# Associations Between Consumption of Ultra-Processed Foods and Diet Quality Among Children and Adolescents

## TL;DR

This study shows that eating more ultra-processed foods is linked to poorer diet quality and higher risk of unhealthy nutrient intakes in children and teens.

## Contribution

The study provides new evidence on how ultra-processed food consumption affects nutrient intake and adherence to dietary guidelines in children.

## Key findings

- Higher UPF intake was associated with increased energy, sugar, and fat consumption but lower protein intake.
- Children in the highest UPF tertile were more likely to exceed added sugar limits and had lower potassium intake.
- Micronutrient intakes like vitamins and minerals were mixed, with some being higher but potassium lower in the highest UPF group.

## Abstract

Background: Ultra-processed foods (UPFs) have emerged as a critical component of diet quality, yet data on the associations between UPF and nutrient intakes remain limited. This study aimed to evaluate nutrient consumption in relation to UPF intake and adherence to international dietary guidelines for non-communicable disease (NCD) prevention. Methods: Data from 469 individuals aged 2–18 years enrolled in the Hellenic National Nutrition and Health Survey (HNNHS) were analyzed. Intakes were assessed using two 24 h recalls, and foods were classified according to the NOVA system. Participants were categorized by UPF energy intake tertiles. Nutrient adequacy was assessed using Nordic Nutrition Recommendations, European Society of Cardiology guidelines for macronutrients, and the Institute of Medicine’s Estimated Average Requirements and Adequate Intake values for micronutrients. Results: Children in the highest UPF tertile had significantly higher intakes of energy, carbohydrates, added sugars, saturated fats, polyunsaturated fats, and cholesterol, but lower intakes of protein compared to those in the lowest tertile. Fiber intake remained inadequate across all tertiles, with no significant differences. Regarding adherence to NCD prevention guidelines, children in the 3rd UPF tertile had a 2.3 times higher prevalence ratio for exceeding added sugar recommendations, while their protein intake prevalence ratio was 0.8 times lower. For micronutrients, the highest UPF tertile showed significantly elevated intakes of vitamins E, B1, folate, calcium, iron, copper, and sodium, but lower potassium intake compared to the lowest tertile. Conclusions: Our results underscore the need for effective public health strategies to improve diet quality in children and adolescents and prevent diet-related NCDs.