“A study funded by the World Cancer Research Fund and Cancer Research UK and published in eClinicalMedicine, a Lancet open access clinical journal, provides new evidence of a link between ultra-processed foods (UPFs) and an increased risk of developing cancer.” (Chang et al., 2023; Ewing-Chow, 2023).
“A team from Imperial College London used UK Biobank data to assess the diets of 197,426 people between the ages of 40 and 69, who completed 24-hour dietary recalls during a three-year period.” Ultra-processed food consumption was expressed as a percentage of total food intake in grams per day and was assessed against the risk of developing and/or dying from 34 different types of cancer over a period of 10-years (Chang et al., 2023; Ewing-Chow, 2023).
“After the researchers adjusted for socio-demographic factors, physical activity, smoking status, and dietary factors, it was found that a 10% increase in consumption of ultra-processed food was linked to a 2% increase in being diagnosed with any cancer and a 6% increase in dying from cancer of any kind. The researchers also found that, with each additional 10% increase in consumption of ultra-processed food, there was a 19% increased risk for ovarian cancer and a 30% increased risk of dying from ovarian cancer. There was also a 16% increase in risk of dying from breast cancer with each 10% incremental increase in consumption of UPFs.” (Chang et al., 2023; Ewing-Chow, 2023).
“Further, an analysis of the top 25% tier of UPF consumption (those who consumed ultra-processed foods the most) versus the bottom 25% tier of UPF consumption (those who consumed UPFs the least) revealed a 7% higher risk of overall cancer, a 25% higher risk of developing lung cancer and a 52% higher risk of developing brain cancer in the former group as compared to the latter group.” The authors say that this study is the “most comprehensive assessment for the prospective associations between ultra-processed food consumption and risk of overall and 34 site-specific cancer incidence and associated mortality.” (Chang et al., 2023; Ewing-Chow, 2023).
“According to Northeastern University’s Network Science Institute, 73% of the food supply in the United States is ultra-processed. Demand for these foods is driven by the fact that they are typically more affordable, heavily marketed, perceived as convenient due to long shelf life, and often contain health claims on their packaging.” “This is not the first study to establish a correlation between ultra-processed foods and cancer. A study published in The British Medical Journal on August 31st 2022 found a 29% higher risk for developing colorectal cancer among men who consumed high amounts of ultra-processed foods as compared to men who consumed smaller amounts of UPFs.” Other studies have established a link between ultra-processed foods and type 2 diabetes (Delpino et al., 2022) obesity (Harb et al., 2022), and other ailments (UNICEF, 2022; Ewing-Chow, 2023), including chronic kidney disease (National Kidney Foundation, 2022; Du et al., 2022).
The World Health Organization and United Nations’ Food and Agriculture Organization (FAO) recommend restricting ultra-processed foods as part of a healthy sustainable diet. The researchers note that there are ongoing efforts to reduce intake of ultra-processed foods around the world…. Brazil has banned the marketing of ultra-processed foods in schools. A recent study published in the journal Nutrients showed a positive correlation between ultra-processed food consumption and trans fatty acids and sugar intake in the diets of schoolchildren in Bahia, Brazil (Menezes et al., 2023).
“Dr. Chang believes that the negative health associations of ultra-processed foods should be addressed by targeting the food environment to which consumers are exposed.” As a result, Dr. Chang has urged, “we need clear front of package warning labels for ultra-processed foods to aid consumer choice….” (Askew, 2023).
Dr. Carlos Monteiro, a professor of Nutrition and Public Health at the University of Sao Paulo, Brazil, developed a food classification system divided into four groups, called NOVA (a name, not an acronym), based on the level of processing. See below for a summary of the NOVA classification system, which groups different foods into one of four categories: Group 1 (unprocessed or minimally processed foods), Group 2 (oils, fats, salt, and sugar – also called processed culinary ingredients), Group 3 (processed foods), and Group 4 (ultra-processed foods).
GROUP 1: UNPROCESSED OR MINIMALLY PROCESSED FOODS
Unprocessed or Natural foods are obtained directly from plants or animals and do not undergo any alteration following their removal from nature.
Minimally processed foods are natural foods that have been submitted to cleaning, removal of inedible or unwanted parts, fractioning, grinding, drying, fermentation, pasteurization, cooling, freezing, or other processes that may subtract part of the food, but which do not add oils, fats, sugar, salt or other substances to the original food.
Examples:
Natural, packaged, cut, chilled or frozen vegetables, fruits, potatoes, and other roots and tubers • nuts, peanuts, and other seeds without salt or sugar • bulk or packaged grains such as brown, white, parboiled and wholegrain rice, corn kernel, or wheat berry • fresh and dried herbs and spices (e.g., oregano, pepper, thyme, cinnamon) • fresh or pasteurized vegetable or fruit juices with no added sugar or other substances • fresh and dried mushrooms and other fungi or algae • grains of wheat, oats and other cereals • fresh and dried herbs and spices • grits, flakes and flours made from corn, wheat or oats, including those fortified with iron, folic acid or other nutrients lost during processing • fresh, chilled or frozen meat, poultry, fish and seafood, whole or in the form of steaks, fillets and other cuts • dried or fresh pasta, couscous, and polenta made from water and the grits/flakes/flours described above • fresh or pasteurized milk; yoghurt without sugar • eggs • tea, herbal infusions • lentils, chickpeas, beans, and other legumes • coffee • dried fruits • tap, spring and mineral water
GROUP 2: OILS, FATS, SALT, AND SUGAR
Group 2 is also called Processed Culinary Ingredients. These are products extracted from natural foods or from nature by processes such as pressing, grinding, crushing, pulverizing, and refining. They are used in homes and restaurants to season and cook food and thus create varied and delicious dishes and meals of all types, including broths and soups, salads, pies, breads, cakes, sweets, and preserves. Use oils, fats, salt, and sugar in small amounts for seasoning and cooking foods and to create culinary preparations. As long as they are used in moderation in culinary preparations based on natural or minimally processed foods, oils, fats, salt, and sugar contribute toward diverse and delicious diets without rendering them nutritionally unbalanced.
Examples:
Oils made from seeds, nuts and fruits, to include soybeans, corn, oil palm, sunflower or olives • butter • white, brown and other types of sugar and molasses obtained from cane or beet • lard • honey extracted from honeycombs • coconut fat • syrup extracted from maple trees • refined or coarse salt, mined or from seawater • starches extracted from corn and other plants • also any food combining 2 of these, such as ‘salted butter’
GROUP 3: PROCESSED FOODS
Processed foods are products manufactured by industry with the use of salt, sugar, oil or other substances (Group 2) added to natural or minimally processed foods (Group 1) to preserve or to make them more palatable. They are derived directly from foods and are recognized as versions of the original foods. They are usually consumed as a part of or as a side dish in culinary preparations made using natural or minimally processed foods. Most processed foods have two or three ingredients.
Examples:
Canned or bottled legumes or vegetables preserved in salt (brine) or vinegar, or by pickling • canned fish, such as sardine and tuna, with or without added preservatives • tomato extract, pastes or concentrates (with salt and/or sugar) • salted, dried, smoked or cured meat or fish • fruits in sugar syrup (with or without added antioxidants) • coconut fat • beef jerky • freshly-made cheeses • bacon • freshly-made (unpackaged) breads made of wheat flour, yeast, water and salt • salted or sugared nuts and seeds • fermented alcoholic beverages such as beer, alcoholic cider, and wine
GROUP 4: ULTRA-PROCESSED FOODS
Ultra-processed foods are industrial formulations made entirely or mostly from substances extracted from foods (oils, fats, sugar, starch, and proteins), derived from food constituents (hydrogenated fats and modified starch), or synthesized in laboratories from food substrates or other organic sources (flavor enhancers, colors, and several food additives used to make the product hyper-palatable). Manufacturing techniques include extrusion, moulding and preprocessing by frying. Beverages may be ultra-processed. Group 1 foods are a small proportion of, or are even absent from, ultra-processed products.
Examples:
Fatty, sweet, savory or salty packaged snacks • pre-prepared (packaged) meat, fish and vegetables • biscuits (cookies) • pre-prepared pizza and pasta dishes • ice creams and frozen desserts • pre-prepared burgers, hot dogs, sausages • chocolates, candies and confectionery in general • pre-prepared poultry and fish ‘nuggets’ and ‘sticks’ • cola, soda and other carbonated soft drinks • other animal products made from remnants • ‘energy’ and sports drinks • packaged breads, hamburger and hot dog buns • canned, packaged, dehydrated (powdered) and other ‘instant’ soups, noodles, sauces, desserts, drink mixes and seasonings • baked products made with ingredients such as hydrogenated vegetable fat, sugar, yeast, whey, emulsifiers, and other additives • sweetened and flavored yogurts, including fruit yogurts • breakfast cereals and bars • dairy drinks, including chocolate milk • infant formulas & drinks, and meal replacement shakes (e.g., ‘slim fast’) • sweetened juices • pastries, cakes and cake mixes • margarines and spreads • distilled alcoholic beverages such as whisky, gin, rum, vodka, etc.
Sources:
NOVA Classification Reference Sheet (2018)
World Cancer Research Fund International (2022)
To address the high and rising prevalence of obesity and diabetes, Colombia’s Ministry of Health has introduced Resolutions which regulate front-of-pack labelling. Resolution No 2492 – also known as ‘The Junk Food Law’ – has been recently published, modifying Resolution No 810 of 2021. The food & beverage industry now has a timeline of 6 months to comply with the new rules, which come into effect on 15 June 2023.* (Leatherhead Research, 2023).
In November 2022, “the Colombian Congress approved a tax on sugar-sweetened beverages (SSB) and ultra-processed products (UPPs), making Colombia one of the first countries in the world to tax ultra-processed products. Both the tax for SSBs and the tax for UPPs will be implemented in November 2023. In addition, the Ministry of Health issued a resolution to enforce a new regulation to include octagonal front of package warning labels on foods high in sugar, sodium, trans fats, fats and with any sweeteners. Colombia will follow other countries in the region such as Argentina, Brazil and Mexico when this goes into effect in June 2023. In countries like Colombia with high rates of obesity and diabetes, it’s critical to shift diets away from ultra-processed products.” Colombia joins 73 other countries that have a tax on sugar-sweetened beverages. Both Colombia and Mexico are pioneers in Latin America, in implementing taxes on ultra-processed foods (Universidad Nacional De Colombia, 2022).
“These policy wins come after six years of efforts by the Global Health Advocacy Incubator’s (GHAI) Colombian partners who advocated tirelessly for them while facing significant industry interference during the policymaking process. GHAI provided technical assistance to Colombian partners on advocacy, research, legal, and communications strategy to advocate for policy-makers to support food policies, to mobilize civil society support and to counter industry tactics.” (Global Health Advocacy Incubator, 2023).
“Since this advocacy campaign was launched by civil society organizations, both the Ministry of Finance and Health recognized the importance and need to implement SSB and UPP taxes, despite industry’s claims that its products were healthy and didn’t require taxes. Civil society also worked with allies in Congress and the Ministries of Finance and Health to push for the tax. Their efforts marked the first time a proposal from civil society received more than 70 signatures of support from members of Congress belonging to different political parties. Knowing there was strong public support, SSB industries supported the inclusion of the tax – another first for civil society in Colombia and a result of partners’ successful advocacy efforts” (Global Health Advocacy Incubator, 2023).
“Partners’ media advocacy efforts to demonstrate the importance of defining ultra-processed products and including them in the fiscal reform are evident through the increase in media coverage on the topic. The national government has also recognized civil society’s efforts and acknowledged the importance of taxing these products to address their health impacts.” (Global Health Advocacy Incubator, 2023).
How Can I Avoid Ultra-Processed Foods?
To avoid ultra-processed foods, see the following tips from the World Cancer Research Fund International (2022):
- “Cook from scratch at home as often as you can – if you know what’s going into your breakfast, lunch and dinner, then you are in control.
- Read the ingredients list – products with more than 5 ingredients tend to be ultra-processed.
- Swap fizzy or sugary drinks for unsweetened tea, coffee and water.
- Snack on fruit or seeds, rather than pre-packed snacks (for healthier alternatives try the oat berry breakfast bars or chocolate and orange frozen yogurt bar).
- Avoid foods high in added sugars, saturated fat, and sodium by reading food labels.
- Eat a diet that comprises mainly whole grains, pulses (such as beans and lentils), fruit and vegetables.”
References
Chang K, Gunter MJ, Rauber F. Ultra-processed food consumption, cancer risk and cancer mortality: a large-scale prospective analysis within the UK Biobank. eClinicalMedicine 2023;101840. https://www.thelancet.com/action/showPdf?pii=S2589-5370%2823%2900017-2
Global Health Advocacy Incubator. Colombia enacts two major healthy food policies. January 4, 2023. Available at: https://www.advocacyincubator.org/featured-stories/2023-01-04-colombia-enacts-two-major-healthy-food-policies#:~:text=In%20November%2C%20the%20Colombian%20Congress,be%20implemented%20in%20November%202023
Amendment to nutrition and front-of-pack labelling for processed foods in Colombia. Leatherhead Research. January 20, 2023. Available at: https://www.leatherheadfood.com/news-detail/colombia-junk-food-law-labelling/
Universidad Nacional De Colombia. Healthy taxes, a partial victory. December 19, 2022. Available at: https://periodico.unal.edu.co/articulos/los-impuestos-saludables-una-ganancia-a-medias?lgn=en
Ewing-Chow D. New evidence that ultra-processed foods may increase cancer risk. Forbes. January 31, 2023. Available at: https://www.forbes.com/sites/daphneewingchow/2023/01/31/new-evidence-that-ultra-processed-foods-may-increase-cancer-risk/?sh=1a9e0d632013
Askew K. ‘Protect the population from ultra-processed foods’ scientists urge as consumption again linked to cancer risk. Food Navigator – Europe. February 1, 2023. Available at: https://www.foodnavigator.com/Article/2023/02/01/Protect-the-population-from-ultra-processed-foods-scientists-urge-as-consumption-again-linked-to-cancer-risk
UNICEF. Policy Brief. Front-of-pack nutrition labelling of foods and beverages. Available at: https://www.unicef.org/media/116686/file/Front-of-Pack%20Nutrition%20Labelling%20(FOPNL).pdf In: UNICEF Advocacy Packages for Food Environment Policies. UNICEF. March 2022. Available at: https://www.unicef.org/documents/advocacy-packages-food-environment-policies
Ultra-processed foods lead to higher risk of kidney disease, new study finds. National Kidney Foundation. June 6, 2022. Available at: https://www.kidney.org/news/ultra-processed-foods-lead-to-higher-risk-kidney-disease-new-study-finds
Du H, Kim H, Crews DC, et al. Association between ultraprocessed food consumption and risk of incident CKD: A prospective cohort study. American Journal of Kidney Diseases. 2022; 80(5):589-598.E1.
Harb, A.A., Shechter, A., Koch, P.A. et al. Ultra-processed foods and the development of obesity in adults. Eur J Clin Nutr 2022. https://doi.org/10.1038/s41430-022-01225-z
Delpino FM, Figueiredo LM, Bielemann RM, et al. Ultra-processed food and risk of type 2 diabetes: a systematic review and meta-analysis of longitudinal studies. Int J Epidemiol. 2022 51(4):1120-1141. doi: 10.1093/ije/dyab247.
Menezes CA, Magalhães LB, da Silva JT, et al. Ultra-processed food consumption is related to higher trans fatty acids, sugar intake, and micronutrient-impaired status in schoolchildren of Bahia, Brazil. Nutrients. 2023 15(2):381. doi: 10.3390/nu15020381.
World Cancer Research Fund International. What is ultra-processed food and should we be worried about it? March 24, 2022. Available at: wcrf.org
Sustainable RDN 