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Ultra-processed foods and excessive free sugar intake in the UK: a nationally representative cross-sectional study
  1. Fernanda Rauber1,2,
  2. Maria Laura da Costa Louzada2,3,
  3. Euridice Martinez Steele1,2,
  4. Leandro F M de Rezende2,4,
  5. Christopher Millett2,5,
  6. Carlos A Monteiro1,2,
  7. Renata B Levy2,6
  1. 1 Departamento de Nutrição, Universidade de Sao Paulo, Sao Paulo, Brazil
  2. 2 Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de Sao Paulo, Sao Paulo, Brazil
  3. 3 Departamento de Políticas Públicas e Saúde Coletiva, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
  4. 4 Escola Paulista de Medicina, Departamento de Medicina Preventiva, Universidade Federal de São Paulo, Sao Paulo, Brazil
  5. 5 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
  6. 6 Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
  1. Correspondence to Dr Fernanda Rauber; rauber.fernanda{at}


Objectives To describe dietary sources of free sugars in different age groups of the UK population considering food groups classified according to the NOVA system and to estimate the proportion of excessive free sugars that could potentially be avoided by reducing consumption of their main sources.

Design and setting Cross-sectional data from the UK National Diet and Nutrition Survey (2008–2014) were analysed. Food items collected using a 4-day food diary were classified according to the NOVA system.

Participants 9364 individuals aged 1.5 years and above.

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

Data analysis Poisson regression was used to estimate the associations between each of the NOVA food group and intake of free sugars. We estimated the per cent reduction in prevalence of excessive free sugar intake from eliminating ultra-processed foods and table sugar. Analyses were stratified by age group and adjusted for age, sex, ethnicity, survey year, region and equivalised household income (sterling pounds).

Results Ultra-processed foods account for 56.8% of total energy intake and 64.7% of total free sugars in the UK diet. Free sugars represent 12.4% of total energy intake, and 61.3% of the sample exceeded the recommended limit of 10% energy from free sugars. This percentage was higher among children (74.9%) and adolescents (82.9%). Prevalence of excessive free sugar intake increased linearly across quintiles of ultra-processed food consumption for all age groups, except among the elderly. Eliminating ultra-processed foods could potentially reduce the prevalence of excessive free sugar intake by 47%.

Conclusion Our findings suggest that actions to reduce the ultra-processed food consumption generally rich in free sugars could lead to substantial public health benefits.

  • food processing
  • ultra-processed
  • free sugar
  • United Kingdom

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  • Contributors CAM, EMS, FR, MLdCL and RBL designed the research. FR and RBL undertook data management and analysis. CAM, CM, EMS, FR, LFMdR, MLdCL and RBL interpreted the data. FR wrote the first draft of the manuscript. All authors read, edited and approved the final manuscript.

  • Funding This work was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), grant numbers 2015/14900-9, 2016/14302-7 (FR is a beneficiary of a postdoctoral fellowship) and 2014/25614-4 (LFMR is a beneficiary of a doctoral fellowship).

  • Disclaimer FAPESP had no role in the design, analysis or writing of this manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All relevant research ethics and governance committees approved the survey.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Computerized raw data files and documentation from this survey were obtained under license from the U.K. Data Archive ( Details of how food item classification was accomplished are further explained in previously published papers (Rauber et al, Nutrients. 2018 - see Supplementary Table S1