BMJ Open 6:e009892 doi:10.1136/bmjopen-2015-009892
  • Nutrition and metabolism
    • Research

Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study

Press Release
  1. Carlos Augusto Monteiro1,2
  1. 1Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
  2. 2Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
  3. 3Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
  1. Correspondence to Dr Carlos Augusto Monteiro; carlosam{at}
  • Received 3 September 2015
  • Revised 29 October 2015
  • Accepted 11 November 2015
  • Published 9 March 2016


Objectives 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.

Design Cross-sectional study.

Setting National Health and Nutrition Examination Survey 2009–2010.

Participants We evaluated 9317 participants aged 1+ years with at least one 24 h dietary recall.

Main outcome measures Average dietary content of added sugars and proportion of individuals consuming more than 10% of total energy from added sugars.

Data analysis 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.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

blog comments powered by Disqus