Trends in Consumption of Ultraprocessed Foods Among US Youths Aged 2-19 Years, 1999-2018

Abstract

Importance: The childhood obesity rate has been steadily rising among US youths during the past 2 decades. Increasing evidence links consumption of ultraprocessed foods to excessive calorie consumption and weight gain, but trends in the consumption of ultraprocessed foods among US youths have not been well characterized.

Objective: To characterize trends in the consumption of ultraprocessed foods among US youths.

Design, setting, and participants: Serial cross-sectional analysis using 24-hour dietary recall data from a nationally representative sample of US youths aged 2-19 years (n = 33 795) from 10 cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999-2000 to 2017-2018.

Exposures: Secular time.

Main outcomes and measures: Percentage of total energy consumed from ultraprocessed foods as defined by NOVA, an established food classification system that categorizes food according to the degree of food processing.

Results: Dietary intake from youths were analyzed (weighted mean age, 10.7 years; 49.1% were girls). From 1999 to 2018, the estimated percentage of total energy from consumption of ultraprocessed foods increased from 61.4% to 67.0% (difference, 5.6% [95% CI, 3.5% to 7.7%]; P < .001 for trend), whereas the percentage of total energy from consumption of unprocessed or minimally processed foods decreased from 28.8% to 23.5% (difference, -5.3% [95% CI, -7.5% to -3.2%]; P < .001 for trend). Among the subgroups of ultraprocessed foods, the estimated percentage of energy from consumption of ready-to-heat and -eat mixed dishes increased from 2.2% to 11.2% (difference, 8.9% [95% CI, 7.7% to 10.2%]) and from consumption of sweet snacks and sweets increased from 10.7% to 12.9% (difference, 2.3% [95% CI, 1.0% to 3.6%]), but the estimated percentage of energy decreased for sugar-sweetened beverages from 10.8% to 5.3% (difference, -5.5% [95% CI, -6.5% to -4.5%]) and for processed fats and oils, condiments, and sauces from 7.1% to 4.0% (difference, -3.1% [95% CI, -3.7% to -2.6%]) (all P < .05 for trend). There was a significantly larger increase in the estimated percentage of energy from consumption of ultraprocessed foods among non-Hispanic Black youths (from 62.2% to 72.5%; difference, 10.3% [95% CI, 6.8% to 13.8%]) and Mexican American youths (from 55.8% to 63.5%; difference, 7.6% [95% CI, 4.4% to 10.9%]) than the increase among non-Hispanic White youths (from 63.4% to 68.6%; difference, 5.2% [95% CI, 2.1% to 8.3%]) (P = .04 for trends).

Conclusions and relevance: Based on the NHANES cycles from 1999 to 2018, the estimated proportion of energy intake from consumption of ultraprocessed foods has increased among youths in the US and has consistently comprised the majority of their total energy intake.

Figure 1.. Changes in Estimated Percentage of Energy Intake From Consumption of Subgroups of Ultraprocessed Foods Among US Youths

Based on dietary data of US youths aged 2-19 years collected in the National Health and Nutrition Examination Survey (NHANES) from 1999-2000 to 2017-2018. Arrows pointing to the right indicate an increase in consumption over time (eg, ready-to-heat and -eat mixed dishes) and arrows pointing to the left indicate a decrease in consumption over time (eg, sugar-sweetened beverages). ^aIncluded cakes, cookies, pies, and pastries.

Figure 2.. Trends in Estimated Percentage of Energy Intake From Ultraprocessed Foods Among Population Subgroups of US Youths

Based on dietary data of US youths aged 2-19 years collected in the National Health and Nutrition Examination Survey (NHANES) from 1999-2000 to 2017-2018. Data were adjusted for NHANES weights to be nationally representative. GED indicates general equivalency diploma.