Ultra-processed food consumption in Italy

Study design and methodology

The survey employed a cross-sectional design to assess dietary habits amongst Italian adults between September 2021 and April 2025. Researchers recruited 1,629 participants (79.8% women; mean age 42.1 years) through social media platforms and email using snowball sampling methods (Ruggiero et al., 2025).

The study utilised the validated 94-item NOVA Food Frequency Questionnaire (NFFQ), specifically designed to categorise foods according to processing extent: unprocessed or minimally processed foods (MPFs), processed culinary ingredients (PCIs), processed foods (PFs), and ultra-processed foods (Dinu et al., 2021).

Adherence to the Mediterranean Diet was evaluated using the Medi-Lite questionnaire, which assigns scores from 0 to 18 based on consumption patterns of nine food groups, with higher values indicating greater adherence (Sofi et al., 2014).

Principal findings

The study revealed that UPFs contributed 20.0% (95% CI: 19.5–20.6) of total energy intake amongst participants, while MPFs accounted for 39.2%, PFs for 31.8%, and PCIs for 9.0%. The principal UPF sources were packaged biscuits (14.9%), chocolate (10.6%), bread alternatives including crackers and breadsticks (9.9%), ready-to-heat pizza and focaccia (4.5%), and plant-based drinks (4.5%) (Ruggiero et al., 2025). These findings align with previous Italian estimates from the INHES survey, which reported 17.3% energy from UPFs in adults (Ruggiero et al., 2021), suggesting relative stability in consumption patterns over the past decade.

Sociodemographic analysis demonstrated significant variations in UPF intake. Older participants (>64 years) consumed substantially fewer UPFs compared to younger adults (≤40 years) (β = −3.34; 95% CI: −5.96 to −0.72). Geographical differences emerged, with residents of Central (β = −2.92; 95% CI: −4.31 to −1.53) and Southern Italy (β = −1.51; 95% CI: −3.01 to −0.01) reporting lower UPF consumption than Northern counterparts. Married individuals or those living with partners consumed fewer UPFs than single participants (β = −2.52; 95% CI: −4.03 to −1.02) (Ruggiero et al., 2025).

The study identified a robust inverse linear relationship between Mediterranean Diet adherence and UPF consumption (R = −0.27; p < 0.001). Participants with high MD adherence consumed only 15.2% of energy from UPFs, compared to 25.2% amongst those with low adherence. Conversely, individuals with strong MD adherence derived 44.6% of energy from MPFs, substantially higher than the 32.3% observed in low-adherence groups (Ruggiero et al., 2025). These findings corroborate previous research demonstrating that traditional Mediterranean dietary patterns naturally displace ultra-processed products (Dinu et al., 2022).

Discussion and implications

The 20% energy contribution from UPFs in this Italian sample remains markedly lower than estimates from non-Mediterranean European countries, where UPF consumption can exceed 50% of daily energy intake, as observed in the United Kingdom and Netherlands (Rauber et al., 2019; Vellinga et al., 2022). This comparative advantage likely reflects the enduring influence of traditional culinary practices and cultural food preferences in Italy. However, the observed North-South gradient suggests regional heterogeneity in dietary transitions, potentially driven by varying rates of urbanisation and preservation of traditional food systems (Ruggiero et al., 2019).

The age-related decline in UPF consumption aligns with international evidence indicating that older generations maintain stronger connections to home cooking and traditional food preparation methods (Wolfson et al., 2024). Conversely, younger adults increasingly rely on convenient industrial products, reflecting shifting lifestyle demands and evolving cultural norms surrounding food (Vandevijvere et al., 2019). The higher UPF intake amongst single individuals may reflect reduced motivation for meal preparation and less structured eating routines (Sandri et al., 2023).

From a public health perspective, the inverse association between Mediterranean Diet adherence and UPF consumption underscores the protective role of traditional dietary models. The Mediterranean Diet naturally emphasises minimally processed foods such as fruits, vegetables, whole grains, and extra-virgin olive oil, thereby limiting space for ultra-processed alternatives in the diet (Sofi et al., 2025). Nevertheless, progressive declines in MD adherence across Southern Europe warrant continued dietary surveillance and targeted interventions to reinforce traditional eating patterns (Damigou et al., 2023).

Limitations and future directions

The authors acknowledge several methodological limitations. The convenience sampling approach and predominance of female participants (79.8%) may limit generalisability to the broader Italian population. Self-reported dietary data are susceptible to recall bias, potentially affecting accuracy (Ruggiero et al., 2025). Furthermore, the cross-sectional design precludes causal inference regarding the relationship between UPF consumption and health outcomes. Future research employing representative sampling and prospective cohort designs would strengthen evidence and enable examination of temporal trends in Italian dietary patterns.

Conclusions

This study provides timely evidence that ultra-processed foods contribute a modest proportion of total energy intake amongst Italian adults, consistent with other Mediterranean populations. The robust inverse association between UPF consumption and Mediterranean Diet adherence highlights the continued relevance of traditional dietary models in mitigating industrial food product incorporation. However, observed sociodemographic disparities – particularly concerning age, geographical region, and household structure – suggest vulnerability amongst specific population segments.

Public health strategies promoting Mediterranean dietary patterns, improving minimally processed food affordability, and enhancing nutrition education may help counter the growing influence of ultra-processed foods within the Italian food environment. The unresolved issue, the author adds, is how to distinguish ultra-processed foods with balanced nutritional profiles, which may be compatible with a healthy diet and even with the Mediterranean diet, such as some bakery products and plant-based foods.

Dario Dongo

Foto di Sydney Troxell

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