Can European risk-factor monitoring capture ultra-processed food consumption?

Background

Ultra-processed foods (UPF) are increasingly recognised as a risk factor for non-communicable diseases (NCDs). European dietary monitoring remains shaped by dietary guidelines, food groups and behavioural risks. This study assessed whether current frameworks capture UPF within integrated NCD risk-factor surveillance.

Methods

JA PreventNCD Country Fact Sheets from 16 countries identified frameworks monitoring dietary behaviour. European Health Interview Survey(EHIS), Children Obesity Surveillance Initiative(COSI) and Health Behaviour in School-aged Children(HBSC) were selected for prevalence and combined life-course coverage. Using NOVA as the referential UPF framework, their dietary indicators were assessed for compatibility. EU Menu Guidance (EMG) and FoodEx2-based assessment served as a comparator, given evidence of suitability for estimating UPF intake. The EMG was reviewed for NCD risk factors beyond diet.

Results

A structural trade-off was identified between UPF measurement precision and integrated risk-factor surveillance. EHIS, COSI and HBSC provide broad behavioural risk coverage across the life course, but their dietary indicators are too aggregated for NOVA-classification. EMG and FoodEx2-based assessment provides food-level detail for UPF estimation, including anthropometry and physical activity, but mainly to interpret energy balance rather than support NCD prevention-oriented surveillance. Neither approach sufficiently supports assessment of how UPF exposure relates to wider behavioural and psychosocial risk factors, or how these risks cluster.

Conclusions

European NCD risk-factor monitoring reflects a focus on dietary adequacy, food groups, guideline adherence and behavioural risks. Changing food environments and supply-side shifts highlight a need to widen rather than replace existing priorities. Validated UPF measures could strengthen prevention policies and regulation if incorporated alongside dietary adequacy and behavioural risk data.

Key messages

• Current monitoring frameworks show a trade-off between UPF estimation and wider NCD risk-factor surveillance.

• Validated UPF measures could help assess how UPF exposure relates to and clusters with other NCD risks across the life course.