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. 2025 Jul 28;14(15):2648.
doi: 10.3390/foods14152648.

Unhealthy Ultra-Processed Food, Diet Quality and Adherence to the Mediterranean Diet in Children and Adolescents: The DELICIOUS Project

Francesca Giampieri  1   2   3   4 , Alice Rosi  5 , Evelyn Frias-Toral  6   7 , Osama Abdelkarim  8   9 , Mohamed Aly  8   9 , Achraf Ammar  10   11 , Raynier Zambrano-Villacres  12 , Juancho Pons  13 , Laura Vázquez-Araújo  14   15 , Nunzia Decembrino  16 , Alessandro Scuderi  17 , Alice Leonardi  18 , Lorenzo Monasta  19 , Fernando Maniega Legarda  2   20   21 , Ana Mata  22 , Adrián Chacón  22 , Pablo Busó  22 , Giuseppe Grosso  18   23
Affiliations

Unhealthy Ultra-Processed Food, Diet Quality and Adherence to the Mediterranean Diet in Children and Adolescents: The DELICIOUS Project

Francesca Giampieri et al. Foods. .

Abstract

Background: Western dietary patterns worldwide are increasingly dominated by energy-dense, nutrient-deficient industrial foods, often identified as ultra-processed foods (UPFs). Such products may have detrimental health implications, particularly if nutritionally inadequate. This study aimed to examine the intake of unhealthy UPFs among children and adolescents from five Mediterranean countries (Italy, Spain, Portugal, Egypt, and Lebanon) involved in the DELICIOUS project and to assess the association with dietary quality indicators.

Methods: A survey was conducted with a sample of 2011 parents of children and adolescents aged 6 to 17 years to evaluate their dietary habits. Diet quality was assessed using the Youth Healthy Eating Index (Y-HEI), the KIDMED index to determine adherence to the Mediterranean diet, and compliance with national dietary guidelines.

Results: Increased UPF consumption was not inherently associated with healthy or unhealthy specific food groups, although children and adolescents who consumed UPF daily were less likely to exhibit high overall diet quality and adherence to the Mediterranean diet. In all five countries, greater UPF intake was associated with poorer compliance with dietary recommendations concerning fats, sweets, meat, and legumes.

Conclusions: Increased UPF consumption among Mediterranean children and adolescents is associated with an unhealthy dietary pattern, possibly marked by a high intake of fats, sweets, and meat, and a low consumption of legumes.

Keywords: Mediterranean diet; children and adolescents; ultra-processed food.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Association between (a) daily UPF and (b) high UPF consumption and adequate adherence to individual country-specific dietary recommendations. Squares denote odds ratios (ORs) and lines denote 95% confidence intervals.
See this image and copyright information in PMC

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