Secular trend towards ultra-processed food consumption and expenditure compromises dietary quality among Taiwanese adolescents

  • Yu-Chun Chen
  • Yi-Chen Huang
  • Yuan-Ting C. Lo
  • Hsing-Juan Wu
  • Mark L. Wahlqvist
  • Meei-Shyuan Lee
Keywords: Ultra-processed food; Adolescent; NOVA; NAHSIT; Taiwan; Dietary quality


Objective: To compare two Nutrition and Health Surveys in Taiwan (NAHSITs) 15–18 years apart to evaluate secular changes in ultra-processed food (UPF) consumption and expenditure among Taiwanese adolescents aged 16–18 years and the influences of such changes on dietary quality.

Design: This cross-sectional study was based on two representative surveys (NAHSIT 1993–1996, n = 788; NAHSIT 2011, n = 1,274) of senior high school students. Dietary information and food expenditure were based on 24-h dietary recall. All food items were classified into original foods, processed culinary ingredients, processed foods, and UPFs based on NOVA criteria. Dietary quality was categorized as poor or good based on the mean of the Youth Healthy Eating Index–Taiwan Revised.

Results: Compared to 1993–1996, adolescents consumed less energy from original foods (55 vs. 39%) but more from processed foods (12 vs. 18%) and UPFs (21 vs. 25%) in 2011, with no apparent gender differences. Those who consumed more UPFs had the lowest proportions of protein energy intake in both surveys (13.7 and 13.1%). Those who consumed more UPFs had higher levels of saturated fat and lower levels of monounsaturated and polyunsaturated fat, dietary fiber, and micronutrient intakes. The participants who consumed more UPFs and fewer original foods exhibited poorer dietary quality. Boys and girls exhibited equal UPF expenditure in both surveys despite an increase in UPF energy consumption. The adjusted odds ratios (95% confidence interval) were 1.33 (1.16–1.52) and 1.36 (1.10–1.69) for the risk of poor dietary quality with 10% increases in UPF energy intake and expenditure, respectively, in 2011.

Conclusions: UPF energy consumption among Taiwanese adolescents increased between 1993–1996 and 2011. Observed trends in expenditure suggest that lower UPF costs influenced food choices during this period. Increasing UPF intake and expenditure was associated with poor dietary quality.


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  1. Poti JM, Mendez MA, Ng SW, Popkin BM. Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households? Am J Clin Nutr 2015; 101: 1251–62. doi: 10.3945/ajcn.114.100925.

  2. Wahlqvist ML. Food structure is critical for optimal health. Food Funct 2016; 7: 1245–50. doi: 10.1039/c5fo01285f.

  3. Monteiro CA. Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutr 2009; 12: 729–31. doi: 10.1017/S1368980009005291.

  4. Monteiro CA, Levy RB, Claro RM, de Castro IR, Cannon G. Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil. Public Health Nutr 2011; 14: 5–13. doi: 10.1017/S1368980010003241.

  5. Moubarac JC. Persisting problems related to race and ethnicity in public health and epidemiology research. Rev Saude Publica 2013; 47: 104–15.

  6. Tavares LF, Fonseca SC, Garcia Rosa ML, Yokoo EM. Relationship between ultra-processed foods and metabolic syndrome in adolescents from a Brazilian Family Doctor Program. Public Health Nutr 2012; 15: 82–7. doi: 10.1017/S1368980011001571.

  7. Moubarac JC, Parra DC, Cannon G, Monteiro C. Food classification systems based on food processing: significance and implications for policies and actions – a systematic literature review and assessment. Curr Obes Rep 2014; 3: 256–72. doi: 10.1007/s13679-014-0092-0.

  8. Bielemann RM, Santos Motta JV, Minten GC, Horta BL, Gigante DP. Consumption of ultra-processed foods and their impact on the diet of young adults. Rev Saude Publica 2015; 49: 28. doi: 10.1590/S0034-8910.2015049005572.

  9. Louzada ML, Baraldi LG, Steele EM, Martins AP, Canella DS, Moubarac JC, et al. Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Prev Med 2015; 81: 9–15. doi: 10.1016/j.ypmed.2015.07.018.

  10. Juul F, Hemmingsson E. Trends in consumption of ultra-processed foods and obesity in Sweden between 1960 and 2010. Public Health Nutr 2015; 18: 3096–107. doi: 10.1017/S1368980015000506.

  11. Martins AP, Levy RB, Claro RM, Moubarac JC, Monteiro CA. Increased contribution of ultra-processed food products in the Brazilian diet (1987–2009). Rev Saude Publica 2013; 47: 656–65. doi: 10.1590/S0034-8910.2013047004968.

  12. Moubarac JC, Batal M, Martins AP, Claro R, Levy RB, Cannon G, et al. Processed and ultra-processed food products: consumption trends in Canada from 1938 to 2011. Can J Diet Pract Res 2014; 75: 15–21. doi: 10.3148/75.1.2014.15.

  13. Storey M, Anderson P. Income and race/ethnicity influence dietary fiber intake and vegetable consumption. Nutr Res 2014; 34: 844–50. doi: 10.1016/j.nutres.2014.08.016.

  14. Dwyer J. Nutritional requirements of adolescence. Nutr Rev 1981; 39: 56–72.

  15. Kemm JR. Eating patterns in childhood and adult health. Nutr Health 1987; 4: 205–15. doi: 10.1177/026010608700400404.

  16. Chao KC, Chang CC, Owaga E, Bai CH, Huang TC, Pan WH, et al. Hb and dyslipidaemia as predicting markers of serum alanine aminotransferase elevation in Chinese adolescents. Public Health Nutr 2016; 19: 1067–73. doi: 10.1017/S1368980015002293.

  17. Yeh CY, Liao PS, Liu CY, Liu JF, Chang HY. An empirical study of Taiwan’s food security index. Public Health Nutr 2010; 13: 1056–63. doi: 10.1017/S1368980009991686.

  18. Pan WH, Chang YH, Chen JY, Wu SJ, Tzeng MS, Kao MD. Nutrition and health survey in taiwan (nahsit) 1993~1996: dietary nutrient intakes assessed by 24-hour recall. Nutr Sci J 1999; 24: 11–39.

  19. Department of Health. Nutrient composition data bank for foods in Taiwan Area. Taipei, Taiwan: DOH; 1998.

  20. Wu SJ, Chang YH, Wei IL, Kao MD, Lin YC, Pan WH. Intake levels and maj or food sources of energy and nutrients in the Taiwanese elderly. Asia Pac J Clin Nutr 2005; 14: 211–20.

  21. Chiang PH, Wahlqvist ML, Lee MS, Huang LY, Chen HH, Huang ST. Fast-food outlets and walkability in school neighbourhoods predict fatness in boys and height in girls: a Taiwanese population study. Public Health Nutr 2011; 14: 1601–9. doi: 10.1017/S1368980011001042.

  22. Feskanich D, Rockett HR, Colditz GA. Modifying the healthy eating index to assess diet quality in children and adolescents. J Am Diet Assoc 2004; 104: 1375–83. doi: 10.1016/j.jada.2004.06.020.

  23. Monteiro CA, Levy RB, Claro RM, Castro IR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica 2010; 26: 2039–49.

  24. Monteiro CA, Cannon G, Levy RB, Moubarac J-C, Jaime P, Martins AP, et al. NOVA. The star shines bright. [Food classification. Public health]. World Nutr 2016; 7: 28–38.

  25. Lo YT, Chang YH, Lee MS, Wahlqvist ML. Dietary diversity and food expenditure as indicators of food security in older Taiwanese. Appetite 2012; 58: 180–7. doi: 10.1016/j.appet.2011.09.023.

  26. Louzada ML, Martins AP, Canella DS, Baraldi LG, Levy RB, Claro RM, et al. Impact of ultra-processed foods on micronutrient content in the Brazilian diet. Rev Saude Publica 2015; 49: 45. doi: 10.1590/S0034-8910.2015049006211.

  27. Monteiro CA. The present role of industrial food processing in food systems and its implications for controlling the obesity pandemic. J Nutr Sci Vitaminol 2015; 61: S203.

  28. Monteiro CA, Cannon G. The impact of transnational ‘big food’ companies on the South: a view from Brazil. PLoS Med 2012; 9: e1001252. doi: 10.1371/journal.pmed.1001252.

  29. Baker P, Friel S. Processed foods and the nutrition transition: evidence from Asia. Obes Rev 2014; 15: 564–77. doi: 10.1111/obr.12174.

  30. Monteiro CA, Gomes FS, Cannon G. The snack attack. Am J Public Health 2010; 100: 975–81. doi: 10.2105/AJPH.2009.187666.

  31. Monteiro CA, Moubarac JC, Cannon G, Ng SW, Popkin B. Ultra-processed products are becoming dominant in the global food system. Obes Rev 2013; 14(Suppl 2): 21–8. doi: 10.1111/obr.12107.

  32. Powell LM, Nguyen BT, Han E. Energy intake from restaurants: demographics and socioeconomics, 2003–2008. Am J Prev Med 2012; 43: 498–504. doi: 10.1016/j.amepre.2012.07.041.

  33. Sparrenberger K, Friedrich RR, Schiffner MD, Schuch I, Wagner MB. Ultra-processed food consumption in children from a Basic Health Unit. J Pediatr (Rio J) 2015; 91: 535–42. doi: 10.1016/j.jped.2015.01.007.

  34. Pan WH, Wu HJ, Yeh CJ, Chuang SY, Chang HY, Yeh NH, et al. Diet and health trends in Taiwan: comparison of two nutrition and health surveys from 1993–1996 and 2005–2008. Asia Pac J Clin Nutr 2011; 20: 238–50. doi: 10.6133/apjcn.2011.20.2.14.

  35. Fardet A. Minimally processed foods are more satiating and less hyperglycemic than ultra-processed foods: a preliminary study with 98 ready-to-eat foods. Food Funct 2016; 7: 2338–46. doi: 10.1039/c6fo00107f.

  36. Rauber F, Campagnolo PD, Hoffman DJ, Vitolo MR. Consumption of ultra-processed food products and its effects on children’s lipid profiles: a longitudinal study. Nutr Metab Cardiovasc Dis 2015; 25: 116–22. doi: 10.1016/j.numecd.2014.08.001.

  37. Moodie R, Stuckler D, Monteiro C, Sheron N, Neal B, Thamarangsi T, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet 2013; 381: 670–9. doi: 10.1016/S0140-6736(12)62089-3.

  38. World Health Organization, Food and Agriculture Organization of the United Nations. Preparation and use of food-based dietary guidelines: report of a joint FAO/WHO consultation. WHO technical report series; 880. Geneva: WHO; 1998.

  39. Fischer CG, Garnett T. Plates, pyramids and planets. Developments in national healthy and sustainable dietary guidelines: a state of play assessment. FAO and University of Oxford; 2016. Available from: [cited 23 February 2017].

  40. Wahlqvist ML. Connected Community and Household Food-Based Strategy (CCH-FBS): its importance for health, food safety, sustainability and security in diverse localities. Ecol Food Nutr 2009; 48: 457–81. doi: 10.1080/03670240903308596.

  41. Lee MS, Huang YC, Su HH, Lee MZ, Wahlqvist ML. A simple food quality index predicts mortality in elderly Taiwanese. J Nutr Health Aging 2011; 15: 815–21. doi: 10.1007/s12603-011-0081-x.

How to Cite
Chen Y-C, Huang Y-C, Lo Y-T, Wu H-J, Wahlqvist M, Lee M-S. Secular trend towards ultra-processed food consumption and expenditure compromises dietary quality among Taiwanese adolescents. fnr [Internet]. 2018Sep.17 [cited 2018Oct.21];620. Available from:
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