Can European risk-factor monitoring capture ultra-processed food consumption?
Abstract
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.
Related
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- Circulating metabolites and fatty acids associated with ultra-processed food consumption: results from the EPIC study
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- Ultra-processed food consumption and dental pain in adolescents: a descriptive analysis, Brazil, 2019.
BibTeX
@article{frydensberg2026european,
title = {{Can European risk-factor monitoring capture ultra-processed food consumption?}},
author = {MS Frydensberg and TM Sørensen and ES Høstrup and IDS Figueira and NML Rasmussen and V Possenti and N Rossi},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1323},
url = {https://doi.org/10.1093/eurpub/ckag169.1323},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Can European risk-factor monitoring capture ultra-processed food consumption?
AU - MS Frydensberg
AU - TM Sørensen
AU - ES Høstrup
AU - IDS Figueira
AU - NML Rasmussen
AU - V Possenti
AU - N Rossi
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1323
UR - https://doi.org/10.1093/eurpub/ckag169.1323
AB - 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.
SN - 1101-1262
SN - 1464-360X
ER -