So, what exactly is ultra-processing and ultra-processed food and drink?
- Ultra-processing is a new, popular term that is cropping up in media circles. It appears to be partly driven by the ‘clean eating’ trend and the publication of the NOVA system (a name not an acronym), developed by Professor Monteiro and his team at the University of São Paulo, Brazil.
- The term ultra-processing has arisen from the NOVA food classification system which categorises foods according to the extent and purpose of food processing, rather than in terms of nutrients.
Foods and food products are classified into four distinct groups:
Group 1: Unprocessed or minimally processed foods, eg, fresh foods, grains, legumes, meat, poultry, fish, seafood
Group 2: Processed culinary ingredients, eg, salt, sugar and molasses, honey, vegetable oils, starches
Group 3: Processed foods, eg, salted, cured or smoked foods, canned fruit and vegetables, fresh breads
Group 4: Ultra-processed food and drink (UPFD) products, eg, packaged snacks, bread and buns, breakfast cereals, pre-prepared meals, chocolate, confectionary.
- UPFD are typically defined as those with five or more ingredients.
- UPFD often include sugar, oils, fats, salt, antioxidants, stabilisers and preservatives without specifying cut-off thresholds for these per gram or per portion.
- The public awareness of UPFD is a belief that these foods and drinks are high in calories, high in fat, high in sugar, high in salt, refined starches, poor sources of protein, poor sources of fibre, low nutrient density, hyper-palatable, fast food, obesity triggers, cancer triggers and protein diluting effect.
- As food types and nutrients are NOT considered in the NOVA system, a food could be ‘ultra-processed’ yet be of value in terms of nutritional density.
Ultra-processed foods aren’t always the enemy
The real reality is that most of the food and drinks that we consume are processed to some extent. Simply put, processing is any food that has been altered in some way during its preparation which can be as basic as freezing, drying, canning and baking. Scaremongering and confusing the public about UPFD is not the best way forward. Equally, reducing the number of ingredients to less than five may not be feasible in many instances. Furthermore, UPFD listed by NOVA and identified through the analysis of food labels can have ‘functional’ value. Here we provide some particular examples.
- Breakfast cereals are considered an ultra-processed food, yet low sugar brands fortified with micronutrients and vitamins have an important role to play in health. Without the fortification of breakfast cereals, research has shown that the percentage of children (aged 2 to 18 years) with intakes of niacin, iron, thiamine and vitamin A below the Estimated Average Requirement increased by 155, 163, 113 and 35%, respectively.
- Infant formula is also considered an ultra-processed food, but clearly, whilst breast feeding for the first six months of life is regarded as the optimal way of feeding infants, for those who cannot feed infants this way formulas have an important role to play.
- Vegetarian and vegan sausages could be classified as an ultra-processed food, yet have a valuable role to play in meeting consumers demands who want more flexibility in their diets. Mycoprotein™ is high in protein, low in fat and produced as sustainably as possible. The product has also been tested clinically with recent evidence finding that its consumption may help to reduce energy intake and insulin release in overweight adults.
- Products such as gluten-free bread (alongside bread per se) are also classified as ultra-processed. Yet gluten-free living already entails a substantial restriction when it comes to food choice. This, in turn, has been linked to social and psychological distress. So it seems that classifying foods such as these as ultra-processed could only exacerbate these restrictive feelings.
- Further UPFD products with functional value include probiotic drinks and cholesterol lowering spreads.
So how should we choose which foods to eat?
Ideally, a whole foods approach should be considered as it is difficult to tease out whether the NOVA classification system would ultimately lead consumers to choose better diets compared to advised healthy diet patterns.
And what can manufactures do to help?
Many manufacturers are now reducing the sugar and salt content and improving the nutritional profile of their products. It could be predicted that given growing populations and modern-day lifestyles processed foods may not disappear but change form i.e. increasingly have functional health roles. Also the clean eating trend is still going strong and we could see this shift across into clean labelling, although this itself could have extended ramifications.
Food producers should look to review energy, fat and salt profiles, use natural colours, preservatives, antioxidants and emulsifiers where possible that are EU approved, and sustainable production methods.
Why the NOVA classification system needs improving
On the whole media coverage around the consumption of UPFD is largely based on studies using the NOVA definition. Whilst this is relatively straightforward to apply it has its setbacks. It is a crude classification system of grouping foods into categories based on their degree of processing.
- The NOVA definition of UPFD uses the word ‘formulations’, which is open to interpretation, and states that these ‘often include’ sugar, oils, fats, salt, antioxidants, stabilisers and preservatives rather than ‘do’ and does not include cut-offs to assess the nutritional profile.
- The number of ingredients is ‘typically five or more’. So, in theory, if food producers wish to move into group 3 components such as fortificants, product stabilisers and preservatives would need to be removed from the list. This poses potential nutritional and food safety risks.
- In the UK, many foods that fall under the bank of UPFD are already limited. For example, we have had the recent Change4Life Campaign specifying that children should eat no more than two refined supermarket snacks per day (each no more than 100 kcal).
- Certain foods listed in group 2 such as salt and sugar are also restricted foods. Bearing this in mind, group 4 foods should not be earmarked as being unhealthful whilst those in lower groups go ignored.
So, all in all, the definition of ultra-processing requires further scientific rigour before we jump ahead and public policies relating to this are put into place.
References:
Derbyshire EJ (2018) Ultra-processing unleashed. What is it and should we fear it? Complete Nutrition Vol.18 No.3: pp. 74-76.
Gibney MJ (2018) Ultra-processed foods: definitions and policy issues. Current Developments in Nutrition [Epub ahead of print].
Gibney MJ et al. (2017) Ultra-processed foods in human health: a critical appraisal. Am J Clin Nutr 106(3):717-724.
