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expert reaction to study looking at ultra-processed foods and cardiometabolic risk factors in children

A study published in JAMA Network Open looks at UPFs and cardiometabolic risk factors in children. 


Prof Mark Hanson, Emeritus Professor of Human Development and Health, and British Heart Foundation Professor, University of Southampton, said:

“The study of Khoury and colleagues adds to previous work showing an association between unhealthy diet in childhood and obesity and cardiometabolic risk, now with information on blood risk markers and ultraprocessed foods in the diet.

“The authors correctly refrain from claiming causality.  We know that unhealthy diets track from parents to children.  Here the mothers of higher risk children were younger, more likely to be overweight or obese, not to breast feed and to have lower educational and employment status.

“In tackling the social problem of obesity and cardiometabolic disease, the study raises the question of when best to intervene – in parents before they conceive, in pregnancy, or in young children?”


Dr Duane Mellor, Dietitian and Spokesperson for British Dietetic Association, said:

“This is an interesting paper looking at the dietary pattern of young children aged 3-6 years old in seven cities across Spain.  This study according to the title looked at the association between body weight, body fatness, blood pressure and cholesterol and the reported food intake using a 125 food questionnaire.  This reported an association between intakes of ultra-processed foods and higher body weight, body fatness, waist circumference, fasting glucose and lower HDL cholesterol — we can’t say that this was a causal relationship as it was an observation of the association between food intake and these markers of health at the baseline/start of this study.  Although the authors attempted to correct for a number of variables including their mothers level of education and age, they did not consider the effect of overall diet quality or healthiness.

“When looking more closely at the data, although the title proposes that the association between diet and risk of markers of heart and metabolic health is down to intake of ultra processed foods, it seems that those reported to have higher intakes of ultra processed food, actually drank more sugary drinks, ate more sugar and candies, and ate less fibre, healthy fats, white and unprocessed meats, vegetables, fruit, nuts, and legumes along with less refined cereals.  So, rather than specifically suggesting that ultra-processed foods are associated with cardio-metabolic risk factors, the association perhaps is that lower quality diets which lacks vegetables, fruit, nuts, legumes and unprocessed meats along with healthy fats, protein and fibre are being found to be associated with a high risk in this study.  So, although the concept of ultra-processed foods is getting a lot of attention, rather than clearly showing that ultra processed foods are the problem this study appears to show that a less healthy diet that contains less minimally processed foods such as vegetables, fruit, nuts, legumes and unprocessed meats is perhaps more of an issue.  This point is something the authors suggest in the final conclusion of the paper, saying that nutritional advice needs to highlight the importance of promoting unprocessed or minimally processed foods.  So perhaps an alternative title for this paper could have been ‘diets low in vegetables, fruits, nuts etc and cardiometabolic risk in children’.”


Prof Gunter Kuhnle, Professor of Nutrition and Food Science, University of Reading, said:

“This study investigates the associations between ultra-processed food intake and CVD risk in children.  However, the method the authors used to estimate UPF intake is very unreliable – many of the food categories included in the questionnaire can be either ultra-processed or non-ultra processed, such as breads, pizzas or cakes1.  This introduces a huge measurement error which makes the results unreliable.

“The data in the paper suggest that those children classed as consuming low amounts of ultra-processed foods consumed more fibre and more fruits and vegetables – and it is likely that this is an explanation for the observed differences, not the degree of processing of the foods consumed.

“Observational studies are unlikely to provide us more insight into the associations between UPF intake and health as most studies do not use appropriate methods to determine UPF intake.”


1 the questionnaire used is here:



‘Ultraprocessed Food Consumption and Cardiometabolic Risk Factors in Children’ by Nadine Khoury et al. was published in JAMA Network Open at 16:00 UK time on Friday 17 May 2024.

DOI: 10.1001/jamanetworkopen.2024.11852



Declared interests

Prof Mark Hanson: “No conflicts of interest.”

Dr Duane Mellor: “I have discussed and been a consultant about the concept of UPF for EUFIC, and APPGs (both unpaid as part of my previous academic role), and members of the food industry (including Mars and Danone as a paid independent consultant).”

Prof Gunter Kuhnle: “


  • University of Reading (since 2010) and member of the USS pension scheme which has a portfolio that includes manufacturers of ultra-processed foods;
  • Director of the University of Reading Chemical Analysis Facility with frequent interaction with instrument manufacturers and external and internal users from a range of backgrounds</href.

Research funding

  • current funding from BBSRC TUKFS (Co-I, since 2020);
  • past research funding from Mars, Inc (2014-2018); EU Horizon Programme (2012-2016);
  • Please see my ORCID record for details.

Committee membership

  • Committee on Toxicity (COT) and various working groups;
  • past member of the EFSA ANS panel and the American Academy of Nutrition and Dietetics working group on flavanols; Scientific advisory committee of the British Nutrition Foundation; Organising committee of the International Conference on Polyphenols and Health.

Scientific organisations

  • Scientific organisations: British Mass Spectrometry Society, Nutrition Society, Deutsche Gesellschaft für Epidemiologie and Deutsche Gesellschaft für Ernährung; Trinity Hall Alumni Organisation;
  • Registered Nutritionist.


  • Trustee of a Parent Teacher Association;
  • Family Vineyard.”


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