The American journal of clinical nutrition · 2026
Ultraprocessed food consumption and the global burden of noncommunicable disease: a 45-country comparative risk assessment.
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Nguyen Thi Anh, Nguyen Nam Nhat, Nguyen Hung Song, Linh Tran Thanh Duy, Nguyen Ngan Thi Kim, Hoang Yen Nhi, Ho Dang Khanh Ngan
Аннотация
BACKGROUND: Ultraprocessed foods (UPFs) increasingly contribute to diets in high-income countries (HICs) and are rapidly displacing traditional food systems in low- and middle-income settings (LMICs). Recent meta-analyses have established dose-response associations between UPF consumption and multiple noncommunicable diseases (NCDs), yet the global disease burden attributable to these foods remains unquantified across diverse populations.
OBJECTIVES: This study aimed to estimate population attributable fractions (PAFs) and attributable burden, including disability-adjusted life years (DALYs) and deaths, for 8 NCD outcomes associated with UPF consumption across 47 country/regional estimates spanning all World Bank income groups, with attributable burden derived for the 45 estimates with matching WHO Global Health Estimates (GHE) cause data and type 2 diabetes (T2D) as the prespecified primary outcome.
METHODS: We conducted a comparative risk assessment using UPF consumption data (% energy from NOVA Group 4 foods) from 47 dietary surveys, dose-response relative risks per 10% energy increment from meta-analyses, and the 2021 WHO GHE. PAFs were computed with a theoretical minimum risk exposure level (TMREL) of 10% energy and Monte Carlo simulation (10,000 iterations) for uncertainty quantification.
RESULTS: A clear income gradient was observed: mean T2D PAFs were 20.2% in HICs (n = 32), 14.2% in upper-middle-income countries (n = 6; excluding Lebanon), 0.9% in LMICs (n = 6), and 2.7% in low-income countries (n = 2). UPF consumption ranged from 4.0% (Ethiopia) to 57.5% (United States). Country-specific T2D PAFs reached 41.4% [95% confidence interval (CI): 29.2%, 52.2%] in the United States, 40.8% (28.4%, 51.6%) in the United Kingdom, 36.2% (24.6%, 46.6%) in the Netherlands, and 35.5% (24.2%, 45.5%) in Norway. UPF consumption above the TMREL was associated with an estimated 3.4 million all-cause deaths (95% CI: 1.3, 6.0 million) and 5670 thousand (3266, 8348) T2D DALYs annually. Results were stable across TMREL sensitivity analyses (aggregate all-cause attributable deaths range 2469-6590 thousand for TMREL bracketing 0%-15%; primary 3362 thousand at TMREL = 10%).
CONCLUSIONS: UPF consumption above a 10% energy threshold is associated with a sizable NCD burden that varies markedly across countries and is concentrated in high-income settings. The income gradient points to an opportunity for early preventive food policy in countries undergoing the nutrition transition.
OBJECTIVES: This study aimed to estimate population attributable fractions (PAFs) and attributable burden, including disability-adjusted life years (DALYs) and deaths, for 8 NCD outcomes associated with UPF consumption across 47 country/regional estimates spanning all World Bank income groups, with attributable burden derived for the 45 estimates with matching WHO Global Health Estimates (GHE) cause data and type 2 diabetes (T2D) as the prespecified primary outcome.
METHODS: We conducted a comparative risk assessment using UPF consumption data (% energy from NOVA Group 4 foods) from 47 dietary surveys, dose-response relative risks per 10% energy increment from meta-analyses, and the 2021 WHO GHE. PAFs were computed with a theoretical minimum risk exposure level (TMREL) of 10% energy and Monte Carlo simulation (10,000 iterations) for uncertainty quantification.
RESULTS: A clear income gradient was observed: mean T2D PAFs were 20.2% in HICs (n = 32), 14.2% in upper-middle-income countries (n = 6; excluding Lebanon), 0.9% in LMICs (n = 6), and 2.7% in low-income countries (n = 2). UPF consumption ranged from 4.0% (Ethiopia) to 57.5% (United States). Country-specific T2D PAFs reached 41.4% [95% confidence interval (CI): 29.2%, 52.2%] in the United States, 40.8% (28.4%, 51.6%) in the United Kingdom, 36.2% (24.6%, 46.6%) in the Netherlands, and 35.5% (24.2%, 45.5%) in Norway. UPF consumption above the TMREL was associated with an estimated 3.4 million all-cause deaths (95% CI: 1.3, 6.0 million) and 5670 thousand (3266, 8348) T2D DALYs annually. Results were stable across TMREL sensitivity analyses (aggregate all-cause attributable deaths range 2469-6590 thousand for TMREL bracketing 0%-15%; primary 3362 thousand at TMREL = 10%).
CONCLUSIONS: UPF consumption above a 10% energy threshold is associated with a sizable NCD burden that varies markedly across countries and is concentrated in high-income settings. The income gradient points to an opportunity for early preventive food policy in countries undergoing the nutrition transition.