Urbanicity and socioeconomic status are jointly associated with ultra-processed food consumption
Abstract
Background: Dietary behaviours may vary by urbanicity and socioeconomic status (SES), but evidence on their joint association with ultra-processed food (UPF) consumption is limited. We examined differences in UPF intake across combined urbanicity–SES categories in a large Italian cohort.
Methods: Cross-sectional data from 21,836 adults in the Moli-sani cohort (enrolled 2005–2010) were analysed. Dietary intake was assessed using the Nova classification system, and the energy contribution of UPFs was estimated. Participants were classified according to area of residence (urban/rural) and a composite index of socioeconomic disadvantage; these variables were combined to define four urbanicity–SES categories. Multivariable general linear models were used to estimate adjusted means and 95% confidence intervals (CI) of UPF intake across exposure groups, controlling for potential confounders.
Results: UPF intake (% kcal) was highest among urban non-disadvantaged participants (n = 10,562; 20.3 %kcal; 95%CI: 20.1–20.6), followed by rural non-disadvantaged (n = 3927; 19.3; 95%CI: 19.0–19.6), urban disadvantaged (n = 4169; 18.9; 95%CI: 18.6–19.2), and lowest among rural disadvantaged individuals (n = 3178; 17.679; 95%CI: 17.4–18.0). All pairwise comparisons between categories were statistically significant (all p < 0.05), indicating distinct patterns of UPF consumption across different urbanicity–SES strata. The strongest difference was observed between urban non-disadvantaged and rural disadvantaged participants (mean difference=2.6; 95%CI: 2.3–2.9).
Conclusions: UPF consumption differed across groups defined by urbanicity and socioeconomic status. The highest intake was observed among urban non-disadvantaged participants, whereas the lowest was found among rural disadvantaged individuals. These findings suggest that both urban context and socioeconomic conditions should be considered in public health strategies aimed at reducing UPF consumption.
Key messages: • UPF consumption differs across groups defined by urbanicity and socioeconomic status, with the highest intake observed in urban non-disadvantaged participants
• Public health actions aimed at improving diet quality should consider both urban food environments and socioeconomic conditions
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BibTeX
@article{bonaccio2026urbanicity,
title = {{Urbanicity and socioeconomic status are jointly associated with ultra-processed food consumption}},
author = {M Bonaccio and A Di Castelnuovo and E Ruggiero and S Costanzo and S Esposito and G Di Costanzo and C Cerletti and MB Donati and G De Gaetano and L Iacoviello},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.008},
url = {https://doi.org/10.1093/eurpub/ckag169.008},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Urbanicity and socioeconomic status are jointly associated with ultra-processed food consumption
AU - M Bonaccio
AU - A Di Castelnuovo
AU - E Ruggiero
AU - S Costanzo
AU - S Esposito
AU - G Di Costanzo
AU - C Cerletti
AU - MB Donati
AU - G De Gaetano
AU - L Iacoviello
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.008
UR - https://doi.org/10.1093/eurpub/ckag169.008
AB - Background: Dietary behaviours may vary by urbanicity and socioeconomic status (SES), but evidence on their joint association with ultra-processed food (UPF) consumption is limited. We examined differences in UPF intake across combined urbanicity–SES categories in a large Italian cohort. Methods: Cross-sectional data from 21,836 adults in the Moli-sani cohort (enrolled 2005–2010) were analysed. Dietary intake was assessed using the Nova classification system, and the energy contribution of UPFs was estimated. Participants were classified according to area of residence (urban/rural) and a composite index of socioeconomic disadvantage; these variables were combined to define four urbanicity–SES categories. Multivariable general linear models were used to estimate adjusted means and 95% confidence intervals (CI) of UPF intake across exposure groups, controlling for potential confounders. Results: UPF intake (% kcal) was highest among urban non-disadvantaged participants (n = 10,562; 20.3 %kcal; 95%CI: 20.1–20.6), followed by rural non-disadvantaged (n = 3927; 19.3; 95%CI: 19.0–19.6), urban disadvantaged (n = 4169; 18.9; 95%CI: 18.6–19.2), and lowest among rural disadvantaged individuals (n = 3178; 17.679; 95%CI: 17.4–18.0). All pairwise comparisons between categories were statistically significant (all p < 0.05), indicating distinct patterns of UPF consumption across different urbanicity–SES strata. The strongest difference was observed between urban non-disadvantaged and rural disadvantaged participants (mean difference=2.6; 95%CI: 2.3–2.9). Conclusions: UPF consumption differed across groups defined by urbanicity and socioeconomic status. The highest intake was observed among urban non-disadvantaged participants, whereas the lowest was found among rural disadvantaged individuals. These findings suggest that both urban context and socioeconomic conditions should be considered in public health strategies aimed at reducing UPF consumption. Key messages: • UPF consumption differs across groups defined by urbanicity and socioeconomic status, with the highest intake observed in urban non-disadvantaged participants • Public health actions aimed at improving diet quality should consider both urban food environments and socioeconomic conditions
SN - 1101-1262
SN - 1464-360X
ER -