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Multicenter Study
. 2025 Jan 2;8(1):e2457341.
doi: 10.1001/jamanetworkopen.2024.57341.

Ultraprocessed Food Consumption and Obesity Development in Canadian Children

Zheng Hao Chen  1 , Sara Mousavi  1 , Piushkumar J Mandhane  2   3 , Elinor Simons  4 , Stuart E Turvey  5 , Theo J Moraes  6 , Padmaja Subbarao  6   7   8 , Kozeta Miliku  1   8
Affiliations
Multicenter Study

Ultraprocessed Food Consumption and Obesity Development in Canadian Children

Zheng Hao Chen et al. JAMA Netw Open. .

Abstract

Importance: Ultraprocessed foods (UPF), characterized as shelf-stable but nutritionally imbalanced foods, pose a public health crisis worldwide. In adults, UPF consumption is associated with increased obesity risk, but findings among children are inconsistent.

Objectives: To examine the associations among UPF intake, anthropometric adiposity indicators, and obesity status in Canadian children.

Design, setting, and participants: In the CHILD Cohort Study, one of the largest prospective, multicenter, population-based pregnancy cohorts in Canada, diet was assessed during the 3-year visit (September 2011 to June 2016), and anthropometric measurements were assessed at the 5-year visit (December 2013 to April 2018). Data analysis was performed between July 1, 2023, and June 30, 2024.

Exposure: Diet intake was assessed using a semiquantitative food frequency questionnaire at 3 years of age. UPFs were identified using the NOVA classification system.

Main outcomes and measures: Anthropometric adiposity indicators were measured at 5 years of age and used to calculate age- and sex-standardized z scores for body mass index (BMI), waist to height ratio, and subscapular and triceps skinfold thicknesses, and obesity, which was defined using BMI z score cutoffs. Multivariable-adjusted regression analyses were used to examine the associations of UPF with adiposity and obesity development, accounting for parental, birth, and early-childhood factors.

Results: Among 2217 participants included in this study, median age at the outcome assessment was 5.0 (IQR, 5.0-5.1) years, and 1175 (53.0%) were males. At 3 years of age, UPF contributed 45.0% of total daily energy intake. UPF energy contribution was higher in males vs females (46.0% vs 43.9%; P < .001). Among all participants, higher UPF intake at 3 years of age was associated with higher anthropometric adiposity indicators at 5 years of age, primarily driven by males. In males, every 10% UPF energy increase was associated with higher adiposity indicator z scores for BMI (β, 0.08; 95% CI, 0.03-0.14), waist to height ratio (β, 0.07; 95% CI, 0.01-0.12), and subscapular (β, 0.12; 95% CI, 0.06-0.18) and triceps (β, 0.09; 95% CI, 0.03-0.15) skinfold thickness and higher odds of living with overweight or obesity (odds ratio, 1.19; 95% CI, 1.03-1.36). No significant associations were observed among females.

Conclusions and relevance: In this cohort study of Canadian children, high UPF consumption during early childhood was associated with obesity development, primarily in males. These findings can inform targeted public health initiatives for early childhood centers and caregiver education programs to reduce UPF intake and prevent obesity.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Mandhane reported receiving grant funding from the Women’s and Children’s Health Research Institute, the Canadian Institute for Health Research (CIHR), the Public Health Agency of Canada, and Alberta Health and personal fees from the European Society of Clinical Microbiology and Infectious Disease outside the submitted work and a leadership role at Alberta Health Services. Dr Moraes reported receiving grant funding from CIHR, Cystic Fibrosis Canada, and the Physicians’ Services Incorporated Foundation for other projects outside the submitted work. Dr Miliku reported receiving grant funding from CIHR. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Energy Intake From Each NOVA Group at 3 Years of Age Among 2217 Participants in the CHILD Cohort Study
Stacked bar graph shows total energy intake percentage contributed by each NOVA group in the total population and stratified by male and female participants.
Figure 2.
Figure 2.. Ultaprocessed Food (UPF) Intake at 3 Years of Age and Anthropometric Adiposity Indicators at 5 Years Among 2217 Participants in the CHILD Cohort Study
β Estimates with 95% CIs are calculated from linear regression analyses of the associations between every 10% increase in energy intake from UPF intake at 3 years of age and their associations with anthropometric adiposity indicators z scores (body mass index, waist to height ratio, and subscapular and triceps skinfold thickness) at 5 years of age. The basic model accounted for total energy intake. The multivariable-adjusted model accounted for the basic model plus maternal postsecondary degree, maternal UPF intake during pregnancy, household family income, child ethnicity, birth weight, exclusive breastfeeding at 6 months, older siblings, hours of organized physical activity, study site, and season of dietary assessment.
Figure 3.
Figure 3.. Ultraprocessed Food (UPF) Intake at 3 Years of Age and Overweight or Obesity Status at 5 Years of Age Among 2217 Participants in the CHILD Cohort Study
Odds ratios (ORs) with 95% CIs are calculated from logistic regression analyses of the associations every 10% increase in energy intake from UPF intake at 3 years of age and their associations with overweight or obesity status at 5 years of age. The basic model accounted for total energy intake. The multivariable-adjusted model accounted for the basic model plus maternal postsecondary degree, maternal UPF intake during pregnancy, household family income, child ethnicity, birth weight, exclusive breastfeeding at 6 months, older siblings, hours of organized physical activity, study site, and season of dietary assessment.
See this image and copyright information in PMC

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