Ultra-Processed Foods and Premature Death: What the Latest Study Reveals

A summary of a recent study on the association between UPFs and mortality.

On April 28th, a study published in The American Journal of Preventive Medicine made headlines with its findings on the link between ultra-processed food (UPF) consumption and mortality. In today’s post, I’ll summarize the key takeaways from the study and share my perspective on what it means for our food choices.

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Summary of study design and methods:

The study is a meta-analysis of seven prior investigations examining the relationship between processed food intake and mortality.

To estimate mortality rates attributable to ultra-processed food consumption, they drew on large national dietary surveys from eight countries: Brazil, the U.S., the U.K., Canada, Mexico, Colombia, Chile, and Australia. For example, 2017–2018 National Health and Nutrition Examination Survey (NHANES) in the U.S. and the 2015 Canadian Community Health Survey in Canada. These surveys used food frequency questionnaires (FFQs) to assess dietary intake across large, representative samples.

Using this data, the study applied the NOVA classification system, which categorizes foods into four groups based on the extent of processing:

1. Unprocessed or minimally processed foods – e.g., fruits, vegetables, seeds, eggs.

2. Processed culinary ingredients – e.g., oils, butter, sugar, salt.

3. Processed foods – e.g., canned vegetables or fruit, cheese, fresh bakery bread.

4. Ultra-processed foods – e.g., sausages, burgers, granola bars, breakfast cereals (excluding simple ones like shredded wheat), breads with additives, processed protein products (e.g., chicken nuggets), flavoured yogurt.

Key findings:

• UPF consumption varies widely by country: In countries like Colombia and Brazil, UPFs made up less than 20% of total energy intake. This rose to 20%–30% in Chile and Mexico, 37.5% in Australia, 43.7% in Canada, and exceeded 50% in the U.K. and the U.S.

• Mortality risk increases with UPF intake: For every 10% increase in UPF consumption, the risk of all-cause mortality rose by 2.7%.

• Estimated mortality attributable to UPFs: In countries with high UPF consumption (like the U.K. and U.S.), up to 14% of premature deaths were attributed to UPF intake. In countries with lower consumption (like Colombia and Brazil), this figure was closer to 4%.

Points to consider:

Here are a few things to consider along with the results reported above. First, a limitation noted by the study authors is the potential for changes in dietary intake over time, as FFQs capture dietary data from only a single point in time. This snapshot may not fully reflect long-term patterns or variations in diet.

Second, FFQs have their limitations. FFQs are a self-report measure which can introduce inaccuracies. The scientific community often criticizes FFQs and other self-reported dietary tools because individuals may unintentionally underreport or overreport their intake. While it's true that self-reporting isn't always perfect, it's worth acknowledging that dietary intake can vary significantly from day to day and year to year, making it challenging impossible to capture a precise measurement, regardless of the tool.

In my opinion, despite these limitations, FFQs still offer valuable insights, especially in large population studies. Having spent considerable time using these tools with patients, I’ve found that while they may not capture the exact frequency with which someone eats a particular food, they offer a reliable estimate for classifying dietary patterns. For example, if a person reports that 50% of their food intake comes from UPFs on an FFQ, while the exact figure may not be precise, it’s safe to say that they consume a high amount of UPFs. In the context of this study, even if Canada's UPF intake of 43.7% isn’t exact, it’s likely still quite high.

Lastly, the NOVA classification system used in the study helps to categorize foods based on their level of processing. However, like any classification system, it has its imperfections. One key issue is that the UPF category is quite broad, grouping together foods as different as almond milk and hot dogs. Foods are often classified as ultra-processed if they contain additives, which can be a helpful general marker of processing, but not always a nutritionally meaningful one. For instance, a fresh loaf of white bread purchased at a bakery (low in fibre and made with refined flour) is categorized as a less-processed and therefore better option than a whole grain loaf (high in fibre, made with whole grain wheat) that contains a preservative. In reality, the nutritional quality of foods is far more nuanced than these broad categories imply.

Bottomline:

This study has made major headlines over the past few weeks, and understandably, it can spark fear around eating any processed food. However, it specifically focused on UPFs, which, even within the NOVA system, is not a perfect or clear-cut category.

There’s a meaningful difference between a diet where 50% of intake comes from foods like chicken nuggets, hot dogs, potato chips, and salami, versus one that includes UPFs such as almond milk, flavoured yogurt, or protein powder. Grouping these foods under a single label overlooks important differences in their nutritional quality.

While this study isn’t without limitations, it points to an important general trend: a higher intake of low-quality UPFs is likely associated with an increased risk of premature death. However, the degree of risk, which types of foods are most concerning, and how other lifestyle factors (like physical activity or food insecurity) influence outcomes remain unclear.

Many processed foods still provide nutritional value and can support a healthy diet. The key is to assess food products as a whole - consider how they contribute to your overall eating pattern, not just how processed they are.

At the end of the day, focus on building a diet that works for you- one that emphasizes minimally processed foods, while still allowing room for convenience, balance, and enjoyment. If low-quality UPFs are a regular part of your routine, consider gradually reducing how often you rely on them. Small, consistent shifts can make a meaningful difference over time and may help lower your risk of chronic diseases and even premature death in the long run.

Thanks for reading! I’d love to hear your thoughts - what do you think about this study? Will it change how you approach ultra-processed foods in your routine? Share your thoughts in the comments below!

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“The Grocery Edit” is written by Brittany Raftis, MScFN, RD. She works as a Registered Dietitian and is passionate about helping people sort through the confusion of ingredients and nutrition facts to reduce stress surrounding daily food choices. She uses an evidence-based approach to clear up misinformation about nutrition and help people select the right products to support their health and enjoyment of food.