Higher ultra-processed food consumption is associated with poor nutritional quality but not with obesity in Israeli adults

Abstract

Introduction: Ultra-processed foods (UPF) intake has increased in recent decades, coinciding with declines in diet quality, nutritional sufficiency, and rises in obesity and chronic diseases. Understanding its impact on health outcomes is crucial.

Methods: This secondary analysis of Israel's cross-sectional study, 2014-2016 National Health and Nutrition Survey includes 2,563 adults (25-64 years) with full dietary data. Data was obtained by a 24-hour recall based on an interview for dietary intake data, and anthropometric measurements such as weight, height, and waist circumference (WC). UPF consumption (percentage of total energy intake) was calculated classifying reported foods into four groups according to the NOVA method, based on their processing level. Diet quality was assessed by food group and nutrient intake by UPF consumption levels, while obesity was defined using BMI (≥30), relative fat mass, and waist circumference. Associations were tested using the chi-square test, the Cochran-Armitage trend test for dichotomous variables, and the Cochran-Mantel-Haenszel test for trend analysis across three or more categories. Additionally, logistic regression models were employed to account for potential confounders.

Results: Participants were 46.8% men, average age 42.2 ± 11.1 years, with mean UPF consumption at 34.5% of total energy intake. Upper quartile UPF consumption was associated with younger age (p = 0.0015), low physical activity (p < 0.001) and smoking (p = 0.0162). Higher consumption of UPF was associated with high intake of energy, carbohydrates, saturated fat, and thiamine (p < 0.0001). It was also significantly linked to lower total intake of fat, protein, monounsaturated fatty acids, dietary fiber, folic acid, vitamin B₁₂, vitamin C, and zinc. No significant association was found between UPF consumption and obesity (N = 1825).

Discussion: UPF consumption is negatively correlated with nutrition quality but not with obesity among Israeli adults. Future obesity studies should thoroughly examine the etiological role of UPF. Furthermore, effective strategies should be developed to lower the level of processing in the food industry and to reduce the consumption of UPF.

Keywords: 24 hour-recall; MABAT; NOVA; diet quality; nutrients.

Figure 1

Creation of the final analytical data set from Rav MABAT adults survey 2014–16. BMI, body mass index; RFM, relative fat mass.

Figure 2

Percent of macro-nutrients consumption according to the reference value by consumption of ultra-processed foods. Israeli adults ages 25–64, 2014–16. For proteins, carbohydrates and total fats the reference value is the DRI (Dietary Reference Intake): carbohydrates make up 45 to 65% of total daily calories, total fat—20 to 35% of total daily calories and protein—10 to 35% of total daily calories. For saturated fats, mono-unsaturated fats and poly-unsaturated fats the reference value is the Israel Ministry of Health and the IOM (Institute of Medicine, USA): saturated fats make up 7 to 10% of total daily calories, mono-unsaturated—10 to 13% of total daily calories and poly-unsaturated—8 to 12% of total daily calories.

Figure 3

Percent of selected vitamin consumption less than the reference value (estimated average requirements—EAR) by consumption of ultra-processed foods. Israeli adults ages 25–64, 2014–16. For adults aged 19 + years, EAR for vitamin C is 75 mg/d for males and 60 mg/d for females, EAR for vitamin B₁₂ is 2 mcg/d, EAR for thiamin is 1 mg/d for males and 0.9 mg/d for females, EAR for folic acid is 320 mcg/d.

Figure 4

Percent of selected vitamin consumption with reference to international recommendations (recommended dietary allowance—RDA) of the overall diet according to the consumption of ultra-processed foods. Israeli adults ages 25–64, 2014–16. *p < 0.05. For adults aged 19 + years, RDA for vitamin C is 90 mg/d for males and 75 mg/d for females, RDA for vitamin B₁₂ is 2.4 mcg/d, RDA for thiamin is 1.2 mg/d for males and 1.1 mg/d for females, RDA for folic acid is 400 mcg/d.