Ultra-processed food consumption and excess weight among US adults

Ultra-processed foods provide 58 % of energy intake and 89 % of added sugars in the American diet. Nevertheless, the association between ultra-processed foods and excess weight has not been investigated in a US sample. The present investigation therefore aims to examine the association between ultra-processed foods and excess weight in a nationally representative sample of US adults. We performed a cross-sectional analysis of anthropometric and dietary data from 15 977 adults (20-64 years) participating in the National Health and Nutrition Examination Survey 2005-2014. Dietary data were collected by 24-h recall. Height, weight and waist circumference (WC) were measured. Foods were classified as ultra-processed/non-ultra-processed according to the NOVA classification. Multivariable linear and logistic regression was used to evaluate the association between ultra-processed food consumption (% energy) and BMI, WC and odds of BMI≥25 kg/m², BMI≥30 kg/m² and abdominal obesity (men: WC≥102 cm, women: WC≥88 cm). Prevalence of BMI≥25 kg/m², BMI≥30 kg/m² and abdominal obesity was 69.2, 36.1 and 53.0 %, respectively. Consuming ≥74.2 v. ≤36.5 % of total energy from ultra-processed foods was associated with 1.61 units higher BMI (95 % CI 1.11, 2.10), 4.07 cm greater WC (95 % CI 2.94, 5.19) and 48, 53 and 62 % higher odds of BMI≥25 kg/m², BMI≥30 kg/m² and abdominal obesity, respectively (OR 1.48; 95 % CI 1.25, 1.76; OR 1.53; 95 % CI 1.29, 1.81; OR 1.62; 95 % CI 1.39, 1.89, respectively; P_{for trend}<0.001 for all). A significant interaction between being female and ultra-processed food consumption was found for BMI (F_4,79=4.89, P=0.002), WC (F_4,79=3.71, P=0.008) and BMI≥25 kg/m² (F_4,79=5.35, P<0.001). As the first study in a US population, our findings support that higher consumption of ultra-processed food is associated with excess weight, and that the association is more pronounced among women.