The global dominance of ultraprocessed foods (UPFs) presents a critical 21st-century public health challenge, with increasing evidence linking these industrial formulations to premature mortality.
While this connection is growing, a groundbreaking study by Nilson et al. (2025) featured in this analysis offers a pivotal advance: it’s the first to comprehensively quantify attributable premature deaths across eight diverse countries, providing a novel global perspective on UPF’s impact on all-cause mortality.
These UPFs, defined by the NOVA classification, are ‘industrial formulations made mostly or entirely with substances extracted from foods, often chemically modified, and from additives, with little if any whole food added‘ (Monteiro et al., 2019).
Background and rationale
The epidemiological evidence linking ultraprocessed food consumption to adverse health outcomes has grown substantially in recent years. Previous research has consistently demonstrated associations between high UPF intake and increased risk of noncommunicable diseases, including obesity, diabetes, cardiovascular disease, and certain cancers. A notable umbrella review incorporating 45 pooled analyses with nearly 9.8 million participants found that adherence to ultraprocessed dietary patterns was associated with 32 poor physical and mental health outcomes (Lane et al., 2024).
Recent systematic reviews and meta-analyses have provided increasingly robust evidence for the mortality risks associated with UPF consumption. A comprehensive updated systematic review and meta-analysis by Liang et al. (2025), encompassing 18 studies with 1,148,387 participants and 173,107 deaths, demonstrated that participants with the highest UPF consumption had a 15% increased risk of all-cause mortality compared to those with the lowest consumption. This analysis revealed a clear dose-response relationship, with each 10% increase in UPF consumption associated with a 6% increase in mortality risk, providing compelling evidence for the need to quantify population-level impacts.
Despite this growing evidence base, modelling studies examining the population-level impact of UPF consumption on mortality have been limited. Previous comparative risk assessments have primarily focused on specific dietary components such as sugar-sweetened beverages, processed meats, and individual nutrients, rather than examining the broader implications of food processing levels on population health outcomes.
Methodology and study design
This pivotal research employed a sophisticated two-stage analytical approach combining meta-analytical techniques with comparative risk assessment modelling.
The methodology represents a significant advancement in nutritional epidemiology, providing robust quantitative estimates of the relationship between UPF consumption and mortality outcomes.
Meta-analysis phase
The first phase involved conducting a dose-response meta-analysis of observational cohort studies to establish the quantitative relationship between UPF consumption and all-cause mortality. The investigators systematically selected studies based on recently published systematic reviews, applying stringent inclusion criteria that focused exclusively on research utilising the Nova classification system and excluding studies examining individual ultraprocessed food items.
Seven prospective cohort studies met the inclusion criteria, encompassing 239,982 participants and 14,779 deaths. The researchers extracted maximally adjusted relative risks (RRs) and 95% confidence intervals for all-cause mortality across different categories of UPF contribution to total energy intake. A random-effects dose-response model using generalised least squares was employed for trend estimation, acknowledging that true UPF effects on mortality may vary between studies and populations.
Population attributable fraction analysis
The second analytical phase focused on population attributable fraction (PAF) estimation across eight countries representing diverse UPF consumption patterns: low consumption (Colombia and Brazil); intermediate consumption (Chile and Mexico); high consumption (Australia, Canada, United Kingdom, and United States).
UPF consumption data were obtained from the most recent national dietary surveys in each country, including the Pesquisa de Orçamentos Familiares (Brazil), National Health and Nutrition Examination Survey (United States), National Diet and Nutrition Survey (United Kingdom), Canadian Community Health Survey, and corresponding national surveys from Mexico, Colombia, Chile, and Australia.
Foods were classified according to the Nova system into four categories: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultraprocessed foods.
Premature mortality data for individuals aged 30-69 years were sourced from the Global Burden of Disease Study, representing the most comprehensive available mortality statistics.
Major findings and outcomes
Dose-response relationship
The meta-analysis revealed a linear dose-response association between ultraprocessed food consumption and all-cause mortality. The pooled relative risk demonstrated that each 10% increase in the percentage of UPFs in total energy intake corresponded to a 2.7% increase in all-cause mortality risk. This finding represents the first quantitative synthesis providing precise estimates of the mortality risk associated with incremental increases in UPF consumption.
The linear relationship is particularly significant as it suggests that even modest reductions in UPF consumption may yield meaningful health benefits at the population level. Unlike threshold effects observed for some dietary risk factors, this relationship indicates that any reduction in UPF intake may be beneficial for population health outcomes. These findings align closely with recent meta-analytical evidence from Liang et al. (2025), which demonstrated consistent dose-response relationships across multiple populations and study designs.
Cross-country consumption patterns
Cross-country consumption analysis revealed striking disparities in UPF intake levels, reflecting different stages of the nutrition transition and varying food system characteristics:
- Colombia and Brazil demonstrated the lowest consumption rates, with 15.0% and 17.4% of total energy intake respectively;
- intermediate consumption was observed in Chile (22.8%) and Mexico (24.9%);
- high-income countries such as Australia (37.5%), Canada (43.7%), United Kingdom (53.4%), and United States (54.5%) showed substantially elevated UPF consumption.
These findings highlight the global nutrition transition, whereby traditional dietary patterns based on fresh foods and culinary preparations are increasingly replaced by industrially processed products. The progression from low to high UPF consumption nations demonstrates the potential trajectory that many low- and middle-income countries (LMIC) may follow without appropriate policy interventions.
Population attributable fractions
The population attributable fractions varied dramatically according to national UPF consumption levels, ranging from 3.9% in Colombia to approximately 14% in both the United Kingdom and United States. These figures represent the proportion of premature deaths that could theoretically be prevented by reducing UPF consumption to zero, highlighting the substantial public health impact of these dietary patterns.
In absolute terms, the attributable deaths ranged from approximately 2,000 annually in Chile to nearly 124,000 in the United States. These figures reflect both population size and consumption patterns, with the United States bearing the largest absolute burden due to its combination of high UPF consumption and large population size. The attributable mortality in Brazil, despite lower UPF consumption, reached over 25,000 deaths annually, reflecting the country’s substantial population and the significant health impact even at moderate consumption levels.
Sensitivity analysis
Leave-one-out sensitivity analysis confirmed the robustness of the primary findings, with consistent results across all analytical permutations. The linear relationship between UPF consumption and mortality risk remained stable regardless of which individual study was excluded from the meta-analysis, strengthening confidence in the overall conclusions and demonstrating the methodological rigour of the approach.
Discussion and implications
Mechanistic pathways
The study’s findings contribute substantially to understanding the mechanistic pathways linking ultraprocessed dietary patterns to adverse health outcomes. The demonstration of a linear dose-response relationship suggests multiple interconnected mechanisms may be operating simultaneously:
- ultraprocessed foods typically exhibit poor nutrient profiles, being high in added sugars, sodium, and unhealthy fats whilst lacking essential nutrients and dietary fibre;
- the industrial processing involved in UPF production may generate novel compounds through thermal processing and chemical reactions that could have deleterious health effects (Anses, 2024);
- the physical structure of UPFs, often requiring minimal chewing and promoting rapid consumption, may disrupt normal satiety mechanisms and contribute to overconsumption and subsequent health consequences.
Displacement hypothesis
The displacement hypothesis represents a crucial consideration in understanding UPF impacts on population health. UPF consumption may crowd out nutritionally superior whole foods and traditional culinary preparations from dietary patterns. This displacement effect extends beyond simple nutrient substitution, potentially affecting eating behaviours, meal patterns, and food culture more broadly.
The cultural implications of this dietary transition are profound, as traditional food systems often represent important social and cultural practices that contribute to overall wellbeing. The replacement of these systems with industrial food products may have consequences extending beyond nutritional considerations to encompass social cohesion and cultural identity.
Public health implications
Public health implications of these findings are substantial, particularly given the global expansion of UPF availability and consumption. The study’s demonstration that UPF-attributable mortality varies from approximately 4% to 14% across countries suggests that dietary pattern interventions could yield considerable population health benefits. Countries with high UPF consumption face the greatest potential gains from policy interventions targeting these products.
The research provides compelling evidence for the need for comprehensive food system reforms addressing multiple levels of intervention. The magnitude of attributable mortality observed, particularly in high-consumption countries, suggests that UPF reduction should be considered a public health priority comparable to other established risk factors such as tobacco use and physical inactivity.
Policy recommendations
The findings support the urgent need for policy interventions addressing ultraprocessed food consumption through multiple mechanisms. National dietary guidelines should explicitly address food processing levels in their recommendations, moving beyond traditional nutrient-focused approaches to embrace food-based and processing-aware guidance.
Regulatory frameworks targeting UPF marketing, availability, and fiscal measures merit serious consideration as components of comprehensive prevention strategies. Suggested interventions include:
- front-of-package labelling systems that clearly identify ultraprocessed products, such as the black frame around the Nutri-Score logo proposed in 2021 by professor Serge Hercberg;
- restrictions on marketing to children, as recently introduced in Norway and the UK;
- taxation policies that make UPFs less economically attractive relative to whole and healthier foods. As also suggested by WHO (2024) and already implemented in Colombia (2023).
At the same time, policies should support local food production and traditional food preparation skills, as improvements to the food environment can foster healthier dietary patterns. The multi-level approach is essential given the complex factors influencing food choices and the need to address both individual and environmental determinants of dietary behaviour.
Limitations and methodological considerations
Study limitations
The study acknowledges several important limitations that warrant consideration in interpreting the findings. The limited number of cohort studies meeting inclusion criteria restricts the geographical and demographic diversity of the evidence base. Most included studies originated from high-income countries, potentially limiting generalisability to low- and middle-income populations where UPF consumption patterns and baseline mortality risks may differ substantially.
Residual confounding represents an inherent limitation of observational research, despite the use of maximally adjusted models in individual studies. The complex relationships between socioeconomic factors, lifestyle behaviours, and dietary patterns make complete confounder control challenging. Additionally, the assumption of similar relative risks across age and sex groups may not accurately reflect true population heterogeneity in UPF susceptibility.
Methodological considerations
The theoretical minimum risk assumption of 0% UPF consumption may not represent a realistic or achievable target in contemporary food environments. Some degree of food processing is necessary for food safety and preservation, and complete elimination of all UPFs may not be feasible or desirable from a practical standpoint. Future research should consider more realistic counterfactual scenarios that reflect achievable policy targets.
Temporal considerations also warrant attention, as the analysis may not fully capture potential time lags between dietary changes and mortality outcomes. The relationship between UPF consumption and health may vary depending on duration of exposure, age at initiation, and individual susceptibility factors not adequately captured in the current analysis.
Future research directions
Research priorities
Future research priorities should include longitudinal studies in diverse populations, particularly those in low- and middle-income countries (LMIC) where UPF consumption is rapidly increasing. Mechanistic research investigating the biological pathways linking UPF consumption to mortality outcomes could inform more targeted intervention strategies and enhance understanding of the underlying causal mechanisms.
Intervention studies evaluating the effectiveness of various policy approaches in reducing UPF consumption and improving health outcomes would provide crucial evidence for policy implementation. Such studies should examine both individual-level interventions and population-level policy changes to determine the most effective approaches for different contexts and populations.
Global coordination
The global nature of the ultraprocessed food challenge calls for coordinated international responses. These may include trade policy considerations, industry accountability measures — especially the often-overlooked ‘S’ for Social in ESG (Environmental, Social and Governance) — and knowledge-sharing mechanisms between countries at different stages of the nutrition transition.
International organisations and multilateral agencies should consider developing frameworks to address UPF consumption as a global health priority, as already suggested by FAO (Monteiro et al., 2019). The writer also argues that UPF producers should be held accountable for the hidden public health costs of their products, as demonstrated and quantified in the FAO’s State of Food and Agriculture (SOFA) reports (FAO, 2023; 2024).
Interim conclusions
This comprehensive study provides compelling evidence that ultraprocessed food consumption represents a significant contributor to premature mortality across diverse populations. The demonstration of a linear dose-response relationship suggests that population-level interventions targeting UPF reduction could yield substantial health benefits, with the magnitude of potential impact varying according to baseline consumption levels.
The findings underscore the urgent need for policy interventions addressing ultraprocessed food consumption through comprehensive approaches encompassing regulatory, fiscal, and environmental strategies. The substantial mortality burden identified in this study, ranging from approximately 4% to 14% of premature deaths across countries, highlights the public health significance of addressing UPF consumption as a priority comparable to other major risk factors.
National dietary guidelines should explicitly incorporate food processing considerations into their recommendations, whilst regulatory frameworks should address UPF marketing, availability, and economic incentives. The evidence supports a paradigm shift in nutrition policy from nutrient-focused approaches to comprehensive strategies that recognise the fundamental importance of food processing levels in determining health outcomes.
The global implications of these findings extend beyond individual countries to encompass international trade, food system governance, and sustainable development considerations. Addressing the ultraprocessed food challenge will require coordinated efforts across multiple sectors and levels of governance, supported by continued research and evidence-based policy development. The convergence of evidence from multiple recent studies, including comprehensive meta-analyses, strengthens the case for urgent action to reduce UPF consumption and protect population health globally.
Dario Dongo
Cover art copyright © 2025 Dario Dongo (AI-assisted creation)
References
- Anses. (2024). Avis relatif à la caractérisation et à l’évaluation des impacts sur la santé de la consommation d’aliments dits ultratransformés (Saisine n° 2022-SA-0155). Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail. https://www.anses.fr/fr/system/files/NUT2022-SA-0155.pdf
- Food and Agriculture Organization of the United Nations. (2023). The State of Food and Agriculture 2023: Revealing the true cost of food to transform agrifood systems. FAO. https://doi.org/10.4060/cc7724en
- Food and Agriculture Organization of the United Nations. (2024). Value-driven transformation of agrifood systems. FAO, Rome, 2024 https://doi.org/10.4060/cd2616en
- Lane, M. M., Gamage, E., Du, S., Ashtree, D. N., McGuinness, A. J., Gauci, S., Baker, P., Lawrence, M., Rebholz, C. M., Srour, B., Touvier, M., Jacka, F. N., O’Neil, A., Segasby, T., & Marx, W. (2024). Ultra-processed food exposure and adverse health outcomes: Umbrella review of epidemiological meta-analyses. BMJ, 384, e077310. https://doi.org/10.1136/bmj-2023-077310
- Liang, S., Zhou, Y., Zhang, Q., Yu, S., & Wu, S. (2025). Ultra-processed foods and risk of all-cause mortality: An updated systematic review and dose-response meta-analysis of prospective cohort studies. Systematic Reviews, 14, 53. https://doi.org/10.1186/s13643-025-02800-8
- Monteiro, C. A., Cannon, G., Levy, R. B., Moubarac, J. C., Louzada, M. L., Rauber, F., Khandpur, N., Cediel, G., Neri, D., Martinez-Steele, E., Baraldi, L. G., & Jaime, P. C. (2019). Ultra-processed foods: What they are and how to identify them. Public Health Nutrition, 22(5), 936-941. https://doi.org/10.1017/S1368980018003762
- Monteiro, C.A., Cannon, G., Lawrence, M., Costa Louzada, M.L. & Pereira Machado, P. (2019). Ultra-processed foods, diet quality, and health using the NOVA classification system. Food and Agriculture Organization, FAO, Rome. ISBN 978-92-5-131701-3. V. http://www.fao.org/3/ca5644en/ca5644en.pdf
- Nilson, E. A. F., Delpino, F. M., Batis, C., Machado, P. P., Moubarac, J. C., Cediel, G., Corvalán, C., Ferrari, G., Rauber, F., Martinez-Steele, E., Louzada, M. L. C., Levy, R. B., Monteiro, C. A., & Rezende, L. F. M. (2025). Premature mortality attributable to ultraprocessed food consumption in 8 countries. American Journal of Preventive Medicine, 68(6), 1091-1099. https://doi.org/10.1016/j.amepre.2025.02.018
- Rico-Campà, A., Martínez-González, M. A., Alvarez-Alvarez, I., Mendonça, R. D., de la Fuente-Arrillaga, C., Gómez-Donoso, C., & Bes-Rastrollo, M. (2019). Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ, 365, l1949. https://doi.org/10.1136/bmj.l1949
- World Health Organization (2024, 14 June). Fiscal policies to promote healthy diets: WHO guideline. ISBN-13: 978-92-4-009101-6. https://www.who.int/publications/i/item/9789240091016
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
