Scientists recently led a study showing it’s possible to build a healthy diet with 91% of the calories coming from ultra-processed foods (as classified using the NOVA scale) while still following the recommendations from the 2020-2025 Dietary Guidelines for Americans (DGA).
While the study by scientists at the US Department of Agriculture’s (USDA) Human Nutrition Research Centre highlights the versatility of using DGA recommendations in constructing healthy menus, the diet also fell short, however, in meeting certain nutritional needs, like vitamin D and E.
“This was a proof-of-concept showing a more balanced view of healthy eating patterns, where using ultra-processed foods can be an option,” said ARS research nutritionist Julie Hess at the Grand Forks Human Nutrition Research Centre. “According to current dietary recommendations, the nutrient content of a food and its place in a food group are more important than the extent to which a food was processed.”
For the past two decades, Americans have continually consumed more industrially manufactured foods, growing from 53.5% of their daily calories in 2001 and 2002 to 57% in 2017 to 2018. These foods are often referred to as “ultra-processed foods” or “UPF”.
There is evidence these foods are linked to chronic diseases, and being formulated for flavour, cost, and an extended shelf life, may not provide adequate nutrition.
The scientists were curious to know if a person could meet all of the DGA strictly from UPF and devised a study presenting a proof-of-concept seven-day menu, which scored 86 out of 100 points on the Healthy Eating Index (HEI), with 91% of the calories in the diet obtained from UPF. It missed just two nutritional targets: it was high in sodium and low in whole grains.
By comparison, the average American diet scores just 59 on the HEI.
The menu is not an actual recommended meal plan, but is instead an experiment and a demonstration of the flexibility of DGA recommendations.
To construct their menu in a way that aligned with current nutritional recommendations, the researchers adapted the MyPyramid menu.
The study was published in Science Direct.
What are ‘ultra-processed’ foods?
One of the issues with assessing UPF, said study lead author Hess, is defining what they are.
“Our study found that several nutrient-dense foods, like whole wheat bread, non-fat milk, canned fruit, tofu, fruit juice, and canned fish could be considered ultra-processed,” she said.
The researchers collaborated with external “graders” who rated the foods under consideration based on their level of processing.
“Some of the foods they considered ‘ultra-processed’ that did not end up on our menu were: almond butter, pork loin, smoked oysters, soy milk, cottage cheese, non-fat Greek yogurt, lactose-free milk, and apple juice,” said Hess.
Some of the foods that were included were black bean soup, oatmeal, a baked potato with chilli, tofu stir fry and steak.
“Some foods our graders considered less processed that we did not include in our menu were: apple sauce, canned peas and canned mushrooms,” she added.
Also excluded from consideration were some foods that the researchers felt did not fit a DNA category, such as French fries, pickles, banana chips, sesame sticks, and a plant-based “meat” burger.
Unexpected foods
Michelle Routhenstein, cardiology dietitian at EntirelyNourished.com, who was not involved in the study, said: “It is also important to note that nutrient-dense foods like beans and legumes, for instance, can be considered ultra-processed due to the citric acid or additives added as preservatives. And while this is considered ultra-processed, they still confer health benefits that we need to evaluate in the big picture as well.”
Why an ultra-processed foods meal plan was created
Knowing the 2025 DGA scientific committee would be discussing UPF, Hess’ team built the experimental menu according to the most commonly used system for identifying ultra-processed foods, the NOVA system.
“My research is centred on identifying and evaluating strategies to help Americans meet recommendations from the Dietary Guidelines for Americans, which means I follow closely the activities and conversation related to the development of dietary guidance in the US,” said Hess.
Suspected hazards of ultra-processed foods
As vaguely defined as UPFs may be, there are ample concerns regarding the health effects of foods widely considered ultra-processed.
Dr Marialaura Bonaccio of the IRCCS Istituto Neurologico Mediterraneo Neuromed in Italy, who was not involved in the study, said: “The well-documented adverse health effects of UPF are not exclusively related to the poor nutritional content of these foods, but are possibly triggered by non-nutritional factors, like food additives, contaminants from plastics, alteration to the food matrix, etc.”
There are studies finding that “UPF is independently associated with eg, mortality, cardiovascular disease, and certain cancers”, said Bonaccio.
Consideration of such health effects was beyond the scope of this study. However, Routhenstein cautioned, “ultra-processed foods, regardless of if people are following a vegan, vegetarian diet, etc, cause an increase in cystatin c, an inflammatory biomarker that increases risk of heart disease, kidney disease, and stroke”.
“In light of this, a work exclusively focused on the nutritional quality of UPF, which of course could be also adequate in some cases, in my opinion, is completely misleading,” said Bonaccio.
Study details
Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods
Julie Hess, Madeline Comeau, Shanon Casperson, Joanne Slavin, Guy Johnson, Mark Messina, Susan Raatz, Angela Scheett, Anne Bodensteiner , Daniel Palmer,
Published in The Journal of Nutrition on 24 June 2023
Abstract
Background
A proposed topic for the 2025 Dietary Guidelines for Americans (DGA) Scientific Advisory Committee to address is the relationship between dietary patterns with ultra-processed foods (UPF) and body composition and weight status. Implementing the NOVA system, the most commonly applied framework for determining whether a food is “ultra-processed,” in dietary guidance could omit several nutrient-dense foods from recommended healthy diets in the DGA.
Objective
The purpose of this proof-of-concept study was to determine the feasibility of building a menu that aligns with recommendations for a healthy dietary pattern from the 2020 DGA and includes ≥80% kcal from UPF as defined by NOVA.
Design
To accomplish this objective, we first developed a list of foods that fit NOVA criteria for UPF, fit within dietary patterns in the 2020 DGA, and are commonly consumed by Americans. We then used these foods to develop a 7-d, 2000 kcal menu modelled on MyPyramid sample menus and assessed this menu for nutrient content as well as for diet quality using the Healthy Eating Index-2015 (HEI-2015).
Results
In the ultra-processed DGA menu that was created, 91% of kcal were from UPF, or NOVA category 4. The HEI-2015 score was 86 out of a possible 100 points. This sample menu did not achieve a perfect score due primarily to excess sodium and an insufficient amount of whole grains. This menu provided adequate amounts of all macro- and micronutrients except vitamin D, vitamin E, and choline.
Conclusions
Healthy dietary patterns can include most of their energy from UPF, still receive a high diet quality score, and contain adequate amounts of most macro- and micronutrients.
See more from MedicalBrief archives:
Depression risk fed by ultra-processed foods – Australian study
Cancer threat raised by ultra-processed foods – UK-led study
NHS assesses studies on mortality risk of ultra-processed foods