Nutrition/Obesity
Ultra-processed Foods and Nutrient Profiling Criteria for Front-of-Package Labeling: Identifying High-Risk Foods in NHANES 2021-2023 Anais Elena Fernandez Calzavara* Anais Elena Fernandez Calzavara Fernandez Calzavara University of California Irvine
Background. Ultra-processed foods (UPFs) are consistently associated with higher chronic disease risk, yet the overlap with foods high in nutrients of public health concern (saturated fat, sodium, and added sugar – HFSS) is unclear. The U.S. Food and Drug Administration has proposed front-of-package (FOP) labeling for HFSS foods. Clarifying the overlap may provide more nuanced public health guidance for distinguishing high-risk foods from other UPFs.
Objective. Estimate the proportion of UPFs that would qualify as HFSS and UPFs contributions to total energy intake.
Design/Methods. This was a cross-sectional descriptive analysis of dietary intake among 8,153 adults (≥18 y) in the NHANES 2021–2023 cycle using two 24-h recalls. Foods were classified as UPFs and evaluated for HFSS using absolute food-level nutrient thresholds. Participant-level percentages of energy from UPFs were averaged across recalls. The proportion of consumed UPFs high in each or ≥1 nutrient and their contribution to calories from HFSS were calculated. Unique UPF items were assessed for FOP labeling criteria.
Results. UPFs provided 39.1% (95% CI: 38.6-39.7) of daily energy. Of these, 50.2% (95% CI: 49.6-50.9) were high in saturated fat, 15.7% (95% CI: 15.2-16.1) in sodium, and 14.2% (95% CI: 13.7-14.7) in sugar. UPFs contributed 25.0% (95% CI: 24.5-25.5), 14.4% (95% CI: 14.0-14.8), and 9.3% (95% CI: 9.0-9.7) of daily calories from high saturated fat, sodium, and sugar, respectively. Among 1,450 unique UPFs, 57.7% (95% CI: 55-60) would require an FOP label for saturated fat, 28.4% (95% CI: 26-31) for sodium, and 14.3% (95% CI: 12-16) for sugar. Roughly a third (31%, 95% CI: 29-33) would require no label.
Conclusions. UPFs contributed substantially to saturated fat, sodium, and sugar intake, but not all UPFs were HFSS foods. These findings suggest that FOP labeling could help identify high-risk foods among UPFs, while UPF classification alone would be an imperfect indicator for nutrients of concern.