More Than Half of Calories Consumed in US Come From Ultraprocessed Foods Interview with:
Euridice Martinez Steele 
University of São Paulo, São Paulo What is the background for this study?

Response: Several leading health bodies, including the World Health Organization, the Canadian Heart and Stroke Foundation, the American Heart Association, and the US Dietary Guidelines Advisory Committee have concluded that excess added sugar intake increases the risk not only of weight gain, but also of obesity and diabetes, which are associated with a heightened risk of cardiovascular disease, and tooth decay.

All reports recommended limiting intake of added sugars. In the US, the USDGAC recommended limiting added sugars to no more than 10% of total calories.

To design and implement effective measures to reduce added sugars, their dietary sources must be clearly identified. Added sugars can be consumed either as ingredients of dishes or drinks prepared from scratch by consumers or cook, or as ingredients of food products manufactured by the food industry. According to market disappearance data from 2014, more than three quarters of the sugar and high fructose corn syrup available for human consumption in the US were used by the food industry. This suggests food products manufactured by the industry could have an important role in the excess added sugars consumption in the US. However, to assess this role, it is essential to consider the contribution of manufactured food products to both total energy intake and the energy intake from added sugars, and, more relevantly, to quantify the relationship between their consumption and the total dietary content of added sugars. To address these questions, we performed an investigation utilizing 2009-2010 National Health and Nutrition Examination Survey (NHANES). What are the main findings?

Response: In this analysis of nationally representative data, we confirmed the excessive consumption of added sugars in the US.

We also provide new evidence that ultra-processed foods represent more than half of all calories in the US diet, and contribute nearly 90% of all added sugars.

Added sugars represented 1 in every 5 calories in the average ultra-processed food product—far higher than the calorie content of added sugars in processed foods and in unprocessed or minimally processed foods and processed culinary ingredients, including table sugar, combined.

A strong linear association emerged between the dietary content of ultra-processed foods and the overall dietary intake of added sugars.

Moreover, the risk of exceeding the recommended upper limit of 10% energy from added sugars was far higher when ultra-processed food consumption was high, and risk differences were even more pronounced for exceeding a limit of 20% energy.

Notably, only those Americans whose ultra- processed food consumption was within the lowest 20% had an average daily added sugar intake that fell below the maximum recommended limit. What should clinicians and patients take away from your report?

Response: Decreasing the consumption of ultra-processed foods may be an effective way of reducing the excessive added sugar intake in the US.

In other words, a way to avoid excessive added sugar intake is not to replace real food (minimally processed foods and freshly-prepared dishes and meals) by ultra-processed food and drink products. For example, avoid replacing water, pasteurized fresh milk, and freshly squeezed fruit juices by soft drinks, milk drinks and reconstituted, flavored fruit juices; not replacing freshly prepared dishes (broth, soups, salads, sauces, rice, pasta, steamed vegetables, pies) by products that do not require culinary preparation (packaged soups; instant noodles; pre-prepared frozen dishes and sandwiches; cold cuts and sausages; ready-to-eat sauces; cake-mixes). What recommendations do you have for future research as a result of this study?

Response: Intervention, cohort and cross-sectional studies should be carried out in order to study the association between ultra-processed food dietary intake and different health outcomes such as diabetes, obesity or cardiovascular disease. Thank you for your contribution to the community.


Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study

Eurídice Martínez Steele, Larissa Galastri Baraldi, Maria Laura da Costa Louzada,Jean-Claude Moubarac, Dariush Mozaffarian, Carlos Augusto Monteiro

BMJ Open 2016;6:3 e009892 doi:10.1136/bmjopen-2015-009892

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Euridice Martinez Steele (2016). More Than Half of Calories Consumed in US Come From Ultraprocessed Foods 

Last Updated on March 10, 2016 by Marie Benz MD FAAD