Ultra processed food consumption by urbanization level among US youth and adults: Cross-Sectional Analysis of NHANES 2013-March 2020.

Objective: To describe the mean contribution to total energy and total gram intakes from ultra processed foods (UPF), unprocessed or minimally processed foods (MPF), other Nova categories and subcategories by urbanization level among US youth and adults.

Methods: Cross-sectional data from the National Health and Nutrition Examination Survey from 2013-March 2020 were analyzed. The mean percent of total energy and total gram intakes from Nova categories (MPF, processed culinary ingredients (PCI), processed foods (PF), and UPF) were estimated by urbanization (non-metropolitan statistical areas (non-MSAs, n=3,976), small to medium MSAs (n=9,170), and large MSAs (n=14,637)) for youth 2-19 years and adults 20 and older. Trends by urbanization were assessed using orthogonal contrasts in linear regression models adjusted for sex, age, race/Hispanic origin, and income. Day 1 dietary sample weights accounted for differential probabilities of selection, nonresponse, noncoverage and day of the week.

Results: Among youth, there was no trend in MPF or UPF as a percent of energy by urbanization level. As a percent of grams, MPF increased and UPF decreased with higher urbanization level. After adjustment for sex, age, race and Hispanic origin, and income, only the trend in the percent of grams from MPF remained. Among adults, as both a percent of energy and a percent of grams, MPF increased and UPF decreased with higher urbanization level. These trends remained significant after adjustment for covariates.

Conclusions: Adults in rural areas consumed more UPF and less MPF than those in urban areas in terms of both energy and grams. There were few significant differences by urbanization among youth.