It is important for insurers to understand potential causes, such as high ultra-processed food (UPF) consumption, behind rising rates of non-communicable diseases. In this article from RGA's ReFlections newsletter, Hilary Henly explains the components and classification of UPFs and discusses their impact on human health.
Consumption of ultra-processed foods (UPFs) has risen dramatically in recent decades, leading to increasing rates of overweight and obesity, cardiovascular disease (CVD), cancer, and depression. It may also increase future costs, to both consumers and insurers, for life insurance products.
It is important insurers understand novel causes such as high UPF consumption that are behind rising rates of non-communicable diseases and their potential impacts. This article explains what UPFs are, details their ingredients and how they are classified, and discusses their impact on human health.
Ultra-processed foods (UPFs) are industrially produced foodstuffs. They are made mostly or wholly from additives as well as from ingredients derived from whole foods, and contain several items not usually found in home kitchens. These foods are designed specifically to have long shelf lives; to be extremely palatable, convenient, and affordable; and to be highly profitable.
Nutrition is widely recognized as a crucial factor in health and longevity. As numerous UPFs are high in salt, sugar, and saturated fat, and low in nutrients such as fiber and vitamins, their consumption is increasingly resulting in poor nutritional health, which may lead to more morbidity and mortality claims due to non-communicable diseases.
The NOVA food classification system, which is commonly used to describe population dietary patterns, defines UPFs as “industrial formulations of ingredients that undergo a series of physical, chemical, and biological processes.” First developed in Brazil in 2009, NOVA organizes foods into one of four groups, based on the level of processing involved.3
As a percentage of total calories in many countries, UPF consumption almost tripled from 1990 to 2010, rising from 11% to 32%.1 Recent surveys show that in Europe, the U.S., Canada, New Zealand, and Latin America, UPFs represent between 25% and 60% of total daily energy intake.2 Figures from the U.S. alone show that American adults are consuming more UPFs than ever before. From 2001 to 2002, UPFs accounted for 53.5% of calorie intake, and by 2017-2018, they comprised 57%.3 During roughly the same period (1999-2018), prevalence of obesity climbed from 27.5% to 43% among males and from 33.4% to 41.9% among females.4
According to the British Heart Foundation, more than half of the average British diet is made up of UPFs, higher than any country in Europe.5 Across 22 European countries, the energy share obtained from UPFs ranged from 14% to 44%, reflecting a daily average of 27.2% of total energy intake.6
UPFs often have poor nutritional content, as they are high in sodium, certain artificial sweeteners, additives such as emulsifiers and preservatives, and total and saturated fat. They are also low in potassium, fiber, and micronutrients such as vitamins and minerals. For example, sulfites – additives used widely as preservatives, stabilizers, and flavor enhancers – have been found to cause cardiovascular disease (CVD) in animal models. Artificial sweeteners and emulsifiers are thought to disrupt the gut microbiota, promoting inflammation and metabolic dysregulation.7 In addition, phosphates have been found to be a cardiovascular risk factor, and artificial sweeteners could also exacerbate atherosclerosis.2
UPFs also have been found to be contaminated by microplastics as well as by chemicals such as phthalates and bisphenol A (BPA), which are widely used in food packaging. Studies show a significant association between exposure to phthalates and BPAs and an increased risk of cardiometabolic disorders.2
Other contaminants due to UPF production methods are acrolein, which is formed during the heating of fat, and acrylamide, which is formed in heat-treated food products. Both of these can be toxic to cardiovascular tissue.8 Carcinogenic compounds such as heterocyclic amines and polycyclic aromatic hydrocarbons also have been identified in UPFs.2, 9 And even non-artificial additives such as the thickening agent carrageenan may be cause for concern, as its ingestion may lead to glucose intolerance and insulin resistance.
In 2020, an estimated 2.6 billion people worldwide were either overweight or obese (BMI >30kg/m2), and this figure is projected to rise to higher than 4 billion by 2035.10 Individuals who consume substantial amounts of UPFs have higher odds of obesity than those who consume lesser amounts.
In a U.S. study of 20 inpatient adults given a diet high in either UPFs or unprocessed foods for 14 days, participants on the UPF diet gained an average of 0.9 kg (+/-0.3 kg) in weight, while participants eating an unprocessed diet lost an average of 0.9 kg (+/-0.3 kg). (Those on the UPF diet also consumed on average 508 kcal more per day.) Sodium intake also was significantly higher for those eating UPFs: 5.8 g/day versus 4.6 g/day in the unprocessed foods diet.11
A U.S. study of 9,640 adults ages 20 to 59 found that adults in the highest quintile of UPF consumption (>72.1% energy intake) had 1.6 times higher total body fat percentage compared to those in the lowest quintile (<39.4% energy intake).12
Global cancer incidence continues to rise. Cases are projected to increase from 19.3 million in 2020 to 30.2 million by 2040.13 Research shows that about half of cancer cases could potentially be avoided through diet modification and lower UPF consumption.14
In a study of 20,000 UK Biobank participants ages 40 to 69, mean UPF consumption was 22.9% of the diet. Participants with the highest consumption percentage compared to the lowest showed a 7% higher risk of any cancer, a 25% higher risk for lung cancer, a 52% higher risk for brain cancer, and a 63% higher risk for diffuse large B-cell lymphoma.14
CVD is the most common cause of death both worldwide and in the U.S., causing an estimated 17.9 million deaths worldwide and 840,000 U.S. deaths in 2016.8
Dietary factors play a crucial role in the development and prevention of CVD. High UPF consumption has been found to increase risk of high blood pressure, CVD, myocardial infarction, and stroke. In Europe in 2015, 56% of CVD deaths in men and 48% in women were related to dietary factors alone.2 In fact, a healthy and balanced diet can reduce risk of CVD by up to 50%.15
As UPFs are generally high in carbohydrates, saturated fat, and calories, and low in protein and fiber, the risk of inflammation and oxidative stress may be increased. They are also low in vitamins B12, D, E, and niacin (B6), as well as in a range of minerals (copper, iron, phosphorus, magnesium, selenium, and zinc) that are considered essential for optimal mental health16 and have been associated with alterations in the gut microbiome that are linked to the onset of depression.
Many studies indicate that high UPF consumption may be associated with early all-cause and cause-specific mortality. Individuals whose diets have higher percentages of UPFs are also more likely to smoke, have family histories of non-communicable diseases, and lead sedentary lifestyles, all of which may increase early mortality risk.
The Seguimiento Universidad De Navarra (SUN) prospective cohort study in Spain, comprising 19,899 participants from 1999 to 2014, found that those with the highest quartile of UPF consumption had higher all-cause mortality (HR 1.62) than those in the lowest quartile. For each additional serving of UPF, all-cause mortality increased by 18%.18
A study of UK Biobank participants investigated the relationship between all-cause mortality and consumption of UPFs. Individuals in the highest quartile of consumption compared to the lowest had significantly higher all-cause mortality risk (HR 1.22).15
Analysis from the Prospective Urban Rural Epidemiology (PURE) study of 138,076 participants between ages 35 and 70 across 21 countries found that a diet high in UPFs was associated with a 28% increased risk of all-cause mortality, a 17% increased risk of cardiovascular mortality, and a 32% increased risk of non-cardiovascular mortality compared to those with a low intake of UPFs.9 In a multi-national cohort study by the European Prospective Investigation into Cancer and Nutrition (EPIC) of more than 250,000 participants, higher UPF consumption was associated with increased risk of cancer and cardiometabolic diseases, most notably for animal-based products and for artificially and sugar-sweetened drinks as well (HR 1.09).19
Consumption of UPFs has risen significantly in recent decades, likely contributing to increased global incidence of cancer, CVD, mental health disorders, and overweight and obesity. These increases in non-communicable diseases could be directly impacting insurers, which may face rising claims costs and subsequently may need to adjust the cost of protection. UPFs are one of several novel factors of which insurers should be aware that are changing incidence rates of many diseases, and – over time – may alter the course of human health and longevity.
1. https://www.who.int/publications/i/item/9789290210672
2. https://pubmed.ncbi.nlm.nih.gov/31142457/
3. https://www.fao.org/fsnforum/index.php/resources/trainings-tools-and-databases/ultra-processed-foods-diet-quality-and-health-using-nova
4. https://www.sciencedirect.com/science/article/pii/S0002916522001253?via%3Dihub
5. https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2023/august/ultra-processed-foods-linked-to-cardiovascular-risk
6. https://pubmed.ncbi.nlm.nih.gov/34862518/
7. https://www.jacc.org/doi/10.1016/j.jacc.2021.01.047
8. https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-021-01081-3
9. https://ajcn.nutrition.org/article/S0002-9165(22)105241/pdf#:~:text=Results%3A%20In%20this%20study%2C%209227%20deaths%20and%207934,CI%3A%201.15%2C%201.42%3B%20P-trend%200.001%29%2C%20CV%20mortality%20%28HR%3A
10. https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2023
11. https://pubmed.ncbi.nlm.nih.gov/31105044/
12. https://pubmed.ncbi.nlm.nih.gov/36944386/
13. https://gco.iarc.fr/tomorrow/en/dataviz/isotype
14. https://www.thelancet.com/action/showPdf?pii=S2589-5370%2823%2900017-2
15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9527958/
16. https://www.medicalnewstoday.com/articles/ultra-processed-foods-may-increase-depression-risk-long-term-study-shows#1
17. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809727
18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538973/
19. https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00190-4/fulltext
