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The holistico-reductionist Siga classification according to degree of food processing: An evaluation of ultra-processed foods in French supermarkets

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The qualitative NOVA classification of foods according to their degree of processing is widely used worldwide by researchers. NOVA defines ultra-processed foods (UPFs) by the presence of processed industrial and cosmetic ingredients and additives to modify the sensory properties (aroma, taste, colour and texture) of the reconstituted food. Some drastic processes directly applied to food are also markers of ultra-processing. However, in the intent to develop an elaborated tool for industries and retailers, the Siga classification was developed by combining the four holistic NOVA groups with four new more reductionist subgroups considering the impact of processing on the food/ingredient matrix; the contents of added salt, sugar and fat; the nature and number of markers of ultra-processing (MUPs); and the levels of at-risk additives for health (groups are unprocessed, A0; minimally processed foods, A1; culinary ingredients, A2; balanced, B1/C0.1; greedy, B2/C0.2; processed/ultra-processed foods; and UPFs with more than one MUP, C1). The Siga algorithm was used to characterize 24 932 packaged foods in French supermarkets (baby foods and alcohol excluded), which were representative of the packaged food assortments. The main results showed that two-thirds of the products were ultra-processed. Products with more than one MUP (C1) corresponded to the most represented category, accounting for 54% of the products. Among foods with more than five ingredients, 75% were UPFs. Considering all products, the average numbers of ingredients, MUPs and at-risk additives were 10.1, 2.6 and 0.5, respectively. Among food categories, some contained a high percentage of UPFs: 94, 95, 95, 81, 80, and 87% for salted meats, cooked dishes, flavoured yogurts/white cheeses, energy and gourmet bars, breakfast cereals, and vegetarian dishes, respectively. Finally, the Siga algorithm presents a useful tool for improving the health potential of packaged food and for decision-making on search engine optimization (SEO) policy and assortment management in supermarkets.
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Food &
Function
PAPER
Cite this: DOI: 10.1039/c9fo02271f
Received 28th September 2019,
Accepted 28th January 2020
DOI: 10.1039/c9fo02271f
rsc.li/food-function
The holistico-reductionist Siga classication
according to the degree of food processing:
an evaluation of ultra-processed foods in French
supermarkets
Sylvie Davidou, * Aris Christodoulou, Anthony Fardet and Kelly Frank
The qualitative NOVA classication of foods according to their degree of processing is used worldwide by
researchers. NOVA denes ultra-processed foods (UPFs) by the presence of processed industrial ingredi-
ents and additives to modify the sensory properties (aroma, taste, colour and texture) of reconstituted
food, named cosmeticcompounds, i.e., modifying food appearance. Some drastic processes directly
applied to food are also markers of ultra-processing. However, with the intent to develop an elaborate
tool for industries and retailers, the Siga classication was developed by combining the four holistic NOVA
groups with four more new reductionist subgroups considering the impact of processing on the food/
ingredient matrix; the contents of added salt, sugar and fat; the nature and number of markers of ultra-
processing (MUPs); and the levels of at-risk additives (groups are unprocessed, A0; minimally processed
foods, A1; culinary ingredients, A2; balanced foods, B1/C0.1; high salt, sugar and/or fat level foods, B2/
C0.2; processed/ultra-processed foods; and UPFs with more than one MUP, C1). The Siga algorithm was
used to characterize 24 932 packaged foods in French supermarkets (baby foods and alcohol excluded),
which were representative of the packaged food assortments. The main results showed that two-thirds of
the products were ultra-processed. Products with more than one MUP (C1) corresponded to the most
represented category, accounting for 54% of the products. Among foods with more than ve ingredients,
75% were UPFs. Considering all products, the average number of ingredients, MUPs and at-risk additives
were 10.1, 2.6 and 0.5, respectively. Among food categories, some contained a high percentage of UPFs:
94, 95, 95, 81, 80, and 87% for salted meats, cooked dishes, avoured yogurts/white cheeses, energy and
gourmet bars, breakfast cereals, and vegetarian dishes, respectively. Finally, the Siga algorithm presents a
useful tool for improving the health potential of packaged food and for decision-making on search
engine optimization (SEO) policy and assortment management in supermarkets.
Introduction
The health potential of foods is multiaxial, including matrix
and compositioneects and in some cases, the presence of
processed ingredients and additives.
1
The food matrix results
from nutrient interactions, and can be characterized by
texture, chewiness, color, and other qualitative attributes.
1
While the matrixeect may impact the degree of chewing,
satiety, transit time and/or nutrient synergy, the composition
eect is the direct metabolic impact of food nutrients.
Most foods are processed in one way or another, and tech-
nological treatments as well as the addition of sugars, salt, fats
and additives impact both the food matrix and composition.
Today, the degree of food processing is increasingly
considered in epidemiological studies, especially since the
elaboration of the NOVA classification by Brazilian nutritional
epidemiologists.
24
NOVA ranks foods into four technological
groups: (1) un/minimally processed foods, (2) culinary ingredi-
ents, (3) processed foods, and (4) ultra-processed foods
(UPFs).
5
Beyond NOVA, the degree of processing rarely appears
in epidemiological studies and can be found mainly in the
form of binary comparisons such as red versus processed
meats,
6
fresh fruits versus fruit juices,
7
fruit juices versus swee-
tened beverages,
8
milk versus yogurts versus cheeses,
9
and
wholegrain versus refined cereals.
10
Except for the comparison
of milk versus yogurts versus cheeses, these previous studies
tend to show that more processed foods are less protective
against chronic diseases than minimally processed foods.
1113
Based on the NOVA classification, new results have
notably underlined that populations consuming the most
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E-mail: sylvie@siga.care
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UPFs are the most at risk of chronic diseases and metabolic
deregulations, i.e., overweight/obesity,
1416
adiposity,
17
meta-
bolic syndrome,
18,19
dyslipidaemia,
20
type 2 diabetes,
8
hyper-
tension,
21
total cancers and breast cancer,
22
cardiovascular
diseases,
23
irritable bowel syndrome and functional dyspep-
sia,
24
depressive symptoms,
25,26
and mortality.
27,28
Based on
NOVA, UPFs may be defined as food formulations character-
ized by the addition of cosmetic ingredients/additives primar-
ily for industrial use to mimic, mask, increase or restore
sensory properties (texture, taste, aroma and colour).
5
NOVA is now used worldwide, especially by academic
researchers, and is recognized as a relevant nutritional indi-
cator by the Food and Agriculture Organization of the United
Nations (FAO), the Pan American Health Organization (PAHO)
and the Brazilian dietary guidelines.
4,2931
NOVA can be con-
sidered a qualitative and holistic classification in the same way
that each food group gathers heterogeneous foods of various
compositions, including nutrients, ingredients and/or addi-
tives. However, the holistic concept of UPF encompasses well-
identified common attributes such as the degradation of the
food matrix;
32
high levels of added sugars, fat and salt together
with low levels of protective micronutrients such as fibre, vita-
mins, minerals and antioxidants (i.e.,emptycalories);
3138
poor satiety and hyperglycaemia;
3941
and the inclusion of arti-
ficial or xenobiotic compounds (e.g., aromas, newly formed
compounds and highly processed additives and ingredients).
32
To help consumers make the best food choice, several
scores have been developed, but all are based on a reductionist
approach considering foods as only sums of nutrients, e.g.,
SENS, Nutri-score, Nutrient Rich Food index, trac light,
health star rating, modified reference intake indices and
other nutritional warnings.
4244
These indices or scores
provide an overview of the overall nutritional balance of pack-
aged foods but fail to identify all unhealthy foods that can be
well rated nutritionally, although they are highly processed
and contain many additives (e.g., some light/vegan/gluten-free/
organic foods that are ultra-processed) or hidden sugars (e.g.,
dextrose, maltodextrins, invert sugar, etc.), and have lost their
matrixeect through fractionation (artificialfood matrices
resulting from the recombination of ingredients and additives),
or extrusion-cooking (e.g., extruded-cooked breakfast cereals for
children). In addition, we eat complex food matrices, not nutri-
ents, and two foods with the same nutritional composition, but
dierent matrices may have dierent physiological and meta-
bolic eects in the short term and health eects in the long
term,
1
e.g.,slowversus rapid sugars.
45
In a previous paper, the interconnectedness of holistic and
reductionist thinking was analysed, concluding that scientific
issues should be first considered holistically and then in a
reductionist way when necessary to dissect a particular mecha-
nism.
1
Applied to food classifications according to the degree
of processing, each holistic NOVA food group may be further
dissected in a more reductionist way, notably for dierent pur-
poses in destination to retailers and agro-food industries to
improve the quality of their assortments and products,
respectively.
46,47
Indeed, UPFs may exhibit from one to beyond
ten markers of ultra-processing (MUPs); processed foods may
contain dierent levels of added culinary ingredients, namely,
fat, sugar and salt, and minimally processed foods, and
depending on the processes applied, may exhibit dierent
degrees of food matrix unstructuration, e.g., through grinding,
pressing, and/or skimming. Such distinctions may be useful
for the practical applications of the NOVA classification.
Our main objectives are therefore: (1) to take the NOVA
classification a step further through a holistico-reductionist
approach, taking into consideration the matrixeect (which
plays a substantial role in chewing, satiety, synergistic actions
of nutrients, transit time and nutrient bioavailability); the
quantity of salt, sugar and fat added in recipes; the degree of
processing of industrial/culinary food ingredients and addi-
tives; and the function, number, and potential health risk of
additives; (2) to rationalize the characterization of ultra-proces-
sing and the definition of UPFs; and (3) to propose to small
and large retailers and the agro-food industry a holistico-
reductionist score to highlight the health potential of foods in
line with the most recent scientific knowledge. Such a classifi-
cation is intended to help develop less processed foods but in
a gradual way. Finally, 24 932 packaged foods were evaluated
with the NOVA-based Siga classification.
Materials and methods
The Siga philosophicalapproach and basis
The Siga classification (go forwardin Portuguese, meaning
go further,improve the existent) is based on the combi-
nation of holistic and reductionist approaches (Fig. 1). Holism
is defined globally by the school of thought that tends to
explain a phenomenon as being an indivisible whole: the
simple sum of its parts does not suce to define it. As a
result, holist thinking is in opposition or rather complemen-
tary to the reductionist thought that tends to explain a
phenomenon by dividing it into parts. As shown in Fig. 1,
holism and reductionism coexist, but reductionist thinking or
studies should always be considered secondarily to holistic
thinking to be meaningful and should be included within a
holistic approach as a first step.
1
This idea applies to food
classification: the main holistic food gateway is the degree of
processing, followed by more specific and reductionist criteria
but not the other way around, e.g., beginning to study foods
health potential by its parts ,i.e., nutrients, additives, and/or
other unknown xenobiotics and thereafter to move towards a
more holistic approach.
47
In the Siga classification, NOVA was considered as a holistic
classification and was further dissected into more reductionist
subgroups considering the matrix eects of the un/minimally
processed NOVA group, the degree of processing and un-struc-
turation of ingredients and additives, and added salt, sugar
and fat contents for the NOVA processed and ultra-processed
groups. Therefore, the Siga classification brings finer granular-
ity to NOVA groups. Siga has to be replicable, accurate, and
scientifically valid. Siga is also intended to be based on legal
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information available for everyone, i.e., the list of ingredients
and the nutritional table on food packaging. In that way, the
main assumption is that the degree of processing of the
ingredients that make up the whole complex food accounts for
its overall degree of processing.
NOVA food groups
NOVA food groups have been recently defined as follows:
5
(1) Minimally processed foods, that together with unpro-
cessed foods make up NOVA group 1, are unprocessed foods
altered by industrial processes such as the removal of inedible
or unwanted parts, drying, crushing, grinding, fractioning,
roasting, boiling, pasteurization, refrigeration, freezing,
placing in containers, vacuum packaging or nonalcoholic
fermentation.
(2) NOVA group 2 is composed of processed culinary ingre-
dients. These are substances obtained directly from group 1
foods or from nature, such as oils and fats, sugar and salt.
They are created by industrial processes such as pressing, cen-
trifuging, refining, extracting or mining, and their use is in the
preparation, seasoning and cooking of group 1 foods.
(3) NOVA group 3 is composed of processed foods. These
are industrial products made by adding salt, sugar or other
substances found in group 2 to group 1 foods; using preser-
vation methods such as canning and bottling; and, in the case
of breads and cheeses, using nonalcoholic fermentation. Food
processing here aims to increase the durability of group 1
foods and make them more enjoyable by modifying or enhan-
cing their sensory qualities.
(4) Ultra-processed foods (group 4) are formulations of
ingredients, mostly of exclusive industrial use, that result from
a series of industrial processes (hence ultra-processed)
Ingredients that are characteristic of ultra-processed foods can
be divided into food substances of no or rare culinary use and
classes of additives whose function is to make the final
product palatable or often hyper-palatable (cosmetic
additives).
The NOVA UPF definition has been shown to be useful for
academic studies, but it is not suciently specific for interfa-
cing with the industry or retailers. Therefore, there is a need
for a more specific approach to characterize ultra-processing,
based on the analysis of the ingredients and technological pro-
cesses leading to their production.
Developing an incremental characterization of UPFs
Among several food classifications according to the degree of
processing, NOVA is the most specific, coherent, clear, com-
prehensive and workable.
1
Within the context of the NOVA
food classification, a UPF definition was proposed. However,
the description of UPFs by NOVA is qualitative, notably lacking
an exhaustive list of the characteristic ingredients/additives of
UPFs.
5
To characterize UPFs, the Siga classification therefore is
intended to address this issue by defining a specific and
exhaustive list of MUPs.
In NOVA, several characteristic ingredients/additives of
UPFs are already mentioned: (1) food substances of no or rare
culinary use (), ingredients originating from the fractionation
of whole food and those that have been subjected to hydro-
Fig. 1 The interconnectedness between holistic and reductionist approaches applied to the Siga classication (adapted from Fardet & Rock,
1
with
permission of ASN©).
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lysis, hydrogenation, or other chemical modifications, such as
hydrogenated or interesterified oils, hydrolysed proteins,
soy protein isolate, maltodextrin, invert sugar and high fruc-
tose corn syrup; and (2) cosmetic additives such as dyes and
other colours, colour stabilizers, flavours, flavour enhancers,
non-sugar sweeteners, and processing aids such as carbona-
tion; firming, bulking, anti-bulking, de-foaming, anti-
caking and glazing agents; emulsifiers; sequestrants; and
humectants.
2,48
Similar to foods, ingredients undergo dierent degrees of
processing, and the degree of transformation of an ingredient
accounts for its health potential. In Siga, a MUP must have
undergone highly deteriorating processes, such as chemical
extraction, purification, chemical synthesis, and hydrolysis,
leading to the un-structuration of the initial ingredient matrix
and the subsequent loss of protective bioactive compounds.
For example, concerning sugar-based ingredients, honey is
less processed and is healthier than table sugar,
49
and
glucose-fructose syrup is more processed than table sugar with
dierent potential metabolic eects,
50
notably leading to fatty
liver and liver triglyceride accumulation.
51,52
Similarly, table
sugars may exhibit dierent degrees of refinement from com-
plete/whole sugar to refined white sugar. The same is true for
other industrial sugary ingredients, such as glucose syrup,
invert sugar, dextrose, isolated fructose and maltodextrins,
which are all ultra-processed sugars. Concerning fats, hydro-
genated fats are more processed than refined oils, which are
more processed than virgin oils. For proteins, we can also
observe these dierent degrees of processing, e.g., protein
hydrolysates are more processed than protein isolates. The
idea behind this criterion is the loss of the ingredient matrix
eect. For example, at equal calorie and glucose unit compo-
sitions, isolated starch, modified starch, maltodextrin, glucose
syrup or dextrose do not necessarily have the same glycaemic
response
53
because the starch matrix has been unstructured
through several steps of hydrolysis.
Siga decrypts the degree of transformation for each ingredi-
ent listed on the on packlist based on regulatory texts, tech-
nical specifications and business practices. What matters is
not only the state of un-structuration of the ingredient but also
the result in terms of the depletion of protective bioactive com-
pounds in the final ingredient. Therefore, among ingredients,
Siga distinguishes non-MUPs (minimally processed ingredi-
ents) and MUPs.
Non-MUPs are raw materials or ingredients that have not
been highly modified from the initial matrix, but they can be
altered by processes such as drying, crushing, grinding,
cooking, boiling, pasteurization, refrigeration, freezing, nonal-
coholic fermentation, roasting (i.e., exposing a food to direct
fire or to a suitable heat source, giving an aroma that recalls
the smell of slightly grilled, charred foods), infusion, etc.
These ingredients are thus not devoid of protective bioactive
compounds, even though their food matrix might have been
altered (e.g., juices, purées, powders). These ingredients have
some form of complexity in the nature of their constituent
interactions.
MUPs are deliberately added substances obtained by syn-
thesis or by a succession of physical, chemical, biological pro-
cesses leading to their purification and/or high deterioration
compared to the original material.
Genesis of the Siga classification
Including the matrixeect in minimally processed foods
(NOVA group 1). Scientific evidence converges to recommend a
generic and worldwide protective diet that obeys the 3 V rule:
Végétal (plant foods), Vrai (real foods), and Varié (varied
foods).
1,54
Indeed, epidemiological studies have shown that
protective diets worldwide for the most part obey the 3 V rule
and contain significant proportions of un/minimally processed
foods, e.g., the Mediterranean (high consumption of fruit,
both fresh and dried such as figs and raisins; nuts; vegetables;
whole-cereal products; fish; and seafood), Okinawa (high in
vegetables and legumes, low-GI grains, few fish and lean
meats, low in calories, and nutritionally dense, especially with
regard to phytonutrients in the form of antioxidants and flavo-
noids), Prudent (a higher intake of vegetables, fruits, legumes,
wholegrains, fish, and poultry, whereas the western dietis
characterized by a higher intake of red meat, processed meat,
refined grains, sweets, desserts), Baltic/Nordic (high consump-
tion of fresh fruit and vegetables, whole-cereal products, and
minimally processed animal products) or vegetarian (high in
plant-based foods) diets.
5559
In addition, all national dietary
guidelines worldwide, based on collective and scientific exper-
tise, also recommend favouring raw and/or not overly pro-
cessed foods, with highly processed foods generally being at
the top of food pyramids.
However, raw foods, even if minimally processed, may have
their matrix altered by grinding, peeling, cooking, cutting,
refining and/or pressing, leading to dierent metabolic eects
as shown in apples,
60
almonds
61
and carrots.
62
The matrixeect can be simply defined as follows: a
food with the same composition but dierent matrices, e.g.,
ground versus whole almond, does not have the same meta-
bolic eect or health eect in the long term.
63
The food
matrix results from nutrient interactions and constitutes the
three-dimensional architecture of the food. A matrix can be
solid, semi-solid or liquid, with dierent impacts on nutrient
bioavailability and satiety potential.
64
In the NOVA group 1 of
un/minimally processed foods, mechanical, fermentation and
thermal treatments influence the matrix. For example, grind-
ing decreases the particle size and, hence, chewing time and
the secretion of satiety hormones; thermal treatment more or
less gelatinizes starch, such as in cooked pasta, and pre-fer-
mentation may radically change the food structure.
Based on scientific evidence related to food matrix
eects,
64
NOVA group 1 has been divided into unprocessed
and minimally processed foods (Siga groups A0 and A1A2,
respectively; Fig. 2). Unprocessed foods are raw foods that have
not undergone any technological processes: they are raw milk,
fruits, vegetables, nuts, meat, and eggs. Minimally processed
foods encompass cooked, ground, fermented, and refined
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grains, such as cooked grains, fruits, vegetables, meat, semi-
skimmed pasteurized milk, plain yogurt, 100% fruit juices, etc.
Processed culinary ingredients from the NOVA group 2,
when not too processed, have been included within the Siga
group minimally processed ingredientsgroup (A2), e.g.,
butter, virgin vegetable oils, salt, table sugars, and honey;
however, refined and/or plant-based oils modified through
hydrogenation are considered ultra-processed ingredients and
therefore MUPs.
Impact of sugar, salt and fat contents in processed and
ultra-processed foods (NOVA groups 24). In NOVA groups 3
and 4 of processed foods and UPFs, the amount of added
culinary ingredients is not taken into account: it does not
amount to the same to add one or three servings of sugar to a
plain yogurt or one to three tablespoons of oil to a crudités
salad. In this case, the overly holistic and qualitative approach
does not take into account the nutritional quality, especially
the salt, sugar and fat contents, even if these must be con-
sidered secondarily and not primarily. The Food Standard
Agency (FSA) medium nutritional thresholds of 1.5 g salt per
100 g, 12.5 g sugars per 100 g and 17.5 g fat per 100 g for
foods and of 0.75 g salt per 100 g, 6.25 g sugars per 100 g and
8.75 g fat per 100 g for beverages
65
have been used to create
four Siga subgroups, i.e., nutritionally balanced (below FSA
thresholds) and high level salt/sugar and/or fat (above FSA
thresholds) processed foods and nutritionally balanced and
high level salt/sugar and/or fat UPFs (groups B1/B2 and C0.1/
C0.2, respectively; Fig. 2). Concerning the sugar threshold, it
was 22.5 g per 100 g in the most recent evaluation by the FSA;
however, we chose 12.5 g per 100 g, which appeared to us to be
more adequate and demanding, especially with the WHO rec-
ommendation of not exceeding 10% ideally 5% of daily cal-
ories from simple carbohydrates from added sugars, honey
and fruit juices.
The additives: health risk potential. The risk assessment of
additives is complementary to the evaluation of the degree of
transformation. Considering all the additive variants, there are
currently 375 authorized additives at the European level;
66
some additives have been noted to present a risk for health
when regularly consumed, e.g., phosphate additives
67
and
sodium nitrite.
68
Therefore, Siga developed a methodology to
evaluate additives with regard to health and based on
European Food Safety Authority (EFSA) reports, and additional
French ANSES opinions, and newly published studies since
the last EFSA reports. In the end, 240 additives were evaluated,
and the remaining additives had no EFSA evaluation available.
By default, they have been classified as not at risk.
Siga relies on the definition of the precautionary principle
of European food legislation (Regulation (EC) No. 178/2002,
Article 7), which states that: In specific circumstances where, fol-
lowing an assessment of available information, the possibility of
harmful eects on health is identified but scientific uncertainty
persists, provisional risk management measures necessary to
ensure the high level of health protection chosen in the
Community may be adopted, pending further scientific infor-
mation for a more comprehensive risk assessment.
69
In this
Fig. 2 From NOVA to Siga classications according to the degree and extent of food processing.
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sense, decision-making is temporary and likely to evolve in
light of scientific advances and new published studies. The
evaluation methodology is based on two main criteria
(Fig. 3a):
- The general conclusion of the risk panel (no additive can
be assessed as being at risk if the panel formally concludes
that there is no safety concern);
- The adverse (certain or uncertain) eects observed in
humans and animals or in vitro (no additive can be assessed
as being at risk if there are no relevant adverse eects or no
observed eects) related to the precautionary principle.
69
The
consideration of uncertainties is an integral part of the meth-
odology. Thus, the assessment of the eect of the evaluated
additive takes two forms: no safety concernand safety
concern(Fig. 3b).
Siga definition of UPF. UPFs are characterized by the pres-
ence of at least one deliberately added substance obtained by
synthesis or by a succession of physical, chemical and/or bio-
logical processes leading to its purification and/or substantial
deterioration compared to the original material in the list of
ingredients. UPFs can also be created by the direct application
of a deterioration process (e.g., extrusion-cooking) to the food
Fig. 3 (a) Siga analysis criteria of EFSA reports; (b) the criteria for assigning the level of risk.
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matrix. These substances are named MUPs and can be
indierently an ingredient or an additive, most of which are
obtained by technological processes relating to cracking or
synthesis. Two levels of MUPs are distinguished:
- MUP1: obtained by chemical synthesis identical to natural
substances and/or by successive processes leading to purifi-
cation or obtained by successive processes leading to the high
deterioration of the ingredient matrix, such as isolated
protein, starches, natural flavouring, and yeast extract.
- MUP2: obtained by artificial chemical synthesis or by succes-
sive processes leading to the combined purification and substan-
tial deterioration of the matrix, as is the case for glucose syrup,
dextrose, hydrolysed proteins, carboxymethylcellulose, etc.
Purification processes are physical and/or chemical separ-
ation operations consisting of isolating a component from a
complex foodstu(i.e., chemical solvent extraction, ultrafiltra-
tion, electrophoresis, etc.). High deterioration processes are
physical, chemical and/or biological operations that cause
strong modifications to the initial matrix (beyond thermal
and/or physical alteration processes leading to non-MUPs).
These processes may be hydrolysis processes (chemical or bio-
logical), chemical modifications such as hydrogenation, or
physical treatments such as mechanical separation of meat or
extrusion-cooking. These processes modify the initial matrix/
structure of the original material and result in more than a
simple alteration. Consequently, the substances obtained have
a potential deteriorated matrix eect together with a depletion
of associated protective micronutrients compared to the orig-
inal material. UPFs can be indierently composed of ingredi-
ents or monoingredients. In the latter case, the food is a
UPF-MUP, such as refined oils.
Siga algorithm for food classification. Overall, the Siga
evaluation method works by downgrading substances (ingredi-
ents and additives) according to their degree of transformation
and the assessment of the associated risk. Each of these cri-
teria may result in a downgrading of the evaluated product.
The final class chosen corresponds to the most transformed
class with respect to all these criteria. Similar to NOVA, preser-
vatives and additives are not considered as cosmetic additives.
Therefore, even if a majority of them meets the definition of a
MUP, they are not identified in this way by the Siga algorithm.
However, Siga limits their number and considers their safety
assessment.
In addition, additives or ingredients that are minimally pro-
cessed are not included in the definition of UPFs, e.g., arabic
gum (solidified descending sap exudate) or virgin oils (cold
pressed). Based on fat/salt/sugar contents (if added, as identi-
fied from the ingredient list), and the nature and levels of
assessed risk of additives and/or ingredient degree of proces-
sing, the NOVA group 4 of UPFs was divided into three UPF
subgroups (Fig. 2: C0.1, C0.2, and C1). Groups C0.1 and C0.2
contain only one MUP1 (not assessed as at risk) but dier by
their salt, sugar or fat contents (if added, as identified from
the ingredient list). The presence of at least one MUP2 or an
additive with a safety concern indicates placement in the
C1 group.
The Siga algorithm is made of dierent homemade compu-
ter tools whose objective is to characterize each ingredient on
the packaging to score the food item according to a decision
tree which corresponds to the Siga classification in the
8 groups presented above. A first computer tool allows to
browse the lists of ingredients, in order to isolate all the ingre-
dients from the list. More than 20 000 ingredients according to
their degree of processing and risk assessment (mainly for
additives) were analyzed and categorized as follows: (1) unpro-
cessed ingredients, (2) minimally processed ingredients, (3)
culinary ingredients (minimally processed added fat, sugars or
salt), (4) markers of ultra-processing (levels 1 and 2, i.e., MUP1
and MUP2, respectively), and (5) at-risk substances. Then, a
second computer tool detects ingredients not present in the
previous list of more than 20 000 ingredients. In this case, the
newly identified ingredient is assessed by a Siga expert accord-
ing to our criteria. The last computer tool scores the food
based on the detected ingredients, and the fat, sugar and/or
salt thresholds.
Application of the Siga classification
To generic food group (n= 9) pyramids. Generally, food pyra-
mids are all based on the same scheme including cereals,
legumes, fruits, vegetables, nuts, dairy products, meat, fish
and egg products but without mentioning the degree of pro-
cessing. The Siga algorithm was applied to each of these nine
food groups by selecting a specific food in its database and
categorizing it into the eight Siga technological groups
(A0C1).
To the assortment of a supermarket. The Siga algorithm was
then applied to a sample of 24 932 packaged food products
(baby foods and alcohols excluded) representative of the food
oering in French supermarkets (n= 3296 brands of products
and n= 98 agro-food companies), i.e., with a barcode. The lists
of ingredients were collected online and directly on-site for
four French retailers. The percentages of products for each of
the eight Siga groups (A0C1, Fig. 2) were calculated directly
from the Siga database (crude results, excluding fresh fruits
and vegetables, bread and cheeses, delicatessen, unlabelled
fishmongers packaged in advance). The results are presented
either for all products or for some food category. In this ana-
lysis, drastic processes directly applied to the food that were
considered MUPs (see definition above) were not considered
because they were not mentioned on the packaging as legal
information that Siga could check.
Results
Usual food groups based on the degree of processing
For each food group (cereals, legumes, fruits, vegetable, meat,
fish, dairy and egg products) of the usual pyramids, Siga cate-
gorized a specific food into the eight technological groups
(Fig. 4ai). For example, concerning legumes, fresh peas are
unprocessed, traditional tofu is minimally processed, canned
peas with added salt are processed if the salt content is below
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Fig. 4 Application of the Siga algorithm to the nine usual food groups of pyramids. (a) Legumes, (b) vegetables, (c) cereals, (d) fruits, (e) nuts, (f )
sh, (g) eggs, (h) meats, and (i) dairy.
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the FSA threshold, soya sauce with added salt above the FSA
threshold is a high salt, sugar and/or fat level processed food,
peas with added starch (MUP1) but nutritionally balanced is a
C0.1 UPF, hummus with a high level of added refined oil is a
high salt, sugar and/or fat level C0.2 UPF, pea-based meat sub-
stitutes with added pea proteins and aromas are C1 UPFs
(Fig. 4a), and so on for the following remaining eight food
groups (Fig. 4bi).
Classification of packaged foods in the eight Siga groups
Among the 24 932 packaged foods, 67% were UPFs (from C0.1
to C1) and therefore contain at least one MUP (Fig. 5). Other
foods were either un-/minimally processed (17% in A0A2) or
processed (16% in B1B2). Among the UPFs, only 6% were in
C0.1 and 7% were in C0.2. Therefore, UPFs with more than
one MUP (C1) correspond to the most represented category,
with 54%.
Considering all products, the average number of ingredi-
ents, MUPs and at-risk additives were 10.1, 2.6, and 0.5,
respectively (results not shown in tables or figures). Among
UPFs only, the average number of ingredients and MUPs were
13.2 and 3.8, respectively, and the average number of ingredi-
ents in non-UPF products was 3.7 (results not shown). The
most represented MUP1 (Table 1) were refined oils (30% of
the products), aromatic extracts and natural flavours (26%),
starches (12%), lecithins (10%), and isolated animal and
plant proteins (6%). The most represented MUP2 were hydro-
lysed sugars (23%), artificial/synthetic aromas (19%), and
modified starches (8%) (Table 1). The most represented at-
risk additive was sodium nitrite (E250, 5%) (Table 1).
Otherwise, among non-UPFs, 84% had from one to five
ingredients in their list (Fig. 6a), and 16% had more than
five ingredients; among all products (UPFs + non-UPFs), 67%
of products with 1 ingredient were UPFs (see also Fig. 5),
72% of products with 2 ingredients were UPFs, and 88%
of products with 5 ingredients were UPFs (Fig. 6b). In
addition, only 4% of products were UPFs when only one
ingredient was present, 13% for two ingredients, 25% for 3
ingredients, and 75% for 6 ingredients (Fig. 6c). Finally, the
higher the number of ingredients, the lower the number of
non-UPF products (Fig. 6d).
Classification of packaged foods in some food category
Among the 81 food categories initially defined in the Siga data-
base, some contained a high percentage of UPFs: 94, 95, 95,
81, 80, and 87% for salted meat, cooked dishes, flavoured
yogurts and white cheeses, energy and gourmet bars, breakfast
cereals, and vegetarian dishes, respectively (Fig. 7); of these,
98, 93, 82, 82, and 69%, respectively, contained more than one
MUP.
Discussion
The Siga technological groups, based on holistic NOVA food
groups, distinguish four new subgroups based on more
specific and reductionist criteria. The Siga definition of UPFs
is focused on the extent of processing and the loss of the
matrixeect, for either foods or ingredients, more than on
the function of added ingredients/additives. The Siga defi-
nition also includes at-risk additives and some drastic indus-
trial processes directly impacting the food matrix (i.e.,pung,
pre-frying, extrusion-cooking). The holistic paradigm under-
lying the Siga classification is based on the assumption that
the whole is more than the sum of the parts
1,70
and therefore
that the food or ingredient matrix plays an important role in
good health, including a beneficial synergistic action of nutri-
ents, the presence of protective micronutrient co-factors, a
higher satiety potential and a more appropriate nutrient bio-
availability for the human organism.
3941
In the Siga under-
lying paradigm, the degree of processing comes first and the
nutrient content second, not the contrary.
1
Indeed, we first
consume food matrices, not nutrients, and processing aects
not only the nutrient content but also, above all, the food
matrix.
Fig. 5 Distribution of 24 932 packaged foods marketed in France
according to the degree of processing with the Siga technological
groups. A0: unprocessed, A1: minimally processed foods, A2: minimally
processed culinary ingredients, B1: nutritionally balanced processed
foods, B2: high salt, sugar and/or fat level processed foods, C0.1: nutri-
tionally balanced UPFs level 0, C0.2: high salt, sugar and/or fat level
UPFs level 0, C1: UPFs.
Table 1 Top ten MUPs and additives with safety concerns encountered
in the 24 932 packaged foods
Ingredient/additive
Percentage
of products
MUP1 Refined oils 29.7
MUP1 Aromatic extracts and natural flavours 25.9
MUP2 Hydrolysed sugars 22.5
MUP2 Artificial/synthetic aroma 18.8
MUP1 Starches 12.4
MUP1 E322 (Lecithins) 10.3
MUP2 E14ii (modified starches) 8.1
MUP1 Isolated animal and vegetable proteins 6.0
R1 E250 (sodium nitrite) 5.1
MUP1 E415 (xanthan gum) 4.7
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In this study, we showed that approximately two-thirds of
packaged foods were UPFs, with 13% containing only one
MUP. Therefore, there is a very high level of UPFs among pack-
aged marketed foods. With Siga, UPFs were dierentiated
according to the number of MUPs: considering that the level 0
of ultra-processing is acceptable (C0.1, C0.2), 54% of packaged
products are very highly processed (C1 group). A previous
study carried out in New Zealand supermarkets identified 83%
of packaged foods as UPFs according to NOVA, and these
foods were also the least healthy.
71
In another recent US study,
it was found that among 230 156 packaged foods and bev-
erages (data obtained through Label Insights Open Data data-
base), 71% were UPFs according to NOVA.
72
These percentages
are not so far from that found in this study, and the slight
dierences probably result from both dierences between
countries and discrepancies in the way NOVA and Siga charac-
terize UPFs and their MUPs.
Otherwise, Siga revealed that the UPF percentage among all
foods, including fresh and bulk foods, is approximately 50%
(results not shown). In a recent French study using NOVA
classification in which the authors evaluated 7883 households,
the percentage of UPF sales in French conventional stores was
approximately 39%.
73
Therefore, there seems to be good agree-
ment between the presence of UPF in supermarkets and pur-
chasing behaviours. In the same study, it was also evaluated
that among organic products, the percentages of UPF sales
were approximately 31% and 27% in conventional and organic
stores, respectively,
73
suggesting a lower percentage of UPFs
among organic foods. This result is not surprising because in
organic food, only 48 additives are authorized, which naturally
decreases the likelihood of being classified as a UPF, whose
many additives are MUPs. In addition, the specifications are
stricter in terms of process, e.g., no artificial aromas are
allowed in organic processing.
It was also shown that among the 24 932 packaged foods,
the average number of ingredients was 13.2 for UPF and 3.7
Fig. 6 (a) Cumulative percentages of non-UPF products according to the number of ingredients; (b) among all products (non-UPF + UPF), cumulat-
ive percentages of UPF products with N or more ingredients (i.e.,1, 2, 3, 4, etc.); (c) percentages of non-UPF and UPF products according to
the number of ingredients; and (d) number of non-UPF and UPF products according to the number of ingredients.
Fig. 7 Percentage of food according to the degree of processing cate-
gorised by the Siga classication for six food categories. A0: unpro-
cessed, A1: minimally processed foods, A2: minimally processed culinary
ingredients, B1: nutritionally balanced processed foods, B2: high salt,
sugar and/or fat level processed foods, C0.1: nutritionally balanced UPF
level 0, C0.2: high salt, sugar and/or fat level UPF level 0, C1: UPFs.
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for non-UPF, suggesting that long lists of ingredients are very
indicative of ultra-processing: for example, among products
with 4 ingredients, 55% are UPFs, and this figure is 75% for
products with more than 5 ingredients (Fig. 6c). For all pro-
ducts, the average numbers of ingredients, MUPs and at-risk
additives were 10.0, 2.6, and 0.5, respectively. Since the average
number of MUPs among all UPFs was 3.8, this suggests that,
on average, food products with more than 6 ingredients are
very likely to be UPFs. The most frequently observed MUPs are
refined oils, aromatic extracts/natural flavours, hydrolysed
sugars (i.e., coming from starch hydrolysis), artificial/synthetic
aromas, and starches. Most of these MUPs are used for enhan-
cing taste (refined oils, flavours, aromas, and sugars) while
using a lower amount of real foods (sugars and starches may
replace, by weight, better ingredients that are more expensive),
allowing UPFs to be produced at very low costs.
Food categories, such as salted meats, cooked dishes, fla-
voured yogurts and white cheeses, energy and gourmet bars,
breakfast cereals, and vegetarian dishes, contain very high
levels of UPFs (more than 80%), of which 98, 93, 82, 88, 82,
and 69% contain more than one MUP, respectively. In this
study, we did not give the results for the 81 food categories,
but other food groups also contain high levels of UPFs, e.g.,
fresh creams, vinegars, sandwiches, sodas, ice creams, pizzas,
and confectionaries. These food groups are also described as
UPFs in the NOVA classification, but the Siga classification
does not rank 100% of the products in each category as a UPF,
resulting in some further classification and dierentiating
UPFs from the C0.1 and C0.2 groups from those of the
C1 group.
Concerning their health potential, UPFs generally have a
lower nutrient density profile in terms of protective bioactive
compounds than un-/minimally processed foods, i.e.,fibre,vita-
mins, minerals, trace elements and antioxidants.
38,40,41,7476
These bioactive food compounds are the first line of prevention
against the development of chronic diseases that are multifac-
torial and involve several metabolic deregulations as triggering
factors.
77
Therefore, it is not surprising that regular and exces-
sive consumption of UPFs is associated with increased risks of
chronic diseases.
4,30
In addition, UPFs tend to be more hyper-
glycaemic and less satiating, which can lead to overweight,
obesity, hepatic steatosis and type 2 diabetes when regularly
consumed.
32
When such metabolic dysregulations are triggered,
they can then lead to more serious diseases such as some
cancers, steatohepatitis and cardiovascular diseases.
77
Otherwise, as recently shown in the only interventional study of
UPFs, regularly consuming UPFs led to a higher caloric intake,
probably due to the low satiating potential of these foods.
78
In
this study, a +20% increase in caloric intake was measured over
only two weeks, and this increase was attributed mainly to fat
and carbohydrates.
78
Since the diet composition was the same
at the beginning of the study, this increase had to be attributed
to other factors, notably the food matrix and the presence of
cosmeticingredients/additives to amplify sensory properties,
finally leading to the overconsumption of these foods. Pleasure
to eat is stronger than satiation, probably due to some form of
food addictionas shown in overweight children.
79,80
Indeed,
UPFs tend to exhibit textures that demand less chewing (i.e.,
soft, friable, viscous, semi-solid, liquid) and therefore less satia-
tion.
81
Indeed, among 139 solid/semi-solid foods, it was shown
that UPFs have a significantly lower energy at break(i.e.,the
energy needed until the food texture breaks).
39
In the end, the
hyper-palatability (both in texture, composition and use of cos-
metic ingredients/additives) may well be the first root cause of
their excessive consumption and subsequent excess calorie, salt,
sugar, fat and/or xenobiotic consumption, leading to chronic
diseases in the long term.
Therefore, the Siga classification may present a useful tool
for improving the health potential of packaged foods, e.g.,
through reformulation and/or less drastic processes. For
example, the replacement of glucose syrup by table sugar in a
product ranked C0 may lead an UPF to be switched to a
dierent category of processed foods, i.e., B1 or B2 according
to the sugar content. Then, a food ranked as a high salt, sugar
and/or fat level processed food (B2) may be switched to a
balanced processed food by decreasing added fat, salt and/or
sugar. Due to the low health properties of UPFs
5,30
and based
on the precautionary principle, it is therefore recommended
not to exceed 15% of daily calories from these foods
1
and
among them, to choose UPFs from Siga categories C0.1C0.2
(acceptable/occasional UPFs with one MUP1), which in this
study, constituted approximately 1213% of the packaged
foods. In addition, the Siga score may also be a decision-
making tool for search engine optimization (SEO) policy and
assortment management in supermarkets.
Concerning the consumer, the Siga score fits into a more
holistic scheme based on what we have defined as the 3 V Rule
for, in French, Végétal (Plant foods, maximum 15% daily
animal calories), Vrai (Real foods, maximum 15% daily UPF
calories), and Varié (Varied, if possible organic, local and sea-
sonal), meaning for the consumer that UPF may be consumed
without risk, if in moderation.
1
Then, in a supermarket, the
idea is to encourage consumers selecting non-UPF foods when-
ever possible. However, buying an UPF within the context of
the above-mentioned 3 V Rule is not problematic for health.
In conclusion, it is important to note that Siga is not
intended to substitute the NOVA classification but rather is
intended to be a pragmatic tool and a rational, objective and
actionable score for retailers and the agro-food industry to
improve the quality of both diets and processed foods in a
more gradual or step-by-step manner. NOVA is necessary and
sucient for research and consumers. Siga only brings new
scientific elements for UPF definition and UPF sub-classifi-
cation based on the most recent data, notably to allow for the
identification of less processed ingredients as substitutes of
MUPs in UPFs. Otherwise, the Siga algorithm is scalable
depending on new published scientific evidence and risk evalu-
ations of additives. In the end, due to the high level of UPFs
among labelled-packaged products, dierent types of measures
should be put in place at dierent levels, including preventive
food education at school from 3 to 15 year-olds, consumer
awareness, and even the taxation of certain UPFs which are very
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harmful for health in order for real healthy foods to be less
expensive than UPFs which overall is not the case.
82
Abbreviations
EFSA European Food Safety Authority
FAO Food and Agriculture Organization
FSA Food Standard Agency
MUP Marker of ultra-processing
PAHO Pan American Health Organization
SEO Search engine optimization
UPF Ultra-processed food
Author contributions
The present study was developed by all authors, who formu-
lated the research questions and designed and carried out the
study. Sylvie Davidou and Anthony Fardet took the lead for
writing the manuscript. Aris Christodoulou and Kelly Frank
collected and analysed the food data. Aris Christodoulou, Kelly
Frank and Sylvie Davidou contributed to the health evaluation
of additives and other food ingredients and participated in the
development of the Siga algorithm. All authors reviewed and
approved the final manuscript.
Financial support
This study received funds from Siga Society only.
Conicts of interest
Anthony Fardet has been the president of the Siga scientific
committee since May 2017.
Acknowledgements
Pamela Ebner from Siga Society is greatly acknowledged for
her valuable help in analysing food data.
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... There are currently at least six different systems that are used to classify foods by their degree of processing including the European Prospective Investigation into Cancer (3) , the International Food Information Council (4) , the Siga classification (5) , the University of North Carolina (6) , NOVA and more recently the Food Compass system (7) . The NOVA system has evolved considerably since its initial introduction, initially focusing on number of ingredients and processes and more recently evolving to include the 'purpose of processing' as a central component of the definition (8) . ...
... Despite the demonstrated efficacy of reformulation and fortification efforts to enhance public health, there remains resistance among some opponents of food processing that believe that any effort to reformulate the food supply can only make a food even more ultraprocessed (56) . Similarly efforts to support the protein transition from animal to plant-based sources of meat Beyond ultra-processed: considering the future role of food processing in human health 5 and dairy have been criticised as promoting a UPF environment (18) . Irrespective of these concerns, reformulation remains a fact of life, and will continue to be central to efforts to improve the nutrient density and sustainability of food production and distribution (37) . ...
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Food-based dietary guidelines have been the basis of public health recommendations for over half a century, but more recently, there has been a trend to classify the health properties of food not by its nutrient composition, but by the degree to which it has been processed. This concept has been supported by many association studies, narrative reviews and the findings from one randomised controlled feeding trial, which demonstrated the sustained effect of ultra-processed diets on increasing both energy intake and body weight. This has led to widespread speculation as to specific features of ultra-processed foods that promote increased energy intakes. Rising interest in the ultra-processed topic has led to proposals to include guidance and restrictions on the consumption of processed foods in national dietary guidelines, with some countries encouraging consumers to avoid highly processed foods completely, and only choose minimally processed foods. However, there remains a lack of consensus on the role of processed foods in human health when faced with the challenges of securing the food supply for a growing global population, that is, healthy, affordable and sustainable. There has also been criticism of the subjective nature of definitions used to differentiate foods by their degree of processing, and there is currently a lack of empirical data to support a clear mechanism by which highly processed foods promote greater energy intakes. Recommendations to avoid all highly processed foods are potentially harmful if they remove affordable sources of nutrients and will be impractical for most when an estimated two-thirds of current energy purchased are from processed or ultra-processed foods. The current review highlights some considerations when interpreting the dietary association studies that link processed food intake to health and offers a critique on some of the mechanisms proposed to explain the link between ultra-processed food and poor health. Recent research suggests a combination of higher energy density and faster meal eating rates are likely to influence meal size and energy intakes from processed foods and offers new perspectives on how to manage this in the future. In going beyond the ultra-processed debate, the aim is to summarise some important considerations when interpreting existing data and identify the important gaps for future research on the role of processed food in health.
... such as the Health Star Rating (HSR) in Australia and Aotearoa New Zealand (65), and the Nutri-Score in Europe (66). Alternatively, Davidou et al. have proposed the Siga classification as a variation on the NOVA criteria, whereby the UPF category is subdivided into three subcategories, enabling further classification and differentiation of UPFs (67). Nutritionally balanced UPFs (i.e., lower in added sugar, fat, and salt content), with one marker of ultra-processing (MUP), were assessed more favorably than nutritionally unbalanced UPFs with one MUP, or products with more than one MUP (67). ...
... Alternatively, Davidou et al. have proposed the Siga classification as a variation on the NOVA criteria, whereby the UPF category is subdivided into three subcategories, enabling further classification and differentiation of UPFs (67). Nutritionally balanced UPFs (i.e., lower in added sugar, fat, and salt content), with one marker of ultra-processing (MUP), were assessed more favorably than nutritionally unbalanced UPFs with one MUP, or products with more than one MUP (67). The Siga classification could also serve as a tool to nudge upcycled food production toward healthier end products. ...
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One of the aims of the United Nations Sustainable Development Goals (SDG) is to end hunger and ensure access by all people to safe, nutritious, and sufficient food all year round. An obvious synergy exists between the second SDG “Zero Hunger” and SDG target 12.3 which focuses on halving food waste and reducing food losses. In addition to helping improve global food security, reducing food waste provides financial and environmental benefits. Upcycling food is a technical solution for food waste reduction that retains the nutritional and financial value of food by-products. However, many of the upcycled foods produced are discretionary foods such as biscuits, crackers, and other snack food that are not part of a healthy dietary pattern, and should only be eaten sometimes in small amounts. Given the importance of ensuring a sustainable healthy diet, this paper discusses opportunities for upcycled food manufacturers to produce more nutritious products.
... This significant share of UPFs to supply and intake demonstrates how ubiquitous this food class is in the UK diet, a pattern observed in other high-income countries, such as the USA (6) , Canada (7) and Australia (8) . UPFs represent 83% of packaged supermarket foods in New Zealand (9) , and 67% in France (10) . ...
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Objective Ultra-processed foods (UPF), including those containing food-additive emulsifiers, have received research attention due to evidence implicating them in the pathogenesis of certain diseases. The aims of this research were to develop a large-scale, brand-level database of UPFs in the UK food supply and to characterise the occurrence and co-occurrence of food-additive emulsifiers. Design A database was compiled sampling UPF groups contributing to total dietary energy intake in the UK from the National Diet and Nutrition Survey (2008-2014). Every food in these UPF groups were identified from online supermarket provision from the ‘‘big four’’ supermarkets that dominate the market share in the UK, comprising Tesco, Sainsbury’s, Asda and Morrisons. Results A total of 32,719 food products in the UK supermarket food supply were returned in searches. Of these, 12,844 UPF products were eligible and manually reviewed for the presence of emulsifiers. Emulsifiers were present in 6,642 (51.7%) food products. Emulsifiers were contained in 95.0% of ‘‘Pastries, buns and cakes’’; 81.9% of ‘‘Milk-based drinks”, 81.0% in ‘‘Industrial desserts’’ and in 77.5% of “Confectionary”. Fifty-one percent of all emulsifier-containing foods contained multiple emulsifiers. Across emulsifier-containing foods there were a median of 2 emulsifiers (IQR 2) per product. The five most common emulsifiers were lecithin (23.4% of all UPF), mono- and diglycerides of fatty acids (14.5%), diphosphates (11.6%), xanthan gum and pectin (8.0%). Conclusions Findings from this study are the first to demonstrate the wide-spread occurrence and co-occurrence of emulsifiers in UPF in the UK food supply.
... The European Prospective Investigation into Cancer and Nutrition [117] proposed three main UPF categories: highly processed, moderately processed, and unprocessed foods. ...
Article
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Obesity and overweight are a major public health problem globally. Diet quality is critical for proper child development, and an unhealthy diet is a preventable risk factor for noncommunicable diseases (NCDs), such as obesity. Consumption of sugar-sweetened beverages and ultra-processed foods (UPFs) in childhood may increase the BMI/BMI z-score, body fat percentage, or likelihood of overweight. A strict feeding regulation system allows for sufficient food to be consumed to meet ongoing metabolic demands while avoiding overconsumption. This narrative review explores the issues of obesity and the regulation of food intake related to reward systems and UPF consumption. Nutrient composition alone cannot explain the influence of UPFs on the risk of obesity. Furthermore, the non-nutritional properties of UPFs may explain the mechanisms underlying the relationship with obesity and NCDs. UPFs are designed to be highly palatable, appealing, and energy dense with a unique combination of the main taste enhancer ingredients to generate a strong rewarding stimulus and influence the circuits related to feeding facilitation. How individual UPF ingredients influence eating behavior and reward processes remains not fully elucidated. To increase the knowledge on the relationship between UPFs and pediatric obesity, it may be useful to limit the rapid growth in the prevalence of obesity and subsequent related complications, and to develop new strategies for appropriate food and nutrition policies.
... Based on Law Number 18 of 2012 concerning Food "Food is anything that originates from biological products, whether processed or not that is used as a drink or food for human consumption, including food raw materials, food additives or other ingredients that are used during the process of preparation, manufacture and/or processing of the manufacture of drinks or food." (Ardani, 2020) From the way it is obtained, food can be divided into 3, namely fresh food, processed food, and certain processed food (Davidou et al., 2020). ...
Article
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Food is a primary need for humans and is mandatory to fulfill it. Without food, humans cannot survive because food is a source of energy for humans to carry out their daily activities. To maintain our health, we also need to consume healthy foods and avoid foods that can cause various diseases. Regulation of the Minister of Health Number 30 of 2013 concerning the Inclusion of Information on Sugar, Salt, and Fat Content and Health Messages on Processed Foods and Ready-to-Eat Foods. This research is included in qualitative research and is descriptive in nature. This study is an empirical study of laws and policies in Permenkes No. 30 of 2013. The policy for including information on sugar, salt, and fat content as well as health messages for processed food needs to be accompanied by changes to the Guidelines for Inclusion of Information on Nutritional Value on Food Labels. The food industry in Indonesia can carry out a policy of including information on sugar, salt, and fat content as well as health messages for processed food. But to implement it, the food industry offers a public-private partnership model, namely the Public Health Responsibility Deal as has been done in the UK. and the Millan Declaration in Switzerland.
... The inclusion of % energy and fat criteria in the PAHO NPM also leads to a limited interpretation of what can be classified as a healthy food. The Siga scheme, developed and applied for commercial purposes, also employs a top-down approach, applying NOVA categories before overlaying nutrient criteria (62). However, the complexity of the system, which considers risk assessment of additives and the application of industrial processing techniques, may not be practical for policy purposes, potentially being overly burdensome on manufacturers, enforcement agencies, policy makers, and regulators. ...
Article
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Unhealthy diets are a leading risk factor for non-communicable diseases and negatively impact environmental sustainability. Policy actions recommended to address dietary risk factors, such as restrictions on marketing and front-of-pack labelling, are informed by nutrition classification schemes (NCSs). Ultra-processed foods are associated with adverse population and planetary health outcomes, yet the concept is rarely incorporated in nutrition classification schemes for policy actions. This study aims to develop a novel food processing-based nutrition classification scheme for guiding policy actions. A secondary aim is to validate the scheme by classifying food and beverage items in the Australian food supply (face validity) and comparing them to the classifications of existing NCSs (convergent validity). Two versions of a model were developed, classifying foods and beverages in two steps, first using the NOVA classification system and secondly by applying upper thresholds for added free sugars and sodium, producing a binary output of either healthy or unhealthy. All food and beverage items ( n = 7,322) in a dataset combining the Australian Food Composition Database (AUSNUT 2011–2013) and Mintel’s Global New Product Database (2014–2019) were classified using the two models. The same dataset was also classified by the Health Star Rating system (HSR), The Australian Dietary Guidelines (ADGs), The Pan American Health Organization’s Nutrient Profile Model (PAHO NPM), and the NOVA classification scheme, and pairwise agreement between all NCSs and the two models was determined (using Cohen’s Kappa coefficient). A higher proportion of food categories consistent with dietary patterns that are associated with positive health outcomes, such and fruits, vegetables, and eggs were classified as healthy. And the clear majority of food categories consistent with dietary patterns associated with adverse health outcomes, such as confectionery, snack foods, and convenience foods were classified as unhealthy. The two versions of the model showed substantial agreement with NOVA and the PAHO NPM, fair agreement with the ADGs and slight to moderate agreement with the HSR system. A model NCS combining level of processing and nutrient criteria presents a valid alternative to existing methods to classify the health potential of individual foods for policy purposes.
Article
The 'ultra-processed food' (UPF) concept, with classification of foods by 'level of processing' rather than nutrient profiles, and its relationship with health outcomes, is currently a topic of debate among academics and increasingly referred to in the media. The British Nutrition Foundation convened a virtual roundtable on 6th July 2022 to gather views on the use of the term (and current definitions of) UPF for public health messaging, seeking to establish areas of consensus and disagreement and identify topics for further research. A small group of invited expert stakeholders attended, including representatives from academia, policy, behavioural science, communications, health, food science, retail and consumer interests. Participants' discussions clustered into cogent themes which included: problems with the use of definitions for UPF, the lack of causal evidence and defined mechanisms linking processing per se with poor health outcomes, and advice that may result in consumer confusion. There was agreement that many foods classified as UPF are high in fat, sugars and/or salt and public health messages should continue to focus on reducing these in the diet since it is unclear whether reported associations between high intakes of UPF and poor health reflect poorer dietary patterns (defined by nutrient intakes), and nutrient-health relationships are well established. Examples of misalignment were also highlighted (i.e. some foods are classified as UPF yet recommended in food-based dietary guidelines [featuring in healthy dietary patterns]). This raises challenges for consumer communication around UPF. Concern was also expressed about potential unintended consequences, particularly for vulnerable groups, where advice to avoid UPF could create stigma and guilt due to lack of time or facilities to prepare and cook meals from scratch. It could also impact on nutrient intakes, as some foods classified as UPF represent more affordable sources of important nutrients (e.g. packaged wholemeal bread). Discordance between the concept of UPF and current strategies to improve public health, such as reformulation, was also discussed. The group concluded that the use of the concept of UPF in UK policy (e.g. dietary guidelines) would be unhelpful at present. Overall, participants felt that it was more important to focus on providing practical advice around selection of healthier processed foods and making healthier foods more accessible rather than promoting the avoidance of UPF. The latter may act to demonise all foods classified as UPF by current definitions, including some affordable nutrient-dense foods.
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Besin işleme; bireylere güvenilir ve uzun ömürlü besinler sağlamasının yanında lezzet ve görünüşü iyileştirmek adına uygulanan çeşitli uygulamaları da kapsayan işlemler bütünüdür. Ülkemizde çoğunlukla ambalajlı ve tüketime hazır tüm ürünler işlenmiş besin ana başlığı altında sınıflandırılmakta ve yapılan çalışmalarda katılımcıların işlenmiş besin kavramını sağlıksız, enerji içeriği yüksek ve besleyici değeri düşük besinler olarak ifade ettiği belirtilmektedir. Ancak besin işleme metotları arasında pastörizasyon, sterilizasyon, soğutma, dondurma gibi besin güvenliğinin ve raf ömrünün artırılmasına yönelik işlemler ile beraber besinlerin bazı mikro besin ögeleri ve biyoaktif bileşenler ile zenginleştirilmesi işlemleri de yer almaktadır. Bunların yanında, çoğunlukla düşük maliyetli, tüketimi artırmaya yönelik, enerji içeriğini artırıcı ve besin değerini azaltıcı çeşitli işlemler de tüm dünyada yaygın olarak kullanılmaktadır. Yapılan pek çok çalışma işlenmiş besin tüketimi ile obezite, diyabet, metabolik sendrom ve bazı kanser türleri gibi çeşitli bulaşıcı olmayan kronik hastalıklar arasında ilişki göstermiştir. Farklı epidemiyolojik çalışmalarda işlenmiş besinler, yapılan değişimin kapsamı, doğası, işlemin yeri ve amacına göre farklı şekillerde sınıflandırılmaktadır. Bu derleme kapsamında yapılan literatür taramasında dünyada kabul gören çeşitli besin işleme sınıflandırma sistemleri incelenmiş ve ülkemizde yapılan çalışmalarda kullanılmak üzere terim önerileri sunulmuştur. Buna göre çeşitli sınıflandırma sistemleri içinden NOVA sınıflama sisteminin özellikle besinlerin sağlık etkisinin araştırıldığı çalışmalar açısından daha kapsamlı ve uygulanabilir bir sistem olduğu belirtilmektedir. NOVA sistemi bir sözcüğün kısaltması değil, isimlendirilmesidir. Bu sisteme göre besinler dört temel gruba ayrılmaktadır. Bu terimlerin Türkçe terminolojideki karşılıkları açısından önerilerimiz işlenmemiş/yalın işlenmiş, yemeklerde kullanılan işlenmiş içerikler, işlenmiş besinler ve yoğun işlenmiş besinler ve içecekler olarak verilmiştir. Bu şekilde bir uygulamanın yapılan çalışmalarda yaygınlaşması hem tüketiciler açısından kolay ve anlaşılabilir, hem de araştırmacılar açısından toplum bazlı beslenme önerileri geliştirmek açısından faydalı olacaktır.
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The lack of knowledge among adolescents makes them more sensitive to engage in unhealthy habits which might harm health and nutritional status. A high caloric diet and lack of physical activity are responsible for the generation of reactive oxygen species leading to neurological diseases. The gap in knowledge about Junk food and its complications poses a significant threat to public health policy. Metabolic Syndrome develops due to high fat-induced chronic inflammation and leads to cognition disturbances, stroke, and neurological diseases such as Alzheimer's disease. Adolescent age is the most devastating one where several Lifestyle associated diseases (Sophisticated and cozy lifestyle) occur and is linked with chronic diseases viz., Alzheimer, Non-Alcoholic Steatohepatitis, Type 2 Diabetes Mellitus, Non-Alcoholic Fatty liver disease, Obesity, Hypertension, etc. The unstructured eating behaviors should be prevented at the earliest to overcome the "Fast food Genocide" from eating Processed foods to obesity and nutritional deficiencies leading to neurological complications and destructing the brain cell. As we age, memory begins to decline, and thus by lowering our intake of high calorific foods and salt intake, we could reduce metabolic syndrome-related and age-related issues like blood pressure, T2DM, obesity, etc. Thus, to curb diseases linked with Junk foods, awareness about nutritional values of foods among adolescents and higher tax slabs of junks foods should be made to reduce the purchase of such products.
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Honey often referred to as ‘the drink of the gods’, is naturally sweet and a substantially rich source of carbohydrates, amino acids and antioxidants. In spite of being rich in carbohydrates, honey has a low glycemic index and therefore effectively used as a dietary compliance by diabetics. The fructose content of honey has hepatoprotective capability, while the antioxidants present in it provide effective protection against oxidative damage. The therapeutic attribute of honey makes it the food of choice even in infants and diabetics. Honey is endowed with antioxidant, immune modulating, and wound healing, anti-inflammatory, therapeutic, nutritional, antimicrobial and antidiabetic qualities. The present review aims at discussing these capabilities of honey with special reference to its antidiabetic benefits under one dome.
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The definition of what constitutes a healthy diet is continually shifting to reflect the evolving understanding of the roles that different foods, essential nutrients, and other food components play in health and disease. A large and growing body of evidence supports that intake of certain types of nutrients, specific food groups, or overarching dietary patterns positively influences health and promotes the prevention of common non-communicable diseases (NCDs). Greater consumption of health-promoting foods and limited intake of unhealthier options are intrinsic to the eating habits of certain regional diets such as the Mediterranean diet or have been constructed as part of dietary patterns designed to reduce disease risk, such as the Dietary Approaches to Stop Hypertension (DASH) or Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets. In comparison with a more traditional Western diet, these healthier alternatives are higher in plant-based foods, including fresh fruits and vegetables, whole grains, legumes, seeds, and nuts and lower in animal-based foods, particularly fatty and processed meats. To better understand the current concept of a “healthy diet,” this review describes the features and supporting clinical and epidemiologic data for diets that have been shown to prevent disease and/or positively influence health. In total, evidence from epidemiological studies and clinical trials indicates that these types of dietary patterns reduce risks of NCDs including cardiovascular disease and cancer.
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This is a report published by the Food and Agriculture Organization of the United Nations. Jose Graziano da Silva, outgoing FAO director-general, says: ‘Glad to see FAO report on NOVA classification and ultra-processed food, by Carlos Monteiro and the NUPENS/USP team [ showing] consistent evidence on how the consumption of ultra-processed food causes obesity and many chronic non-communicable diseases’. Carlos Monteiro adds: ‘this is the first time that the peer-reviewed literature linking ultra-processed food intake to diet quality and to risk of non-communicable diseases has been brought together and analysed. This report as published by FAO is a great step forward'. The report examines the peer-reviewed literature on the effects of ultra-processed foods on diet quality and on health. Papers on the effects on diet quality reported results from nineteen nationally-representative studies. Papers on health outcomes reported results from nine nationwide cross-sectional studies, sixteen longitudinal studies and one randomized controlled trial. The results from the studies on diet quality show significant and graded associations between the dietary share of ultra-processed foods and dietary nutrient profiles prone to non-communicable diseases, including high or excessive content of free or added sugar, saturated and trans fats, and sodium, and also high dietary energy density; and low or insufficient content of protein and dietary fibre. The results from the studies on health outcomes show plausible, significant, graded associations between the dietary share of ultra-processed foods and the occurrence or incidence of several non-communicable diseases, including obesity and obesity-related outcomes, cardiovascular and metabolic diseases, breast and all cancers, depression, gastrointestinal disorders, frailty in the elderly, and also premature mortality. In the case of short-term increases in body weight and fat, this is solidly supported by a randomised controlled trial conducted by the US National Institutes of Health. These findings are all fully referenced in the report. Carlos Monteiiro adds: 'The conclusion is clear. Governments at all levels now need to agree and enact statutory including fiscal policies that support and protect enjoyment of freshly prepared meals. Worldwide, these are based on minimally processed foods and include processed culinary ingredients and processed foods. This means enormous opportunities for the food industry as a whole including producers of fresh foods, especially co-operative and family farmers that still produce most food all over the world, and also for producers of processed culinary ingredients and processed foods. At the same time, statutory measures must make ultra-processed foods, which are as great a menace to public health as tobacco, less attractive, affordable and available’. ISBN 978-92-5-131701-3
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The US food supply is dominated by highly-processed packaged food and beverage products that are high in energy, saturated fat, sugar, and salt. We report results of a cross-sectional assessment of the 2018 US packaged food and beverage supply by nutritional composition and indicators of healthfulness and level of processing. Data were obtained through Label Insight’s Open Data database, which represents >80% of all food and beverage products sold in the US over the past three years. Healthfulness and the level of processing, measured by the Health Star Rating (HSR) system and the NOVA classification framework, respectively, were compared across product categories and leading manufacturers. Among 230,156 food and beverage products, the mean HSR was 2.7 (standard deviation (SD) 1.4) from a possible maximum rating of 5.0, and 71% of products were classified as ultra-processed. Healthfulness and level of processing varied substantially by category (range: HSR 1.1–3.9; 0–100% ultra-processed) and manufacturer (range: HSR 0.9–4.6; 26–100% ultra-processed). The US packaged food and beverage supply is large, heterogeneous, highly processed, and generally unhealthy. The wide variability in healthfulness and level of processing demonstrates that opportunities exist, through reformulation or replacement, for large-scale improvements to the healthfulness of the US packaged food and beverage supply.
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Objective To assess the prospective associations between consumption of ultra-processed foods and risk of cardiovascular diseases. Design Population based cohort study. Setting NutriNet-Santé cohort, France 2009-18. Participants 105 159 participants aged at least 18 years. Dietary intakes were collected using repeated 24 hour dietary records (5.7 for each participant on average), designed to register participants’ usual consumption of 3300 food items. These foods were categorised using the NOVA classification according to degree of processing. Main outcome measures Associations between intake of ultra-processed food and overall risk of cardiovascular, coronary heart, and cerebrovascular diseases assessed by multivariable Cox proportional hazard models adjusted for known risk factors. Results During a median follow-up of 5.2 years, intake of ultra-processed food was associated with a higher risk of overall cardiovascular disease (1409 cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet 1.12 (95% confidence interval 1.05 to 1.20); P<0.001, 518 208 person years, incidence rates in high consumers of ultra-processed foods (fourth quarter) 277 per 100 000 person years, and in low consumers (first quarter) 242 per 100 000 person years), coronary heart disease risk (665 cases; hazard ratio 1.13 (1.02 to 1.24); P=0.02, 520 319 person years, incidence rates 124 and 109 per 100 000 person years, in the high and low consumers, respectively), and cerebrovascular disease risk (829 cases; hazard ratio 1.11 (1.01 to 1.21); P=0.02, 520 023 person years, incidence rates 163 and 144 per 100 000 person years, in high and low consumers, respectively). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (saturated fatty acids, sodium and sugar intakes, dietary fibre, or a healthy dietary pattern derived by principal component analysis) and after a large range of sensitivity analyses. Conclusions In this large observational prospective study, higher consumption of ultra-processed foods was associated with higher risks of cardiovascular, coronary heart, and cerebrovascular diseases. These results need to be confirmed in other populations and settings, and causality remains to be established. Various factors in processing, such as nutritional composition of the final product, additives, contact materials, and neoformed contaminants might play a role in these associations, and further studies are needed to understand better the relative contributions. Meanwhile, public health authorities in several countries have recently started to promote unprocessed or minimally processed foods and to recommend limiting the consumption of ultra-processed foods. Study registration ClinicalTrials.gov NCT03335644 .
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Objective: To evaluate the association between consumption of ultra-processed foods and all cause mortality. Design: Prospective cohort study. Setting: Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018. Participants: 19 899 participants (12 113 women and 7786 men) aged 20-91 years followed-up every two years between December 1999 and February 2014 for food and drink consumption, classified according to the degree of processing by the NOVA classification, and evaluated through a validated 136 item food frequency questionnaire. Main outcome measure: Association between consumption of energy adjusted ultra-processed foods categorised into quarters (low, low-medium, medium-high, and high consumption) and all cause mortality, using multivariable Cox proportional hazard models. Results: 335 deaths occurred during 200 432 persons years of follow-up. Participants in the highest quarter (high consumption) of ultra-processed foods consumption had a higher hazard for all cause mortality compared with those in the lowest quarter (multivariable adjusted hazard ratio 1.62, 95% confidence interval 1.13 to 2.33) with a significant dose-response relation (P for linear trend=0.005). For each additional serving of ultra-processed foods, all cause mortality relatively increased by 18% (adjusted hazard ratio 1.18, 95% confidence interval 1.05 to 1.33). Conclusions: A higher consumption of ultra-processed foods (>4 servings daily) was independently associated with a 62% relatively increased hazard for all cause mortality. For each additional serving of ultra-processed food, all cause mortality increased by 18%.
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Background: The NOVA food classification scheme divides foods into ultra-processed, processed, unprocessed, and culinary ingredients. Ultra-processed foods contribute >60% of energy to diets in the US. Objective: To characterize ultra-processed foods by energy density, nutrient density, and monetary cost. Methods: The 384 component foods of Fred Hutch (FHCRC) food frequency questionnaire (FFQ), were assigned to 4 NOVA categories and to 7 USDA MyPyramid food groups. Energy density was kcal/g. Nutrient density was measured using the Nutrient Rich Food index NRF9.3. Food prices were collected in local supermarkets from 2004 to 2016. Analyses examined time trends in food prices by NOVA category and by USDA food group. Results: The ultra-processed classification captured mostly grains (91%), fats and sweets (73%), dairy (71%), and beans, nuts and seeds (70%), but only 36% of meat, poultry and fish, 26% of vegetables, and 20% of fruit. Compared to unprocessed foods, ultra-processed foods had lower nutrient density (NRF9.3 per 100 kcal: 21.2 vs. 108.5),higher energy density (mean (SD): 2.2 vs. 1.10 in kcal/g), and lower per calorie cost (0.55 vs. 1.45 in $/100 kcal). Ultra-processed foods did not increase in price as much as unprocessed foods over the 12 year period. Conclusion: Ultra-processed foods tend to be energy-dense, low-cost, and nutrient-poor. Low energy cost could be one mechanism linking ultra-processed foods with negative health outcomes. Food-based Dietary Guidelines may need to address food processing in relation to economic aspects of food choice.
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We investigated whether ultra-processed foods affect energy intake in 20 weight-stable adults, aged (mean ± SE) 31.2 ± 1.6 years and BMI = 27 ± 1.5 kg/m2. Subjects were admitted to the NIH Clinical Center and randomized to receive either ultra-processed or unprocessed diets for 2 weeks immediately followed by the alternate diet for 2 weeks. Meals were designed to be matched for presented calories, energy density, macronutrients, sugar, sodium, and fiber. Subjects were instructed to consume as much or as little as desired. Energy intake was greater during the ultra-processed diet (508 ± 106 kcal/day; p = 0.0001), with increased consumption of carbohydrate (280 ± 54 kcal/day; p < 0.0001) and fat (230 ± 53 kcal/day; p = 0.0004), but not protein (-2 ± 12 kcal/day; p = 0.85). Weight changes were highly correlated with energy intake (r = 0.8, p < 0.0001), with participants gaining 0.9 ± 0.3 kg (p = 0.009) during the ultra-processed diet and losing 0.9 ± 0.3 kg (p = 0.007) during the unprocessed diet. Limiting consumption of ultra-processed foods may be an effective strategy for obesity prevention and treatment.
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Background: The concept of ultra-processed foods (UPFs) is new, and it was proposed for the first time in 2009 as group 4 of the NOVA classification to address the degree of food processing. UPFs include not only “junk foods” but also foods marketed as healthy, such as light, vegan, organic, or gluten-free products. UPFs are characterized by the presence of highly-processed/purified “cosmetic” ingredients and/or additives to restore and/or exacerbate organoleptic properties, i.e., taste, aroma, color and texture. Substantial industrial processing techniques, e.g., puffing, extrusion cooking, and/or extreme fractioning/refining that greatly breakdown the food matrix, may also be markers of ultra-processing. The UPF concept has been consistently criticized for being an overly heterogeneous concept, and the NOVA classification has been criticized for being qualitative only and too imprecise. Scope and approach: This review is intended to discuss the UPF concept from a holistic perspective and to analyze the scientific soundness of criticisms about UPFs and NOVA. The UPF concept is first defined; then, its primary nutritional characteristics are described, followed by their association with health based on human studies. Key findings and conclusions: UPF criticisms differ between holistic and reductionist perspectives. In a holistic concept, reductionist researchers view the proposed definition of UPF as an imprecise, vague and heterogeneous technological group. However, from a holistic perspective, the UPF concept has serious advantages, such as broad and common deleterious health attributes (i.e., the loss of “matrix” effect, empty calories, poorly satiating, hyperglycemic and containing artificial compounds foreign to the human body).