Michael Hunter, MD on Medika Life

More Evidence Linking Ultraprocessed Foods and Early Death

ULTRA-PROCESSED FOOD CONSUMPTION AND PREMATURE DEATH are associated. That’s the finding of a new study from Brazil.

Ultra-processed foods are industrial formulations of substances made from foods (fats, oils, sugars, starch, and protein isolates) with little or no whole foods. Manufacturers often add colors, flavors, emulsifiers, and other additives for cosmetic enhancement and other non-essential purposes.

The result? We have lots of low-cost production products that are convenient and taste great, rather than unprocessed (or minimally processed) foods.

We know that ultra-processed foods can harm our health, leading to chronic conditions such as high blood pressure (hypertension), diabetes, and obesity. A recently reported study from Brazil illustrates another peril: Ultra-processed foods (UPF) consumption appears to be linked with a significant increase in all-cause premature, preventable deaths.

Defining ultra-processed foods

When it comes to my local grocery store, I sometimes fantasize about placing a big sign at the ends of the aisles of processed foods shouting, “avoid this area.” You may have heard a newer term, ultra-processed foods. We are seeing increasing evidence linking this food category to significant health risks.

Photo by Qasim Malick on Unsplash

So, you may wonder, what is the difference between processed and ultra-processed foods? Processed food is simply one altered from its original form.

The International Food Information Council defines processing as “any deliberate change in a food that occurs before it is ready for us to eat.” Examples of processed foods include pasteurized, heated, canned, or dried ones. Some consider refrigerated foods to be processed.

Most foods have processing to some extent. Processing does not always make a given food less healthy. Researchers created a classification scheme to understand processing better.

  • NOVA Group 1. Minimally processed and unprocessed foods. Vegetables, fruits, grains, beans, and nuts fall into this category. These foods may have gone through roasting, boiling, or pasteurization to increase shelf life or make them safe to eat.
  • NOVA Group 2. Processed culinary ingredients obtained directly from group 1 foods or nature. Examples include olive oil, maple syrup, and salt. Group 2 foods are mostly substances used to prepare and cook group 1 foods.
  • NOVA Group 3. Processed foods, including items made by adding ingredients like salt, sugar, or other substances from group 2 to group 1 food. Examples include fresh bread, fruits in syrup, and cheese.
  • NOVA Group 4. Ultra-processed foods. These contain little, if any, of the foods or ingredients from group 1. These items are meant to be convenient, hyper-palatable, and low-cost and are usually high in sugars, refined grains, fats, preservatives, and salt.

Let’s look more closely at NOVA Group 4, the ultra-processed foods. As you can see from the following examples, foods in this group usually have substances you and I don’t use when we cook at home.

Examples of ultra-processed foods

Ultra-processed foods include colorants, flavorings, modified starches, hydrolyzed proteins, hydrogenated oils, artificial sweeteners, and bulking agents. And I would be very remiss if I didn’t include my bete noir, high fructose corn syrup.

While reasonable individuals may disagree about classifying foods as highly processed, the guidelines appear reasonable.

Examples of ultra-processed foods include sugary beverages such as carbonated soft drinks, energy drinks, fruit punch, and sugar-laden coffee drinks.

Reconstituted meat products (such as hot dogs and fish sticks) fall into the ultra-processed category, as do frozen pizza and TV dinners. If you had sweet or savory packaged snacks such as cookies or chips, you had highly-processed foods. Not surprisingly, candies fall into this food group, too.

Other culprits include sweetened breakfast cereals, baking mixes (such as cake, brownie, or cookie mixes), packaged buns, and bread. I recently wrote about protein bars (and shakes).

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Other problematic foods include ice cream, sweetened yogurt, cocoa mixes, instant soups, and boxed pasta products. Finally, margarine and ultra-processed spreads (for example, sweetened cream cheese) are NOVA Group 4 foods.

In summary, as Healthline nicely explains:

"Highly processed, or ultra-processed, foods contain few or no minimally processed or unprocessed ingredients and tend to be higher in calories, salt, fat, and added sugars. Plus, they contain additives such as flavor enhancers and thickeners."

Ultra-processed foods and premature death

Scientists designed a study to estimate premature deaths due to the consumption of ultra-processed foods in Brazil. The researchers estimated that approximately 57,000 individuals between 30 and 69 died prematurely from ultra-processed food consumption.

The Brazilian study is the first to estimate how ultra-processed food consumption impacts longevity. Researchers relied on a previous analysis, which compared the mortality risk of individuals consuming copious processed food to those who ate relatively small amounts of it.

Why age 30 to 69? The World Health Organization (WHO) considers death from non-communicable diseases premature at those ages. Here are the disturbing findings:

"If all adults in Brazil ensured that ultra-processed food made up less than 23 percent of their daily calories, the country might see around 20,000 fewer premature deaths annually. Most Brazilians are below that threshold, but a quarter of the country’s adult population gets up to half of its daily calories from ultra-processed food."

Before we in the United States point fingers, I remind you that, on average, ultra-processed food makes up around 57 percent of daily calories. The study’s lead author volunteers that “it is very likely that heart disease is among the main factors” contributing to these premature deaths. Diabetes, cancer, obesity, and chronic kidney disease may play a role as well,” he adds.

Research links ultra-processed food consumption with other negative health outcomes, including diabetes, cardiovascular disease, cancer, and cognitive decline.

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Finally, this is not the first study to demonstrate an association between ultra-processed food consumption (in large amounts) and a higher overall risk of death. An Italian study reported similar findings.

In addition, previous studies showed that ultra-processed food consumption is linked to other health problems, including an elevated risk for diabetescognitive declineheart disease, and cancer.

Completely avoid ultra-processed foods?

The new study adds to a growing scientific literature linking ultra-processed food consumption to chronic diseases and premature death. The researchers remind us that a healthy, balanced diet should be centered on minimally processed fresh foods when possible. I would steer away from too many ultra-processed foods.

Do we in the United States need policies that disincentivize ultra-processed food consumption? Nutrition education might be one component, as is improving access to healthy foods in so-called food deserts.

It is not essential to dodge all highly processed foods to enjoy a healthy life. I eat for joy and as a part of social engagement. Oh, I like desserts that incorporate dark chocolate. Still, I try to consume such foods in moderation and work hard to increase my consumption of whole, minimally processed foods.

Is this approach easy for me? No, but having grapes, apples, and nuts within reach makes it easier. While I recognize that the term is overly broad, I prefer a Mediterranean diet pattern. And the occasional chocolate dessert.

Thank you for joining me today. I hope that you have a joy-filled day.


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Michael Hunter, MD
Michael Hunter, MD
I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

Michael Hunter, MD

I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

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