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The Role of Diet Quality in Mediating the Association between Ultra-Processed Food Intake, Obesity and Health-Related Outcomes: A Review of Prospective Cohort Studies

Dicken, Samuel J., Batterham, Rachel L.·2021·Nutrients
DOI 10.3390/nu14010023PMC PMC8747015
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Abstract

Prospective cohort studies show that higher intakes of ultra-processed food (UPF) increase the risk of obesity and obesity-related outcomes, including cardiovascular disease, cancer and type 2 diabetes. Whether ultra-processing itself is detrimental, or whether UPFs just have a lower nutritional quality, is debated. Higher UPF intakes are inversely associated with fruit, vegetables, legumes and seafood consumption. Therefore, the association between UPFs and poor health could simply be from excess nutrient intake or from a less healthful dietary pattern. If so, adjustment for dietary quality or pattern should explain or greatly reduce the size of the significant associations between UPFs and health-related outcomes. Here, we provide an overview of the literature and by using a novel approach, review the relative impact of adjusting for diet quality/patterns on the reported associations between UPF intake and health-related outcomes in prospective cohort studies. We find that the majority of the associations between UPFs, obesity and health-related outcomes remain significant and unchanged in magnitude after adjustment for diet quality or pattern. Our findings suggest that the adverse consequences of UPFs are independent of dietary quality or pattern, questioning the utility of reformulation to mitigate against the obesity pandemic and wider negative health outcomes of UPFs.

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  • A systematic review including 37 prospective studies reported that 64 of 66 associations between UPF intake and chronic disease outcomes remained statistically significant after adjusting for diet quality parameters.

    “A systematic review 200 including 37 prospective studies reported that 64 of 66 associations between UPF intake and chronic disease outcomes remained statistically significant after adjusting for diet quality parameters, such as intake of sodium, sugar, and saturated fat; intake of fruits and vegetables; and composite diet quality scores combining nutrients and food groups.”

    From Ultra-processed foods and human health: the main thesis and the evidence (2025) · cites this paper as [200]

  • A recent meta-analysis found that adjusting for diet quality or patterns does not change the consistent evidence for direct associations between greater ultra-processed food exposure and a higher risk of adverse health outcomes.

    “a recent meta-analysis found that adjusting for diet quality or patterns does not change the consistent evidence for direct associations between greater ultra-processed food exposure and a higher risk of adverse health outcomes”

    From Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses (2024) · cites this paper as [75]

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Sorted by citations

Metadata

Authors
Dicken, S. J., & Batterham, R. L.
Affiliations
Centre for Obesity Research, Department of Medicine, University College London (UCL), London WC1E 6JF, UK
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2021-12-22
Volume
14
Issue
1
Pages
23
ISSN
2072-6643
DOI
10.3390/nu14010023
PMC
PMC8747015
Cited by
256
References
22
Language
en
Licence
creativecommons.org/licenses/by/4.0/ (vor)
Funders
  • Medical Research Council (MR/N013867/1)
  • Rosetrees Trust (http://dx.doi.org/10.13039/501100000833)
  • Sir Jules Thorn Charitable Trust (http://dx.doi.org/10.13039/501100000282)
  • National Institute for Health Research (RP-2015-06-005)

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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.

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