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

The DOI matches its Crossref record; 227 of the 227 references it cites were found in a registry or an index; 28 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

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

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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.

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Integrity signals

Registry

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

Cites

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    The density of drink products is 1 kg/L.

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Citations

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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

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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
Venue
The Lancet
Publisher
Elsevier BV
Published
2025-12
Volume
406
Issue
10520
Pages
2667-2684
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
OpenAlex
W4416347057
Cited by
339
References
203
Citations by year
2026: 326 · 2025: 13
FWCI
44.40
Type
journal article
Language
en
Open access
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

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