• Junxiu Liu, Euridice Martinez Steele, Yan Li, Dimitra Karageorgou, Renata Micha, Carlos A Monteiro, and Dariush Mozaffarian.
• Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts. Electronic address: junxiu.liu@mountsinai.org.
• Am J Prev Med. 2022 Feb 1; 62 (2): 252264252-264.

IntroductionConsumption of ultraprocessed foods has been linked with higher intake of added sugars, sodium, and unhealthful fats, but the associations of ultraprocessed foods with overall diet quality and major food groups are not well known.MethodsData were derived from the National Health and Nutrition Examination Survey (2015-2018), including 9,758 adults (aged ≥20 years) and 5,280 children (aged 2-19 years) with 24-hour dietary recalls (≥1), with analysis performed in 2020. Ultraprocessed foods were identified using the NOVA classification, with intake (% energy) assessed in quintiles. Diet quality was assessed using the validated American Heart Association 2020 continuous primary and secondary diet scores and Healthy Eating Index 2015. Poor diet was defined as <40% adherence to the American Heart Association secondary score. Generalized linear regressions estimated relationships between ultraprocessed food intake and diet quality.ResultsCompared with the lowest quintile of ultraprocessed food consumption (<39.1% energy), the American Heart Association primary score in adults was progressively lower in Quintile 2 (-1.99, 95% CI= -2.73, -1.25), Quintile 3 (-3.60, 95% CI= -4.47, -2.72), Quintile 4 (-5.29, 95% CI= -6.28, -4.30), and Quintile 5 (-7.24, 95% CI= -8.13, -6.36; >70.7% energy). Corresponding values in children were -2.05 (95% CI= -3.01, -1.09), -2.97 (95% CI= -4.16, -1.79), -3.82 (95% CI= -5.20, -2.44), and -6.22 (95% CI= -7.20, -5.25; >79.0% energy). The estimated proportion of children having poor diet progressively increased from 31.3% (95% CI=26.2%, 36.5%) in Quintile 1 up to 71.6% (95% CI=68.1%, 75.1%) in Quintile 5. Corresponding proportions of adults having poor diet increased from 18.1% (95% CI=14.3%, 22.0%) in Quintile 1 up to 59.7% (95% CI=55.3%, 64.1%) in Quintile 5. Findings were similar using the American Heart Association secondary score and Healthy Eating Index 2015 score.ConclusionsHigher ultraprocessed food consumption is associated with substantially lower diet quality among children and adults.Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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