Ultra-processed food

What it is

Ultra-processed foods are industrial products made mostly from substances extracted or derived from foods and combined with additives ¹².

The NOVA system sorts foods into four groups by processing rather than nutrient content ³. Group 4 covers products containing a substance never or rarely used in kitchens, or an additive used to make them palatable or more appealing ¹. In a US national survey, ultra-processed foods supplied 57.5% of energy intake ⁴.

What happens in the body

In the NIH inpatient trial, people ate ultra-processed meals faster than unprocessed meals ³. Eating rate was 17 ± 1 kcal/min faster ³. Energy density, drinks excluded, was 1.957 against 1.057 kcal/g ³.

Colonic bacteria ferment undigested polysaccharides to butyrate ⁵. Butyrate is the main energy source of colonocytes ⁵.

Butyrate synthesis by colonic bacteria (acetyl-CoA pathway)Colonic lumen; cytosol of butyrate-producing bacteria

Fermentable polysaccharides
several stepsStarch, xylan and other polysaccharides that escape digestion; via pyruvate
Acetyl-CoA
Thiolase (Thl)Acetyl-CoACondenses two acetyl-CoA and releases CoA
Acetoacetyl-CoA
β-Hydroxybutyryl-CoA dehydrogenase (Hbd)
3-Hydroxybutyryl-CoA
Crotonase (Cro)
Crotonyl-CoA
Butyryl-CoA dehydrogenase–electron-transferring flavoprotein complex (Bcd-Etfαβ)FerredoxinShared by all four butyrate pathways; postulated energy conservation
Butyryl-CoA
Butyryl-CoA:acetate CoA-transferase (But)Acetate → acetyl-CoAAlternative: phosphate butyryltransferase (Ptb) and butyrate kinase (Buk)
Butyrate

In the US survey, fibre fell from 9.6 to 6.7 g per 1000 kcal between the lowest and highest fifths of ultra-processed share ⁴.

What studies show

In two independent feeding trials, adults gained weight or lost less on ultra-processed diets than on less processed diets ³⁶.

In the NIH trial, 20 adults ate each diet ad libitum for 14 days ³. Meals were matched for presented energy, macronutrients, sugars, sodium and fibre ³. Energy intake was 508 ± 106 kcal/day higher on the ultra-processed diet ³. Weight changed by +0.9 ± 0.3 kg on it and −0.9 ± 0.3 kg on the unprocessed diet ³.

In the UPDATE trial, 55 adults received each diet for 8 weeks ⁶. Both diets followed the UK Eatwell Guide ⁶. Weight changed by −2.06% on the minimally processed diet and −1.05% on the ultra-processed diet ⁶. The difference was −1.01 percentage points, or −0.96 kg ⁶.

An umbrella review covered 45 pooled observational analyses ². Convincing associations included those with cardiovascular mortality (risk ratio 1.50) and type 2 diabetes (1.12 per 10% increment of intake) ². By GRADE, 4 analyses were of moderate, 22 of low and 19 of very low quality ².

In US cohorts, 114,064 health professionals were followed for a median of 31 to 34 years ⁷. All-cause mortality was 1536 deaths per 100,000 person-years in the highest quarter of intake and 1472 in the lowest ⁷. The difference was 64 per 100,000 person-years (hazard ratio 1.04, 95% CI 1.01 to 1.07) ⁷.

References

Independent research
Monteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada ML, Rauber F, et al. Ultra-processed foods: what they are and how to identify them Public Health Nutrition, 2019.
doi:10.1017/S1368980018003762 PubMed 30744710
Funding and finding
Funding
This work was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP; grant number 2015/14900-9). The conclusions and opinions in this article are those of the authors and do not necessarily reflect those of FAPESP.
Finding
Commentary by the authors of NOVA. Ultra-processed foods are formulations of ingredients, mostly of exclusive industrial use, that result from a series of industrial processes: fractioning of whole foods into substances, chemical modification of these substances, assembly of modified and unmodified food substances, frequent use of cosmetic additives and sophisticated packaging. A product is identified as ultra-processed when its ingredient list contains at least one food substance never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, hydrolysed proteins) or a class of additive designed to make the product palatable or more appealing (flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).
Independent research
Lane MM, Gamage E, Du S, Ashtree DN, McGuinness AJ, Gauci S, et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses BMJ, 2024.
doi:10.1136/bmj-2023-077310 PubMed 38418082
Funding and finding
Registration
PROSPERO CRD42023412732
Funding
This work was not funded.
Finding
Direct associations for 32 of 45 pooled analyses (71%). Convincing (class I): cardiovascular disease mortality RR 1.50 (95% CI 1.37 to 1.63; GRADE very low), type 2 diabetes RR 1.12 per 10% increment (1.11 to 1.13; moderate), prevalent anxiety OR 1.48 (1.37 to 1.59; low) and common mental disorders OR 1.53 (1.43 to 1.63; low). Highly suggestive (class II): all-cause mortality RR 1.21 (1.15 to 1.27; low), obesity OR 1.55 (1.36 to 1.77; low). Cancer mortality HR 1.00 (0.81 to 1.24). GRADE: 4 moderate, 22 low, 19 very low. No included meta-analysis was funded by a producer of ultra-processed food; none reported the funding sources of its primary studies (AMSTAR 2 item 10).
Independent research
Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake Cell Metabolism, 2019.
doi:10.1016/j.cmet.2019.05.008 PubMed 31105044
Funding and finding
Registration
NCT03407053
Participants
20
Follow-up
14 days on each diet, 28 days as inpatients, crossover without washout
Funding
This work was supported by the Intramural Research Program of the National Institutes of Health, National Institute of Diabetes & Digestive & Kidney Diseases.
Finding
Meals matched for presented energy, energy density including beverages, macronutrients, sugars, sodium and fibre; non-beverage energy density 1.957 kcal/g (ultra-processed) versus 1.057 kcal/g (unprocessed). Ad libitum energy intake 508 ± 106 kcal/day higher on the ultra-processed diet (carbohydrate 280 ± 54, fat 230 ± 53, protein −2 ± 12 kcal/day); weight +0.9 ± 0.3 kg versus −0.9 ± 0.3 kg; body fat +0.4 ± 0.1 kg versus −0.3 ± 0.1 kg; eating rate 17 ± 1 kcal/min and 7.4 ± 0.9 g/min faster; fibre intake 48.5 versus 45.8 g/day (P = 0.41); insoluble share of presented fibre about 16% versus 77%. Fasting PYY 25.1 versus 34.3 pg/ml (baseline 28.9); active ghrelin 54.1 versus 48.3 pg/ml (baseline 61.4). Mean ± SE. A 2019 erratum corrected meal-specific intakes; a 2020 erratum was not read.
Independent research
Martínez Steele E, Popkin BM, Swinburn B, Monteiro CA. The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study Population Health Metrics, 2017.
doi:10.1186/s12963-017-0119-3 PubMed 28193285
Funding and finding
Participants
9,317
Funding
This research received funding from Conselho Nacional de Desenvolvimento Científico e Tecnológico, Edital MCTI/CNPq/Universal (Processo CNPq nº 443477/2014-0) and from Fundação de Amparo à Pesquisa do Estado de São Paulo (Processo FAPESP nº 2015/14900-9).
Finding
Ultra-processed foods supplied 57.5% of energy (mean intake 2,069.9 kcal/day). From the lowest to the highest quintile of the ultra-processed share (means 32.6% and 80.7% of energy): protein 17.9% to 13.1% of energy, carbohydrate 46.5% to 53.4%, added sugars 7.7% to 19.2%, saturated fat 10.1% to 10.9%; fibre 9.6 to 6.7 g/1,000 kcal, potassium 1.6 to 1.0 g/1,000 kcal, magnesium 173.3 to 117.3 mg/1,000 kcal, vitamin C 58.2 to 32.4 mg/1,000 kcal; sodium 1.74 to 1.63 g/1,000 kcal (trend not significant).
Independent research
Vital M, Howe AC, Tiedje JM. Revealing the bacterial butyrate synthesis pathways by analyzing (meta)genomic data mBio, 2014.
doi:10.1128/mBio.00889-14 PubMed 24757212
Funding and finding
Funding
Financial support was provided by the NIH Human Microbiome Project Demonstration Project (UH3 DK083993).
Finding
225 genomes carried a butyrate synthesis pathway. Four pathways (acetyl-CoA, glutarate, 4-aminobutyrate, lysine) converge on the conversion of crotonyl-CoA to butyryl-CoA by the butyryl-CoA dehydrogenase–electron-transferring flavoprotein complex, a step postulated to conserve energy through ferredoxin reduction. In the acetyl-CoA pathway, thiolase, β-hydroxybutyryl-CoA dehydrogenase and crotonase precede this step, and butyryl-CoA:acetate CoA-transferase or phosphate butyryltransferase with butyrate kinase forms butyrate. In stool metagenomes the acetyl-CoA pathway made up a mean 79.7% of butyrate pathways; for that pathway the terminal genes but and buk had median abundances of 77.2% and 21.8%. Butyrate is described as the main energy source for colonocytes.
Independent research
Dicken SJ, Jassil FC, Brown A, Kalis M, Stanley C, Ranson C, et al. Ultraprocessed or minimally processed diets following healthy dietary guidelines on weight and cardiometabolic health: a randomized, crossover trial Nature Medicine, 2025.
doi:10.1038/s41591-025-03842-0 PubMed 40760353
Funding and finding
Registration
NCT05627570
Participants
55
Follow-up
8 weeks on each diet, 2 × 2 crossover with a 4-week washout
Funding
The trial was supported by a National Institute for Health and Care Research UCLH Biomedical Research Centre grant and a Rosetrees Trust grant (PGL22/100041). The Sponsor and funders were not involved in the design, conduct or analysis of the trial.
Finding
Both diets followed the UK Eatwell Guide and were delivered to participants' homes for ad libitum intake. Weight change at 8 weeks −2.06% (95% CI −2.99 to −1.13) on minimally processed food and −1.05% (−1.98 to −0.13) on ultra-processed food; difference −1.01 percentage points (−1.87 to −0.14; P = 0.024), −0.96 kg (−1.76 to −0.17). Fat mass difference −0.98 kg; triglycerides −0.25 mmol/l (−0.42 to −0.09) in favour of minimally processed food; LDL cholesterol fell more on ultra-processed food (difference 0.25 mmol/l, 0.05 to 0.45). Corrected energy density 1.25 kcal/g (minimally processed) versus 1.60 kcal/g (ultra-processed). Diet order interacted significantly with diet (P < 0.001).
Independent research
Fang Z, Rossato SL, Hang D, Khandpur N, Wang K, Lo CH, et al. Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study BMJ, 2024.
doi:10.1136/bmj-2023-078476 PubMed 38719536
Funding and finding
Participants
114,064
Follow-up
median 34 years (women) and 31 years (men)
Funding
This work was supported by the US National Institutes of Health grants (UM1 CA186107; P01 CA87969; U01 CA167552; U01 CA261961; R01 CA263776; and K99 CA283146). The funders had no role in considering the study design or in the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the article for publication.
Finding
48,193 deaths. Highest versus lowest quarter of ultra-processed food intake (whole grains and alcohol excluded from the exposure): all-cause mortality HR 1.04 (95% CI 1.01 to 1.07), 1536 versus 1472 deaths per 100,000 person-years; mortality from causes other than cancer or cardiovascular disease HR 1.09 (1.05 to 1.13); no association with cancer or cardiovascular mortality. Meat, poultry and seafood based ready-to-eat products HR 1.06 to 1.43 across mortality outcomes. Within quarters of Alternative Healthy Eating Index-2010 score, ultra-processed food showed no consistent association with mortality; adjustment for that score attenuated the association toward null, and removal of smoking pack-years from the model strengthened it.
Industry-funded
Forde CG, Heuven LA, van Bruinessen M, Liu Z, Stieger M, de Graaf K, et al. Eating rate has sustained effects on energy intake from ultraprocessed diets: a 2-week ad libitum dietary randomized controlled crossover trial American Journal of Clinical Nutrition, 2026.
doi:10.1016/j.ajcnut.2025.11.012 PubMed 41314613
Funding and finding
Registration
NCT06113146
Participants
41
Follow-up
14 days on each diet with a 14-day washout
Funding
This research is supported by the Dutch Top-Consortium for Knowledge and Innovation Agri & Food (TKI-Agri-food) Project Restructure (TKI 22.150). The Restructure project is a public–private partnership on precompetitive research on the influence of food texture and eating rate on energy intake.
Finding
Single-blind crossover of two diets with about 95% of energy from ultra-processed food, matched for palatability, portion size, energy served, non-beverage energy density and meal variety, differing in texture-derived eating rate. Daily energy intake was 369 kcal/day (95% CI 221 to 517) lower on the slow-eating-rate diet, consistently across the 14 days; body weight did not differ between diets; fat mass decreased by 0.43 kg on the slow-eating-rate diet.
Expert consensus
Guasti L, Bonaccio M, Abreu A, Asteggiano R, Bes-Rastrollo M, Christodorescu R, et al. Ultra-processed foods, lifestyle management, and cardiovascular diseases: a clinical consensus statement of the European Society of Cardiology Council for Cardiology Practice and the European Association of Preventive Cardiology of the European Society of Cardiology European Heart Journal, 2026.
doi:10.1093/eurheartj/ehag226 PubMed 42091095
Funding and finding
Funding
Funding: nothing to declare.
Finding
Associations of ultra-processed food intake with cardiovascular risk factors, incidence and mortality derive predominantly from observational studies, to be interpreted with caution because residual confounding and reverse causation cannot be fully excluded; trials are scarce, short-term and limited to surrogate outcomes, and trials of reduced intake on hard cardiovascular endpoints are lacking. Proposed non-nutrient mechanisms (additives, processing contaminants, packaging migrants, altered food matrix) support biological plausibility without demonstrating causal effects. General cardiologists are advised to assess intake of ultra-processed food and include it in counselling.
Expert consensus
2025 Dietary Guidelines Advisory Committee. Scientific report of the 2025 Dietary Guidelines Advisory Committee: advisory report to the Secretary of Health and Human Services and Secretary of Agriculture US Department of Health and Human Services and US Department of Agriculture, 2024.
doi:10.52570/dgac2025
Funding and finding
Funding
Federal advisory committee convened under the Federal Advisory Committee Act; HHS chartered the Committee and served as administrative lead, and HHS and USDA support development of the Dietary Guidelines. The Departments proposed the scientific questions and worked with the Committee to refine them.
Finding
Systematic review question on dietary patterns with varying amounts of ultra-processed food and growth, body composition and risk of obesity. Children and adolescents, and adults and older adults: patterns with more food classified as ultra-processed are associated with greater adiposity (fat mass, waist circumference, BMI) and greater risk of overweight or obesity (grade limited). Infants and young children, pregnancy and postpartum: grade not assignable. The evidence was difficult to assess because definitions of ultra-processed food varied between studies, many such foods were higher in saturated fat, sodium and added sugars, and food frequency questionnaires do not distinguish processing levels.
Funding unknown
Robinson E, Jones A, Evans R, Finlay A, Brealey J, Gough T, et al. A systematic review and meta-analysis of randomized controlled trials examining the effect of ultra-processed food on energy intake and weight gain Critical Reviews in Food Science and Nutrition, 2026.
doi:10.1080/10408398.2026.2731838 PubMed 42746678
Funding and finding
Funding
Funding statement not read: the publisher's full text returned HTTP 403 to automated access, and the article is absent from PubMed Central and Europe PMC full text. Crossref metadata list no funder.
Finding
Pre-registered. Standardised mean differences for energy intake 0.18 to 0.44 in ultra-processed arms, with statistical significance varying between models; weight gain SMD 0.65 and eating rate SMD 0.96, both significant; palatability and appetite did not differ. Diets were not matched for nutrient profile. Energy intake SMD 0.71 when ultra-processed diets were more energy dense and 0.02 when energy density was similar. Certainty of evidence low. Results read from the PubMed abstract.

Updated 2026-10-21