Article - Premature Mortality Attributable to Ultraprocessed Food Consumption in 8 Countries.

Expert Review

Reviewer: Chloe Steele

1st Jun 2025

Conflict of interest

None

Take home message

• UPFs are associated with an increased risk of premature death in a dose-response relationship.

Evidence category

B: Systematic reviews including RCTs of limited number

Summary review

Introduction

• Ultra-processed foods (UPFs) are becoming the predominant energy source for people in high-middle income countries, accounting for over half of the average daily energy content of the diet in some countries.

• Research has shown that there may be a relationship between high intakes of UPFs and several non-communicable diseases.

• This study aimed to estimate the dose-response association between UPF consumption and all-cause mortality and the total number of deaths attributable to UPFs in 8 countries.

Methods

• This was a meta-analysis of seven observational cohort studies including 239,982 participants and 14,779 deaths.

• Only studies that assessed UPF intake according to Nova classification were included.

• Studies assessing single food UPFs were excluded.

Results

• Lower UPF consumption was seen in Latin America (up to 30% of energy intake).

• This increased to 37.5% in Australia and 43.7% in Canada and was as high as 50% in the United Kingdom and United States.

• As UPF food consumption increased, the risk of all cause death increased.

• This equated to a relative risk of 1.027 (95% CI=1.017, 1.037; P=<0.0001) for every 10% increase in percentage of UPF on total energy intake.

• The lowest percentage of premature deaths attributable to UPFs was in Colombia (3.9%) followed by Brazil (4.5%), Chile (5.7%), Mexico (6.3%), Australia (9.4%), Canada (10.9%), United States (13.7%), and the United Kingdom (13.8%).

Conclusion

• The amount of UPFs consumed in middle-high income countries is concerning and this study shows a linear, dose-response relationship, with higher UPFs associated with higher premature deaths from all causes.

• Given the evidence on UPFs and health, regulatory and fiscal policies need to focus on reducing consumption.

Clinical practice applications

• Given that the study showed an increased risk of premature death for every 10% increase in UPF energy intake, high UPF consumption may be significantly contributing to the risk of premature death.

• Practitioners should encourage minimal UPF consumption through replacement with fresh and whole foods.

• Practitioners should remember that multiple strategies may be required to minimise UPF consumption.

• Education and awareness, behaviour change, and social and environmental support may benefit some people.

• Governmental policies which regulate food marketing and sales in key places such as schools and workplaces, as well as taxing UPFs, may help support decreased consumption.

Considerations for future research

• To tackle the root issues, research should focus on why people are relying on UPFs.

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Abstract

INTRODUCTION

Ultraprocessed foods are becoming dominant in the global food supply. Prospective cohort studies have consistently found an association between high consumption of ultraprocessed foods and increased risk of several noncommunicable diseases and all-cause mortality. The study aimed to (1) estimate the risk of all-cause mortality for ultraprocessed foods consumption and (2) estimate the attributable epidemiologic burden of ultraprocessed food consumption in 8 select countries.

METHODS

First, a dose-response meta-analysis of observational cohort studies was performed to assess the association between ultraprocessed food consumption and all-cause mortality and estimated the pooled RR for all-cause mortality per each 10% increment in the percentage ultraprocessed food. Then, the population attributable fractions for premature all-cause mortality attributable to the ultraprocessed foods in consumption were estimated in 8 select countries with relatively low (Colombia and Brazil), intermediate (Chile and Mexico), and high (Australia, Canada, United Kingdom, and the U.S.) ultraprocessed food consumption. Analysis was conducted in November 2023-July 2024.

RESULTS

The meta-analysis showed a linear dose-response association between the ultraprocessed food consumption and all-cause mortality (RR for each 10% increase in percentage ultraprocessed food=1.03; 95% CI=1.02, 1.04). Considering the magnitude of the association between ultraprocessed foods intake and all-cause mortality and the ultraprocessed food dietary share number (percentage ultraprocessed food) in each of the 8 selected countries, estimations varied from 4% (Colombia) to 14% (United Kingdom and U.S.) of premature deaths attributable to ultraprocessed food intake.

CONCLUSIONS

The findings support that ultraprocessed food intake contributes significantly to the overall burden of disease in many countries, and its reduction should be included in national dietary guideline recommendations and addressed in public policies.

Premature Mortality Attributable to Ultraprocessed Food Consumption in 8 Countries.