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Cited by 2,333Consumer Attitudes and Food LabelingGlobal Public Health Policies and EpidemiologyNutrition, Health, and Society Studies

The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing

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Monteiro, Carlos Augusto, Cannon, Geoffrey, Moubarac, Jean-Claude, Levy, Renata Bertazzi, Louzada, Maria Laura C, Jaime, Patrícia Constante·2018·Public Health Nutrition
DOI 10.1017/s1368980017000234PMC PMC10261019
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Abstract

Given evident multiple threats to food systems and supplies, food security, human health and welfare, the living and physical world and the biosphere, the years 2016–2025 are now designated by the UN as the Decade of Nutrition, in support of the UN Sustainable Development Goals. For these initiatives to succeed, it is necessary to know which foods contribute to health and well-being, and which are unhealthy. The present commentary outlines the NOVA system of food classification based on the nature, extent and purpose of food processing. Evidence that NOVA effectively addresses the quality of diets and their impact on all forms of malnutrition, and also the sustainability of food systems, has now accumulated in a number of countries, as shown here. A singular feature of NOVA is its identification of ultra-processed food and drink products. These are not modified foods, but formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes (hence ‘ultra-processed’). All together, they are energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients. Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption. Studies based on NOVA show that ultra-processed products now dominate the food supplies of various high-income countries and are increasingly pervasive in lower-middle- and upper-middle-income countries. The evidence so far shows that displacement of minimally processed foods and freshly prepared dishes and meals by ultra-processed products is associated with unhealthy dietary nutrient profiles and several diet-related non-communicable diseases. Ultra-processed products are also troublesome from social, cultural, economic, political and environmental points of view. We conclude that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition.

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  • The widespread availability of UPFs compared to fresh foods can encourage snacking over regular meals because UPFs are highly palatable and can be quasi-addictive due to their high levels of sugar, salt, and fat.

    “For example, the widespread availability of UPFs compared to fresh foods can have the effect of encouraging snacking over regular meals, because the former are highly palatable and can be quasi-addictive due to their high levels of sugar, salt, and fat (Monteiro et al. 2018).”

    From Corporate concentration and power matter for agency in food systems (2025) · cites this paper as Monteiro et al. 2018

    The sections “Reasons to emphasize food processing” and “The trouble with ultra-processing” (page numbers unavailable) describe widely available snack products displacing home cooking and meals. The paper also calls ultra-processed products hyper-palatable and sometimes quasi-addictive, but it does not specifically attribute their quasi-addictive quality to high levels of sugar, salt, and fat. (LLM, conf=0.83)

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  • Ultra-processed foods have become a significant, and in some cases the main, source of dietary energy in high-income countries including the United States, Canada, the United Kingdom and Australia.

    “More recently (circa.1950s onwards), ultra-processed foods (UPFs) have become a significant, and in some cases the main, source of dietary energy in high-income countries including the United States, Canada, the United Kingdom and Australia 3,4 .”

    From Ultra‐processed foods and the nutrition transition: global, regional and national trends, food systems transformations and political economy drivers (2020) · cites this paper as [3]

  • The NutriNet-Santé web-based self-administered 24-hour dietary records have been tested and validated against an interview by a trained dietitian and against blood and urinary biomarkers.

    “The NutriNet-Santé web-based selfadministered 24-hour dietary records have been tested and validated against an interview by a trained dietitian, 47 and against blood and urinary biomarkers.48,49”

    From Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort (2020) · cites this paper as [49]

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Research works printed but not linked: 6

  1. [6]6. Food and Agriculture Organization of the United Nations & Food Climate Research Network (2016) Plates, Pyramids, Planet. Developments in National Healthy and Sustainable Dietary Guidelines: A State of Play Assessment. Rome/Oxford: FAO/University of Oxford; available at http://www.fao.org/3/a-i5640e.pdf
  2. [19]19. World Health Organization (2013) WHO Director-General addresses health promotion conference. http://www. who.int/dg/speeches/2013/health_promotion_20130610/ en/ (accessed March 2017).
  3. [26]26. European Food Information Council (2010) The Greatest Thing Since Sliced Bread? A Review of the Benefits of Processed Foods. Brussels: EUFIC; available at: http:// www.eufic.org/article/en/expid/benefits-processed-food- review/
  4. [66]66. Marrón-Ponce JA, Sánchez-Pimienta T, Louzada ML et al. (2017) Energy contribution of ultra-processed foods and sociodemographic determinants in the Mexican popula- tion. Public Health Nutr (under review).
  5. [74]74. World Health Organization (2017) The Influence of Ultra- processed Foods on the Dietary Content of Free Sugars in the US, Canada, Brazil and Colombia. Geneva: WHO (In the Press).
  6. [80]80. Gearhardt A (2015) The science behind food and addic- tion and the potential effect on the food system. In Introduction to the US Food System: Public Health, Environment, and Equity, pp. 405-406 [

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Authors
Monteiro, C. A., Cannon, G., Moubarac, J.-C., Levy, R. B., Louzada, M. L. C., & Jaime, P. C.
Affiliations
Universidade de São Paulo (BR)
Corresponding author
Monteiro, Carlos Augusto
ORCID
Venue
Public Health Nutrition
Publisher
Cambridge University Press (CUP)
Published
2017-03-21
Volume
21
Issue
1
Pages
5-17
ISSN
  • 1368-9800 (ISSN-L)
  • 1475-2727
DOI
10.1017/s1368980017000234
PMC
PMC10261019
OpenAlex
W2603592506
Cited by
2,333
References
82
Citations by year
2026: 311 · 2025: 352 · 2024: 340 · 2023: 279 · 2022: 298 · 2021: 259 · 2020: 254 · 2019: 149 · 2018: 64 · 2017: 24 · 2016: 1
FWCI
125.88
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified)
Locations
  • Public Health Nutrition (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Fundação de Amparo à Pesquisa do Estado de São Paulo (2015/, 15/14900-9)
  • Conselho Nacional de Desenvolvimento Científico e Tecnológico (2014‐0, 443477/2014-0)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Consumer Attitudes and Food Labeling
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Nutrition, Health, and Society Studies
Keywords
NOVA classification, ultra-processed foods, food processing, food system sustainability, diet-related non-communicable diseases, malnutrition, food environment, food marketing, Sustainable Development Goals
MeSH terms
Diet, Food Handling, Food Supply, Humans, Socioeconomic Factors, United Nations, Fast Foods, Food Quality

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