or mortality, chronic kidney disease, Crohn's disease, depression, and all-cause”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    Results remained unchanged in a sensitivity analysis excluding low-quality studies, except for Crohn's disease, where the association became statistically non-significant (for two high-quality studies).

    “Results remained unchanged in a sensitivity analysis excluding low-quality studies, except for Crohn's disease, where the association became statistically non-significant (for two high-quality studies; appendix p 27).”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingreasoning

    UPF sales declined in North America, Australasia, and western Europe, where sales already exceeded 200 kg in 2007, because of declining sweetened carbonated drinks sales and stable or modest increasing sales of other UPF subgroups.

    “UPF sales declined in North America, Australasia, and western Europe, where sales already exceeded 200 kg in 2007, because of declining sweetened carbonated drinks sales and stable or modest increasing sales of other UPF subgroups.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    No associations were found for all-cancer mortality, ulcerative colitis, and colorectal cancer.

    “No associations were found for all-cancer mortality, ulcerative colitis, and colorectal cancer.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingcitation

    In a 1-week crossover RCT at the University of Tokyo Hospital involving nine adults with overweight or obesity, participants consumed 813 kcal/day more and had fewer chews per calorie during the UPF week compared with the non-UPF week.

    “During the UPF week, participants consumed 813 kcal/day more and had fewer chews per calorie, compared with the non-UPF week.[59][60][61][62]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [59] Krop, 2018, Influence of oral processing on appetite and food intake—a systematic review and meta-analysis, Appetite source
    • cites [60] Robinson, 2014, A systematic review and meta-analysis examining the effect of eating rate on energy intake and hunger, Am J Clin Nutr source
    • cites [61] Forde, 2020, Ultra-processing or oral processing? A role for energy density and eating rate in moderating energy intake from processed foods, Curr Dev Nutr source

      Checked before — its earlier verdict is held back until a new check runs.

  • It may state two separate claims as one.

    Findingcitation

    Within countries, the dietary share of UPFs tends to be elevated in groups with high socioeconomic status where overall UPF intake is low, and in groups with low socioeconomic status where overall UPF intake is high.

    “Within countries, the dietary share of UPFs tends to be elevated in groups with high socioeconomic status, where overall UPF intake is low, and in groups with low socioeconomic status, where overall UPF intake is high (appendix p 2).”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingreasoning

    Despite limitations of observational studies (eg, residual confounding and non-differential misclassification of the exposure), associations were consistent across large, high-quality cohorts, and some trials.

    “Despite limitations of observational studies (eg, residual confounding and non-differential misclassification of the exposure), associations were consistent across large, highquality cohorts, and some trials.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    Increases in UPF share were greater in countries with initially low UPF shares (ie, <20%) and smaller where the share was already high (ie, 50%).

    “Increases were greater in countries with initially low UPF shares (ie, <20%) and smaller where the share was already high (ie, 50%).”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingcitation

    Two crossover RCTs on disease precursors confirmed the association with obesity, which was further reinforced by two similar trials published shortly before this Series paper was accepted.

    “As noted earlier, two crossover RCTs on disease precursors confirmed the association with obesity, which was further reinforced by two similar trials published shortly before this Series paper was accepted.227,228”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [227] Dicken, 2025, Ultraprocessed or minimally processed diets following healthy dietary guidelines on weight and cardiometabolic health: a randomized, crossover trial, Nat Med source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [228] Preston, 2025, Effect of ultra-processed food consumption on male reproductive and metabolic health, Cell Metab source

  • It may state two separate claims as one.

    Findingnone given

    From 2007 to 2022, annual UPF sales (initially <150 kg/person) rose in low-income, lower-middle-income, and upper-middle-income countries, and across all lower income regions.

    “From 2007 to 2022, annual UPF sales (initially <150 kg/person) rose in low-income, lower-middleincome, and upper-middle-income countries, and across all lower income regions.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The density of drink products is 1 kg/L.

  • It may state two separate claims as one.

    Findingnone given

    Most existing evidence on the adverse health effects of UPFs is observational and cannot definitively establish causality.

    “Most existing evidence on the adverse health effects of UPFs is observational and cannot definitively establish causality.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper may give no reason why it holds.

    Findingnone given

    National surveys, large cohorts, and three interventional studies consistently show that exposure to the ultraprocessed dietary pattern broadly degrades diet quality.

    “National surveys, large cohorts, and three interventional studies consistently show that exposure to the ultraprocessed dietary pattern broadly degrades diet quality.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Meta-analyses of 15 outcomes (with ≥4 studies) found statistically significant associations for 12, including: overweight or obesity; type 2 diabetes and other cardiometabolic risk factors; cardiovascular, kidney, and gastrointestinal diseases; depression; and all-cause mortality.

    “Meta-analyses of 15 outcomes (with ≥4 studies) found statistically significant associations for 12, including: overweight or obesity; type 2 diabetes and other cardiometabolic risk factors; cardiovascular, kidney, and gastrointestinal diseases; depression; and all-cause mortality.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Study design and conductown data

    All included studies controlled for sociodemographic variables; most adjusted for smoking and physical activity, BMI, alcohol, and potential dietary mediators including key nutrients and food groups or diet quality scores.

    “All studies controlled for sociodemographic variables; most adjusted for smoking and physical activity (n=96), BMI (n=79), alcohol (n=57), and potential dietary mediators, including key nutrients (eg, sodium, saturated fat, and added sugar) and food groups (eg, fruits, vegetables, and legumes), or diet quality scores combining these nutrients and food groups (n=54).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductcitation

    Study quality was evaluated using the Newcastle-Ottawa Scale.

    “MLCL, RBL, LFMR, and GCA evaluated study quality using the Newcastle-Ottawa Scale.98”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [98] Wells

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductown data

    Only one included study stated industry funding.

    “Only one study stated industry funding.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    The systematic review was registered with PROSPERO (CRD42022351111) and conducted following PRISMA and MOOSE guidelines.

    “This systematic review was registered with PROSPERO (CRD42022351111) and conducted following PRISMA 95 and MOOSE 96 guidelines.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [95] Page, 2021, The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, BMJ source
    • cites [96] Stroup, 2000, Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group, JAMA source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    Sensitivity analyses were conducted by excluding studies with Newcastle-Ottawa scores below 7 and studies with fewer than 10 000 participants.

    “Sensitivity analyses were conducted by excluding studies with Newcastle-Ottawa scores below 7 and studies with fewer than 10 000 participants.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Study design and conductown data

    85 studies were rated as good quality (≥7 of 9 points on the Newcastle-Ottawa Scale), 18 were rated as fair (5-6 points), and one as poor (<5 points).

    “85 studies were rated as good quality (ie, ≥7 of 9 points on the Newcastle-Ottawa Scale), 98 18 were rated as fair (5-6 points), and one as poor (<5 points; appendix pp 14-16).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [98] Wells

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Premisecitation

    The Moli-sani study found that 20-33% of associations with all-cause and cardiovascular mortality were mediated by sugar intake, whereas saturated fats and sodium intake had minimal effects.

    “The Moli-sani study found that 20-33% of associations with all-cause and cardiovascular mortality were mediated by sugar intake, whereas saturated fats and sodium intake had minimal effects.52”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Bonaccio, 2021, Ultra-processed food consumption is associated with increased risk of all-cause and cardiovascular mortality in the Moli-sani study, Am J Clin Nutr source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    Disagreements in screening were resolved by MLCL.

    “Disagreements were resolved by MLCL.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    Two trained reviewers independently screened titles, abstracts, and full texts, as supervised by MLCL.

    “Two trained reviewers independently screened titles, abstracts, and full texts, as supervised by MLCL.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Interpretationcitation

    Assigning some items within Nova groups can be challenging without adequate training and standardised methods, but the use of validated protocols and trained raters reduces inaccuracies.

    “Assigning some items within Nova groups can be challenging without adequate training and standardised methods, 201 but the use of validated protocols and trained raters reduces inaccuracies.202”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [201] Braesco, 2022, Ultra-processed foods: how functional is the NOVA system?, Eur J Clin Nutr source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [202] Hutelin, 2024, Creation and validation of a NOVA scored picture set to evaluate ultra-processed foods, Appetite source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    Each study was assessed independently by two researchers, with disagreements resolved by consensus among all evaluators.

    “Each study was assessed independently by two researchers, with disagreements resolved by consensus among all evaluators.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Interpretationreasoning

    The socioeconomic distribution of UPF intake mirrors that of obesity, indicating that UPFs, like obesity, first affect wealthier populations before spreading to groups on lower incomes.

    “This pattern mirrors the socioeconomic distribution of obesity, 36 indicating that UPFs, like obesity, 37 first affect wealthier populations before spreading to groups on lower incomes.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [36] Jaacks, 2019, The obesity transition: stages of the global epidemic, Lancet Diabetes Endocrinol source
    • cites [37] Monteiro, 2004, Socioeconomic status and obesity in adult populations of developing countries: a review, Bull World Health Organ source

  • It may state two separate claims as one.

    Interpretationcitation

    These studies all compare UPF subgroups to the overall non-UPF diet, hindering the isolation of specific effects of ultra-processing within food categories and conflating processing effects with those of the food type.

    “However, these studies all compare UPF subgroups to the overall non-UPF diet, hindering the isolation of specific effects of ultra-processing within food categories and conflating processing effects with those of the food type.219”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [219] Monteiro, 2024, Impact of food ultra-processing on cardiometabolic health: definitions, evidence, and implications for dietary guidance, J Am Heart Assoc source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    After the initial submission of this Series paper, similar associations between UPF consumption and adverse health outcomes were reported in three umbrella reviews of meta-analyses.

    “After the initial submission of this Series paper, similar associations between UPF consumption and adverse health outcomes were reported in three umbrella reviews of meta-analyses.[223][224][225]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [223] Lane, 2024, Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses, BMJ source
    • cites [224] Barbaresko, 2025, Ultra-processed food consumption and human health: an umbrella review of systematic reviews with meta-analyses, Crit Rev Food Sci Nutr source
    • cites [225] Dai, 2024, Ultra-processed foods and human health: an umbrella review and updated meta-analyses of observational evidence, Clin Nutr source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Tobacco smoking involves exposure to thousands of chemical compounds, many of which are toxic or carcinogenic.

    “Tobacco smoking involves exposure to thousands of chemical compounds, many of which are toxic or carcinogenic.212”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [212] Rodgman, 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Several 24 h dietary recalls and food frequency questionnaires specifically designed to assess consumption of Nova food groups have been developed.

    “Several 24 h dietary recalls and food frequency questionnaires specifically designed to assess consumption of Nova food groups have been developed 202,206,[208][209][210][211]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [202] Hutelin, 2024, Creation and validation of a NOVA scored picture set to evaluate ultra-processed foods, Appetite source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [206] Oviedo-Solís, 2022, Relative validity of a semi-quantitative food frequency questionnaire to estimate dietary intake according to the NOVA classification in Mexican children and adolescents, J Acad Nutr Diet source
    • cites [208] Dinu, 2021, Reproducibility and validity of a food-frequency questionnaire (NFFQ) to assess food consumption based on the NOVA classification in adults, Int J Food Sci Nutr source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Interpretationreasoning

    The specificity and analogy criteria do not apply due to the multiplicity of outcomes and the absence of equivalent exposures.

    “The specificity and analogy criteria do not apply due to the multiplicity of outcomes and the absence of equivalent exposures.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    A study across eight countries with varying levels of UPF consumption estimated that UPFs account for 4% (in Colombia) to 14% (in the USA and the UK) of premature all-cause mortality.

    “Additionally, a study across eight countries with varying levels of UPF consumption estimated that UPFs account for 4% (in Colombia) to 14% (in the USA and the UK) of premature all-cause mortality.226”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [226] Nilson, 2025, Premature mortality attributable to ultraprocessed food consumption in 8 countries, Am J Prev Med source

      Checked before — its earlier verdict is held back until a new check runs.

  • It may state two separate claims as one.

    Premisecitation

    Analyses of the health effects of individual UPF subgroups face methodological challenges including confounding by other food components, multicollinearity between UPF subgroups and total UPF intake, low consumption and little variability within specific subgroups, and uncorrected multiple model testing.

    “However, analyses of the health effects of individual UPF subgroups, rather than the overall ultraprocessed dietary pattern, face methodological challenges.These include confounding by other food components (both UPFs and non-UPFs), multicollinearity between UPF subgroups and total UPF intake, low consumption and little variability within specific subgroups, and uncorrected multiple model testing.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [220] Monteiro, 2024, Are all ultra-processed foods bad for health?, Lancet Reg Health Eur source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [221] Gomes, 2023, Comment on Chen et al. Ultra-processed food consumption and risk of type 2 diabetes: three large prospective US cohort studies, Diabetes Care source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisenone given

    Packaged bread was positively associated with anxiety disorders and inversely associated with metabolic syndrome; yoghurts and dairy desserts were inversely associated with type 2 diabetes; and spreads had no association with chronic diseases.

    “Packaged bread was positively associated with anxiety disorders and inversely associated with metabolic syndrome; yoghurts and dairy desserts were inversely associated with type 2 diabetes; and spreads had no association with chronic diseases.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Interpretationreasoning

    Exposure to the ultraprocessed dietary pattern increases intake of toxic compounds, endocrine disruptors, and potentially harmful classes and mixtures of food additives.

    “Harmful consequences include major nutrient imbalances; multiple features that promote overeating; reduced intake of health-protective phytochemicals; and increased intake of toxic compounds, endocrine disruptors, and potentially harmful classes and mixtures of food additives.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    The Mediterranean diet is widely promoted with incomplete knowledge of the specific mechanisms underlying its protective effects.

    “Furthermore, the Mediterranean diet is widely promoted with incomplete knowledge of the specific mechanisms underlying its protective effects, 214”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [214] Schwingshackl, 2020, Mediterranean diet and health status: active ingredients and pharmacological mechanisms, Br J Pharmacol source

      Checked before — its earlier verdict is held back until a new check runs.

  • It may state two separate claims as one.

    Interpretationreasoning

    The evidence fulfils the Bradford Hill criteria of consistency, strength, temporality, biological gradient, plausibility, coherence, and experiment.

    “These criteria are consistency (ie, increased risk repeatedly observed in many countries and settings by different researchers using different methods and research designs); strength (risk equivalent to the protection conferred by the Mediterranean dietary pattern); temporality (exposure precedes the outcome); biological gradient (the higher the dietary share of UPFs, the higher the risk of”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationcitation

    Strong evidence already supports the plausibility of several mechanisms acting alone or in combination: gross nutrient imbalances; overeating driven by UPFs with high energy densities and hyper-palatability, as well as degraded food matrices and soft textures; reduced intake of healthy phytochemicals; and increased exposure to toxic compounds, endocrine disruptors, and harmful classes and mixtures

    “Strong evidence already supports the plausibility of several mechanisms acting alone or in combination: gross nutrient imbalances; [46][47][48][49][50][51][52] overeating 46,55,56,58 driven by UPFs with high energy densities and hyper-palatability, 57 as well as degraded food matrices and soft textures; [58][59][60][61][62] reduced intake of healthy phytochemicals; 66,67 and increased exposure to”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [46] Martini, 2021, Ultra-processed foods and nutritional dietary profile: a meta-analysis of nationally representative samples, Nutrients source
    • cites [47] Martinez Steele, 2022, Potential reductions in ultra-processed food consumption substantially improve population cardiometabolic-related dietary nutrient profiles in eight countries, Nutr Metab Cardiovasc Dis source
    • cites [48] Neri, 2022, Ultraprocessed food consumption and dietary nutrient profiles associated with obesity: a multicountry study of children and adolescents, Obes Rev source

  • It may state two separate claims as one.

    Premisecitation

    In the Harvard cohorts, ultra-processed yoghurts and dairy desserts were associated with all-cause mortality, frailty, and features of prodromal Parkinson's disease; had no association with cardiovascular mortality; and were inversely associated with type 2 diabetes and cardiovascular diseases.

    “For instance, in the Harvard cohorts, ultra-processed yoghurts and dairy desserts were associated with all-cause mortality, 118 frailty, 177 and features of prodromal Parkinson's disease; 216 had no association with cardiovascular mortality; 118 and were inversely associated with type 2 diabetes 137 and cardiovascular diseases. 217”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [118] Fang, 2024, Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study, BMJ source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [177] Fung, 2024, Ultraprocessed foods, unprocessed or minimally processed foods, and risk of frailty in a cohort of United States females, Am J Clin Nutr source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [216] Wang, 2025, Long-term consumption of ultraprocessed foods and prodromal features of Parkinson disease, Neurology source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    John Snow's landmark study linking cholera outbreaks to contaminated water, and his action to block the source, preceded the discovery of Vibrio cholerae.

    “John Snow's landmark study 215 linking cholera outbreaks to contaminated water, and his action to block the source, preceded the discovery of Vibrio cholerae.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [215] Snow, 1855

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

58 of 58

  • The authors state this as an assumption.

    The density of drink products is 1 kg/L.

    “The density of drink products is assumed to be 1 kg/L.”
1 of 1

Citations

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. 2021, Diabetes is “a pandemic of unprecedented magnitude” now affecting one in 10 adults worldwide, Diabetes Res Clin Pract, 181
  2. Zapata, 2022, Intake of energy and critical nutrients according to the NOVA classification in Argentina, time trend and differences according to income, Cad Saude Publica, 38
  3. Gomes, 2023, Comment on Chen et al. Ultra-processed food consumption and risk of type 2 diabetes: three large prospective US cohort studies, Diabetes Care, 46, 1335, 10.2337/dc22-1993 · DOI · Paper page

Cited by

Sorted by citations

Related

Metadata

Authors
Monteiro, C. A., Louzada, M. L., Steele-Martinez, E., Cannon, G., Andrade, G. C., Baker, P., Bes-Rastrollo, M., Bonaccio, M., Gearhardt, A. N., Khandpur, N., Kolby, M., Levy, R. B., Machado, P. P., Moubarac, J.-C., Rezende, L. F. M., Rivera, J. A., Scrinis, G., Srour, B., Swinburn, B., & Touvier, M.
Affiliations
  • Universidade de São Paulo (BR)
  • The University of Sydney (AU)
  • Istituto Neurologico Mediterraneo (IT)
  • University of Michigan (US)
  • Harvard University (US)
  • Deakin University (AU)
  • Instituto Nacional de Salud Pública (MX)
  • The University of Melbourne (AU)
  • Inserm (FR)
  • University of Auckland (NZ)
Corresponding author
Monteiro, Carlos A
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2025-12
Volume
406
Issue
10520
Pages
2667-2684
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(25)01565-x
OpenAlex
W4416347057
Semantic Scholar
756f79fdb3e65fa46432c97c29aec7f6703f30bf
Cited by
339
References
203
Citations by year
2026: 326 · 2025: 13
FWCI
44.40
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • Socio-Environmental Systems Modeling (submittedVersion)
  • HAL (submittedVersion)
Funders
Bloomberg Philanthropies
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Consumer Attitudes and Food Labeling
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Public Health Policies and Epidemiology
Keywords
ultra-processed foods, dietary habits, whole foods, diet-related chronic diseases, diet quality, nutrient imbalance, energy density, food additives, endocrine disruptors, phytochemicals, food sales, global burden of disease, minimally processed foods, food policy
MeSH terms
Food, Processed, Chronic Disease, Diet, Feeding Behavior, Food Handling, Humans

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-11-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-11-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Cited sources are checked with a language model’s help (gpt-6-sol).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review