By christine ince

y granddaughter loves Cheerios. Is it an ultra-processed food (UPF)? I look at the label; the first ingredient listed is whole grain oats, then corn starch, sugar, salt, Tri potassium phosphate, and vitamin E. The cereal is processed, but is it ultra-processed?

There is a consensus that UPFs are not good for you. In the United States, it is estimated that children have increased their intake of UPF to about 70% of their diet, with a disproportionate increase seen in non-Hispanic black children.

What is ultra-processed food? The history of research in this area dates to the mid-1990s when a group of researchers in Brazil noted that their children had increased rates of obesity. They conducted food surveys and found out that the country was migrating from basic food staples to prepackaged processed foods. Dr. Monteiro and his team came up with a grading system called Nova (new in Portuguese) for food groups widely used today.

The Nova system has four groups:

• Minimally processed foods, like, fruits, vegetables, grains, flour, pasta, and rice. May be packaged or frozen.
• Processed culinary ingredients used in cooking, like oil, butter, and salt.
• Processed foods like bread that combine category 1 and 2 ingredients preserving or modifying them, like freshly baked bread or canned tomato sauce.
• Ultra-processed foods is the category we should be concerned about. This food category puts together chemically processed foods with additives like high fructose corn syrup, artificial chemicals, and colors. Foods in this category range may include packaged cookies, ice cream, hot dogs, margarine, and packaged bread.

A study published earlier this year reviewed other studies covering about 10 million people. The authors concluded that there was a direct association between UPF and 32 conditions including overall mortality, type 2 diabetes, obesity, and some mental disorders.

Will cutting out 1-2 servings of UPF per day help? In one study, The Framingham Offspring study, each additional serving of UPF per day (e.g. potato chips, ice cream, a soda), added a 5% increased risk of coronary artery disease.

Another study linked UPF to an increased risk of colon cancer.

There are limitations to these studies. They mainly focus on the level of processed foods and not on the quality of food. For instance, packaged whole wheat bread with additives to preserve shelf life may be in the same category as a candy bar. Overall, the literature agrees that poor-quality food and ultra ultra-processed foods lead to poor health outcomes.

In conclusion, most breakfast cereals are ultra-processed if you look at the ingredients. Find cereals without added sugar, dyes, and additives. There is an app recommended by Monteiro to rate food (us.openfoodfacts.org) and I looked up Cheerios. It did not fall under the ultra-processed category. I was relieved. Common sense is important. You probably don’t need to look up the ingredients of doughnuts to know that they are not a good breakfast food.

Another takeaway: eat at home which is more affordable and healthier. Canned and frozen options are OK without added sugar and salt.

Lastly, lobby your local representatives, grocery stores, and schools to provide healthier options for our children, and set an example for the children by limiting the UPFs yourself!

CHRISTINE INCE, MD, is a semi-retired medical oncologist who writes from Alexandria, Louisiana.