title: Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study.
abstract: OBJECTIVE
  To investigate the contribution of ultra-processed foods to the intake of added sugars in the USA. Ultra-processed foods were defined as industrial formulations which, besides salt, sugar, oils and fats, include substances not used in culinary preparations, in particular additives used to imitate sensorial qualities of minimally processed foods and their culinary preparations.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  National Health and Nutrition Examination Survey 2009-2010.
  
  
  METHODS
  We evaluated 9317 participants aged 1+ years with at least one 24 h dietary recall.
  
  
  METHODS
  Average dietary content of added sugars and proportion of individuals consuming more than 10% of total energy from added sugars.
  
  
  METHODS
  Gaussian and Poisson regressions estimated the association between consumption of ultra-processed foods and intake of added sugars. All models incorporated survey sample weights and adjusted for age, sex, race/ethnicity, family income and educational attainment.
  
  
  RESULTS
  Ultra-processed foods comprised 57.9% of energy intake, and contributed 89.7% of the energy intake from added sugars. The content of added sugars in ultra-processed foods (21.1% of calories) was eightfold higher than in processed foods (2.4%) and fivefold higher than in unprocessed or minimally processed foods and processed culinary ingredients grouped together (3.7%). Both in unadjusted and adjusted models, each increase of 5 percentage points in proportional energy intake from ultra-processed foods increased the proportional energy intake from added sugars by 1 percentage point. Consumption of added sugars increased linearly across quintiles of ultra-processed food consumption: from 7.5% of total energy in the lowest quintile to 19.5% in the highest. A total of 82.1% of Americans in the highest quintile exceeded the recommended limit of 10% energy from added sugars, compared with 26.4% in the lowest.
  
  
  CONCLUSIONS
  Decreasing the consumption of ultra-processed foods could be an effective way of reducing the excessive intake of added sugars in the USA.
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil.
authors.forename: Eurídice
authors.initials: E
authors.lastname: Martínez Steele
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil.
authors.forename: Larissa Galastri
authors.initials: LG
authors.lastname: Baraldi
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil.
authors.forename: Maria Laura da Costa
authors.initials: ML
authors.lastname: Louzada
authors.affiliation: Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Moubarac
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil.
authors.forename: Carlos Augusto
authors.initials: CA
authors.lastname: Monteiro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004032:Diet / Q000706:statistics & numerical data*; D019422:Dietary Sucrose / Q000032:analysis*; D002149:Energy Intake; D057140:Fast Foods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
chemical_list: D019422:Dietary Sucrose
keywords: NHANES; US; added sugars; dietary intake; ultra-processed