Associations Between Ultra-processed Foods Consumption and Indicators of Adiposity in US Adolescents: Cross-Sectional Analysis of the 2011-2016 National Health and Nutrition Examination Survey

Background Ultra-processed foods represent a considerable part of the diet of US children and adolescents, yet their association with total, abdominal, and visceral overweight/obesity remains understudied. Objective To examine associations between dietary contribution of ultra-processed foods and total, abdominal, and visceral overweight/obesity in a nationally representative sample of US adolescents. Design Cross-sectional analyses were performed on data collected from adolescents participating in the 2011-2016 National Health and Nutrition Examination Survey. Participants/setting Participants included 3587 adolescents aged 12 to 19 years, who had data from at least 1 day of valid 24-hour dietary recall data. Main outcome measures Total overweight/obesity, abdominal overweight/obesity, and visceral overweight/obesity data were collected. Statistical analyses performed All food items (grams per day) recorded in the 24-hour recalls were classified according to Nova. Multiple logistic regressions were used to evaluate associations between the dietary contribution of ultra-processed foods (expressed in percentage of total grams per day) and outcomes. Multivariable models were adjusted for sociodemographic covariates, physical activity, total energy intake, whether the individual was following a special diet for weight loss, and indicators of the nutritional quality of the diet. Results In multivariable analyses, the highest consumption of ultra-processed food was associated with 45%, 52%, and 63% higher odds of total, abdominal, and visceral overweight/obesity, respectively (odds ratio [OR] 1.45, 95% CI 1.03-2.06, P for linear trend = .040; OR 1.52, 95% CI 1.06-2.18, P for linear trend = .026; OR 1.63, 95% CI 1.19-2.24, P for linear trend = .005, respectively), compared with the lowest consumption. A 10% increment in the proportion of ultra-processed foods in the diet was associated with an increased risk of both abdominal overweight/obesity (OR 1.07; 95% CI 1.01-1.13) and visceral overweight/obesity (OR 1.07; 95% CI 1.02-1.13). Conclusions Study findings support the growing evidence of cross-sectional and prospective associations between ultra-processed foods and increased adiposity and also with metabolically unhealthy phenotypes of obesity in adolescence. Timely action to reduce the consumption of ultra-processed foods among adolescents is needed.