# Ultra processed food consumption and nutrients adequacy among cancer survivors in Lebanon

## TL;DR

This study explores how ultra-processed food affects nutrient intake among cancer survivors in Lebanon, finding significant micronutrient deficiencies despite low ultra-processed food consumption.

## Contribution

The study is among the first to assess nutrient adequacy in cancer survivors in relation to ultra-processed food consumption in a Middle Eastern context.

## Key findings

- Higher ultra-processed food intake was linked to increased energy and macronutrient intake but lower vitamin C adequacy.
- Most participants had inadequate intake of potassium, vitamin A, and vitamin D.
- Higher education was associated with lower odds of nutrient inadequacy, while ultra-processed food intake was not.

## Abstract

Evidence on the impact of ultra-processed food (UPF) intake on diet quality among cancer survivors remains limited. This study examined UPF consumption and nutrient intake adequacy among cancer survivors in Lebanon.

In this cross-sectional study, adult cancer survivors in remission for at least three months were recruited from two medical centers. Dietary intake was assessed using a validated food frequency questionnaire (FFQ), and food items were categorized according to the NOVA classification. Nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) were calculated. Participant characteristics, nutrient adequacy, and macronutrient intakes were compared across UPF quartiles using Chi-square tests, and ANOVA. Logistic regression was performed to identify predictors of nutrient inadequacy.

The study included 268 participants (mean age: 59 years; 83% female). UPF accounted for 8 ± 7% of total food weight and 17.5 ± 11% of energy intake. Most participants did not meet requirements for potassium (95%), vitamin A (87%), and vitamin D (99%) with mean intakes of 2,527 ± 1236 mg, 350 ± 175 Retinol Activity Equivalents, and 0.8 ± 1.2 µg, respectively. Higher UPF intake was significantly associated with higher energy (p < 0.001), carbohydrate (p < 0.001), protein (p = 0.017), fat (p < 0.001), and saturated fat intake (p < 0.001), and with lower vitamin C adequacy (p = 0.02). In multivariable analysis, higher education predicted lower odds of nutrient inadequacy (AOR = 0.26, 95% CI: 0.1–0.65, p = 0.004), while UPF intake did not.

Despite the relatively low UPF contribution, significant micronutrient inadequacies were observed among cancer survivors. These findings underscore the importance of integrating dietary counseling into cancer care to address nutrient gaps and promote healthier food choices.