Ultraprocessed Food Consumption and Cardiometabolic Risk Factors in Children
Comprehensive Overview
Published in JAMA Network Open in 2024, this study asked whether children who eat more ultraprocessed foods, industrially manufactured products loaded with additives, sugar, and unhealthy fats, face higher cardiometabolic risk, a question already well studied in adults but rarely examined in young children. Researchers analyzed baseline data from the Childhood Obesity Risk Assessment Longitudinal Study, a cross-sectional study of 1,426 preschool children aged 3 to 6 years recruited from schools and health centers across seven cities in Spain. Using a validated food and beverage frequency questionnaire, trained dietitians estimated each child's daily ultraprocessed food intake in grams, adjusted for total energy consumption, and classified foods according to their degree of processing using the NOVA system. Children were then grouped into thirds of ultraprocessed food consumption, and researchers used linear regression models, adjusted for maternal education, maternal BMI, physical activity, and breastfeeding history, to test whether higher intake was associated with adiposity measures, including BMI and waist circumference, and cardiometabolic markers such as blood pressure, cholesterol, and blood glucose. The topline result was that children eating the most ultraprocessed foods had measurably worse body composition and blood glucose and cholesterol profiles than children eating the fewest.
Outcomes and Implications
The most important finding was that children in the highest third of ultraprocessed food consumption had significantly higher z scores for BMI, waist circumference, and fat mass index, along with higher fasting plasma glucose and lower HDL cholesterol, compared with children in the lowest third, even after adjusting for maternal education, maternal BMI, physical activity, and breastfeeding. Each one-standard-deviation increase in ultraprocessed food intake was independently associated with higher BMI, waist circumference, and fat mass index, and with lower HDL cholesterol. In a substitution analysis, hypothetically replacing 100 grams of ultraprocessed food with 100 grams of unprocessed or minimally processed food was associated with lower BMI, fat mass index, and fasting glucose z scores, regardless of whether the ultraprocessed foods were animal- or plant-derived. Most associations held even after further accounting for how closely children followed a Mediterranean diet, suggesting ultraprocessing itself, not simply poor diet quality, contributes to the risk. The associations were notably stronger among children of unemployed or less-educated mothers, pointing to socioeconomic factors shaping both exposure and vulnerability. The authors note that pastries, sweetened beverages, cookies, and candies were the main ultraprocessed products consumed. They conclude that ultraprocessed food consumption in early childhood is associated with adiposity and unfavorable cardiometabolic markers, underscoring the need for public health initiatives promoting unprocessed and minimally processed foods from an early age, while cautioning that the cross-sectional design cannot establish causation and that prospective studies are needed to confirm these findings.