Ultra-processed food intake in association with BMI change and risk of overweight and obesity: A prospective analysis of the French NutriNet-Santé cohort

Autoři: Marie Beslay aff001;  Bernard Srour aff001;  Caroline Méjean aff002;  Benjamin Allès aff001;  Thibault Fiolet aff001;  Charlotte Debras aff001;  Eloi Chazelas aff001;  Mélanie Deschasaux aff001;  Méyomo Gaelle Wendeu-Foyet aff001;  Serge Hercberg aff001;  Pilar Galan aff001;  Carlos A. Monteiro aff004;  Valérie Deschamps aff005;  Giovanna Calixto Andrade aff001;  Emmanuelle Kesse-Guyot aff001;  Chantal Julia aff001;  Mathilde Touvier aff001
Působiště autorů: Sorbonne Paris Nord University, Inserm, INRAE, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center–University of Paris (CRESS), Bobigny, France aff001;  MOISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Montpellier SupAgro, Montpellier, France aff002;  Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France aff003;  Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil aff004;  Santé Publique France (The French Public Health Agency), Nutritional Epidemiology Surveillance Team (ESEN) aff005;  Department of Preventive Medicine, Medical School, University of São Paulo, São Paulo, Brazil aff006
Vyšlo v časopise: Ultra-processed food intake in association with BMI change and risk of overweight and obesity: A prospective analysis of the French NutriNet-Santé cohort. PLoS Med 17(8): e32767. doi:10.1371/journal.pmed.1003256
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1003256



Ultra-processed food (UPF) consumption has increased drastically worldwide and already represents 50%–60% of total daily energy intake in several high-income countries. In the meantime, the prevalence of overweight and obesity has risen continuously during the last century. The objective of this study was to investigate the associations between UPF consumption and the risk of overweight and obesity, as well as change in body mass index (BMI), in a large French cohort.

Methods and findings

A total of 110,260 adult participants (≥18 years old, mean baseline age = 43.1 [SD 14.6] years; 78.2% women) from the French prospective population-based NutriNet-Santé cohort (2009–2019) were included. Dietary intakes were collected at baseline using repeated and validated 24-hour dietary records linked to a food composition database that included >3,500 different food items, each categorized according to their degree of processing by the NOVA classification. Associations between the proportion of UPF in the diet and BMI change during follow-up were assessed using linear mixed models. Associations with risk of overweight and obesity were assessed using Cox proportional hazard models. After adjusting for age, sex, educational level, marital status, physical activity, smoking status, alcohol intake, number of 24-hour dietary records, and energy intake, we observed a positive association between UPF intake and gain in BMI (β Time × UPF = 0.02 for an absolute increment of 10 in the percentage of UPF in the diet, P < 0.001). UPF intake was associated with a higher risk of overweight (n = 7,063 overweight participants; hazard ratio (HR) for an absolute increase of 10% of UPFs in the diet = 1.11, 95% CI: 1.08–1.14; P < 0.001) and obesity (n = 3,066 incident obese participants; HR10% = 1.09 (1.05–1.13); P < 0.001). These results remained statistically significant after adjustment for the nutritional quality of the diet and energy intake. Study limitations include possible selection bias, potential residual confounding due to the observational design, and a possible item misclassification according to the level of processing. Nonetheless, robustness was tested and verified using a large panel of sensitivity analyses.


In this large observational prospective study, higher consumption of UPF was associated with gain in BMI and higher risks of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting UPF consumption.

Trial registration

ClinicalTrials.gov NCT03335644 (https://clinicaltrials.gov/ct2/show/NCT03335644)

Klíčová slova:

Body Mass Index – Cancer risk factors – Diet – Food – Medical risk factors – Obesity – Overweight – Weight gain


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