Americans get more than half of their calories and nearly 90 percent of their added sugar in their diet from “ultra-processed” foods, according to a study published online Wednesday in the journal BMJ Open.
The study also found that people who consumed the most ultra-processed foods were significantly more likely to exceed the recommendation from public health officials that no more than 10 percent of calories should come from added sugar.
In fact, of the 20 percent of people in the study who ate the most ultra-processed foods, 80 percent exceeded that recommended upper limit for added sugar.
“Our study suggests that in the USA, limiting the consumption of ultra-processed foods may be a highly effective way to decrease added sugars,” write the study’s authors. “A reduction in ultra-processed foods should also increase the intake of more healthful, minimally processed foods such as milk, fruits and nuts, and freshly prepared dishes based on whole grains and vegetables, which would produce additional health benefits beyond the reduction in added sugar.”
Yes, that may seem obvious. But this study is apparently the first one to look at the contribution of the entire category of ultra-processed foods to U.S. sugar consumption, rather than on the impact of individual elements within the category, such as soft drinks or fast food.
Ultra-processed foods are those that contain not just salt, sugar, oils and other substances commonly used in cooking, but also flavorings, emulsifiers, colorings, sweeteners and additional additives — ingredients whose purpose is to disguise undesirable features of the final product and to mimic real foods as much as possible.
It’s a category that contains a wide range of popular products, including breads, soft drinks, fruit drinks, milk-based drinks, cakes, cookies, pies, cakes, salty snacks, pizza and breakfast cereals.
It is different, however, from “processed foods,” which include cheese, smoked fish or meat, and vegetables preserved in brine (such as pickles), and from “unprocessed or minimally processed foods,” which include meat, fruit, plain yogurt, grains and vegetables.
America’s sweet tooth
To determine the contribution of ultra-processed foods to the amount of added sugar in the American diet, researchers analyzed dietary data collected from more than 9,000 people who participated in the 2009-2010 National Health and Nutrition Examination Survey (NHANES), an ongoing nationally representative survey of U.S. adults.
They found that ultra-processed foods made up an average of 57.9 percent of the total calories and 89.7 percent of the calories from added sugar consumed by the survey’s participants.
By contrast, processed culinary ingredients (table sugar used by home cooks to prepare a dish or drink from scratch) contributed only 8.7 percent of the calories from added sugars in the participants’ diets. Processed foods contributed even fewer added-sugar calories: 1.6 percent.
Those percentages aren’t surprising, however, given that 21 percent of calories in ultra-processed foods — or 1 in 5 calories — come from added sugar. That rate is eightfold higher than the 2.4 percent of calories from added sugar found in processed foods, the authors of the study point out.
Exceeding the limit
Although health officials recommend that we limit added sugars to no more than 10 percent (or, better yet, 5 percent) of our total calories, research suggests that added sugars make up about 15 percent of total calories in the average American diet.
In this study, only those people who were among the 20 percent who consumed the lowest amount of ultra-processed food met the recommended limit on added sugar.
For the 20 percent of the study’s participants who consumed the most ultra-processed foods, 82 percent exceeded the recommended limit.
Limitations and implications
The study comes with several caveats. Most notably, it relied on people recalling what they ate over the past 24 hours. Such recollections can be problematic.
Still, since previous research has shown that people tend to underreport the amount of sugar-sweetened foods they eat, the dietary contribution of added sugar from ultra-processed foods was most likely underestimated in this study.
So, what is the take-home message? Well, dietary guidelines say we should limit our consumption of added sugar, but they are not always clear on how we should go about that. And it’s quite complicated to determine from reading food labels when you have met the 10 percent added sugar threshold.
This study’s findings suggest a much simpler strategy: Avoid ultra-processed foods as much as possible.
FMI: BMJ Open is, as its name implies, an open-access medical journal, so you can download and read the study in full through the journal’s website.