Intake of ultra-processed food, dietary diversity and the risk of nutritional inadequacy among adults in India

Objective: This study assessed diet diversity and consumption of ultra-processed foods and explored its impact on macronutrient intake and risk of micronutrient inadequacy.Design: Cross-sectional, non-probability snowball sampling.Setting: Nutrient intake was assessed using 24-h dietary recall method and diet diversity through FAO-diet diversity score (DDS). Mann-Whitney U test was used to assess differences in risk of inadequacy across gender. Spearman's rank correlation assessed associations between energy contributed by ultra-processed food and risk of nutrient inadequacy.Participants: A total of 589 adults (20-40 years) belonging to upper-middle and high-income groups.Results: The average individual DDS was 4<middle dot>4 +/- 0<middle dot>6. Most of the participants (>80 %) had intakes less than national recommendations of pulses/eggs/flesh foods, milk/milk products, fruits, vegetables and nuts. Ultra-processed foods contributed to 17 % of total energy intake, 12 % of protein, 17 % of carbohydrate, 29 % of added sugar, 20 % of total fat and 33 % of Na intake. The average risk of nutrient inadequacies for Zn (98 % v. 75 %), folate (67 % v. 22 %) and niacin (83 % v. 44 %) was higher among males than females (P < 0<middle dot>001). The average risk of nutrient inadequacies for Fe (58 % v. 7 %), vitamin B6 (95 % v. 90 %) and vitamin A (68 % v. 44 %) was higher among females than males (P < 0<middle dot>001). There was a positive correlation between energy contributed by ultra-processed food and risk of niacin (rho = 0<middle dot>136, P = 0<middle dot>001) and folate (rho = 0<middle dot>089, P = 0<middle dot>049) inadequacy.Conclusion: Reformulating ultra-processed food to reduce fat, sugar and salt and increase micronutrients and behaviour change communication strategies that promote dietary diversity will improve micronutrient adequacy and diet quality.