Ultra-processed food consumption and excess weight among US adults

Ultra-processed foods provide 58% of energy intake and 89% of added sugars in the American diet. Nevertheless, the association between ultra-processed foods and excess weight has not been investigated in a US sample. The present investigation therefore aims to examine the association between ultra-processed foods and excess weight in a nationally representative sample of US adults. We performed a cross-sectional analysis of anthropometric and dietary data from 15 977 adults (20-64 years) participating in the National Health and Nutrition Examination Survey 2005-2014. Dietary data were collected by 24-h recall. Height, weight and waist circumference (WC) were measured. Foods were classified as ultraprocessed/non-ultra-processed according to the NOVA classification. Multivariable linear and logistic regression was used to evaluate the association between ultra-processed food consumption (% energy) and BMI, WC and odds of BMI >= 25 kg/m(2), BMI >= 30 kg/m(2) and abdominal obesity (men: WC >= 102 cm, women: WC >= 88cm). Prevalence of BMI >= 25 kg/m(2), BMI >= 30 kg/m(2) and abdominal obesity was 69.2, 36.1 and 53.0%, respectively. Consuming >= 74.2 v. >= 36.5% of total energy from ultra-processed foods was associated with 1.61 units higher BMI (95% CI 1.11, 2.10), 4.07 cm greater WC (95 % CI 2.94, 5.19) and 48, 53 and 62% higher odds of BMI >= 25 kg/m(2), BMI >= 30 kg/m(2) and abdominal obesity, respectively (OR 1.48; 95% CI 1.25, 1.76; OR 1.53; 95% CI 1.29, 1.81; OR 1.62; 95% CI 1.39, 1.89, respectively; Pfor trend < 0.001 for all). A significant interaction between being female and ultra-processed food consumption was found for BMI (F4,79 = 4.89, P = 0.002), WC (F-4,F-79 = 3.71, P = 0.008) and BMI >= 25 kg/m(2) (F-4,F-79 = 5.35, P < 0.001). As the first study in a US population, our findings support that higher consumption of ultra-processed food is associated with excess weight, and that the association is more pronounced among women.