As an oncology dietitian, I have long described processed foods as being on a spectrum. For example: on one end of the spectrum you have a whole apple; somewhere in the middle you have dried apples, applesauce, and apple juice; and on the opposite end of the spectrum you have foods such as apple candies or apple pastries. All of those foods contain apple, but they all have been processed to different degrees and all contain a varying level of nutrition. It is not black and white. There is not simply unprocessed food or processed food, but a wide grey middle area that exists. Many Americans are aware that “processed” foods can be less nutritious than unprocessed foods. But at what point of processing and adding additional ingredients like excess salt, fat and sugar does food become more harmful than helpful to us? Until recently, we didn’t have guidance that reflects the spectrum of processed foods to use to make healthy food choices.
The NOVA Classification system for processed foods.
The NOVA classification system was originally identified by researchers in Brazil and has been widely accepted across the globe. This system allows us to better define what foods to consume more often and less often based on their level of processing. The NOVA classification system breaks food into four groups, with NOVA Group 1 foods being unprocessed or minimally processed and NOVA Group 4 foods being ultra-processed. Let’s break down the four groups1:
| Group 1: Unprocessed and Minimally Processed Foods include foods from plants and animals that have either undergone no alteration or are minimally processed, but no oils, fats, sugar, salt or other substance has been added. Consume these foods most often. Unprocessed and minimally processed foods include fresh, frozen, or dried fruits or vegetables,100% juice, potatoes and sweet potatoes, whole grains such as rice, corn and wheat (including pasta), beans and lentils, unsalted nuts and seeds, fresh or frozen meat, poultry or fish, eggs, unsweetened yogurt, milk, tea, coffee, water, herbs, and spices. | Group 2: Processed Culinary Ingredients are products extracted from natural foods that are used in home kitchens and restaurants to season and cook food. Processed culinary ingredients include oils, fats, white and brown sugar, molasses, maple syrup, honey, and salt. |
| Group 3: Processed Foods have been typically produced in a factory, including the addition of salt, sugar, oil, and other substances to unprocessed or minimally processed foods. Processed foods include canned beans or vegetables using salt, canned fruit in syrup, beef jerky and bacon, canned fish, smoked or cured meat, cheese, bread, and fermented alcoholic beverages such as beer, wine and cider. | Group 4: Ultra-Processed Foods (UPFs) are also produced industrially. However, these foods are produced with ingredients produced in laboratories and typically not found in a home kitchen such as isolates, monoglycerides or xanthan gum. Consume these foods less often. Ultra-processed foods include soda, energy drinks, meal replacement drinks, chocolate milk, sweetened yogurts, ice cream, cake mixes, instant sauces or soups, fast food, chicken nuggets, frozen pizza, breakfast cereal, fast food, boxed meals, and distilled alcohol such as rum or vodka. |
Health risks of ultra-processed foods
Over recent decades, we have experienced an increase in global intake of ultra-processed foods (NOVA Group 4.) The average American’s diet currently consists of approximately 50-60% ultra-processed foods.2 This rise in ultra-processed food consumption is drawing awareness, as it is associated with an increase in premature death as well as several additional health conditions, including3:
- Cancer
- Heart disease
- Anxiety
- Depression
- Obesity
- Type 2 diabetes
These findings warrant our attention to consider how we make food choices. Individuals and the food industry are encouraged to make changes to reduce American’s intake of NOVA Group 4 ultra-processed foods.
While these potential health outcomes are certainly alarming, it is important to step back and remember that not all processed foods are created equal and elicit the same level of concern.
Selecting nutritious foods for your diet
Should we eliminate all processed food from our diets? No. There are many processed foods that are very nutritious and can be great additions to your diet. Some examples are canned beans and lentils, 100% whole wheat bread, shredded wheat breakfast cereal, canned nuts, cheese, canned salmon, and fruited yogurt. Ask yourself, “Does this food provide me with nutrition?” If the answer is no, that food may be best consumed on occasion.
Use these recommendations to make healthy food choices4:
- Aim for at least 2/3 of your overall diet to come from plant-based foods such as whole grains, beans and lentils, fruit, and vegetables (NOVA Groups 1, 2, and 3) and limit animal-based foods such as poultry, fish, eggs and dairy (also NOVA groups 1, 2, and 3) to no more than 1/3 of your overall diet.
- Compare nutrition labels and choose foods that contain less sodium, added sugar and saturated fat.
- Limit NOVA Group 4 foods that provide little to no nutritional benefit such as pastries, soda, packaged cookies, candy, fried foods and fast food.
- Although alcoholic beverages span both NOVA Groups 3 and 4, note that alcohol intake should be limited if you choose to consume alcohol.
- If you eat red meat including beef, pork, lamb or goat, limit to no more than 12-18 oz per week (cooked), and avoid processed meat such as lunch meat, bacon, hot dogs and sausage.
- Limit sugar sweetened beverages. Aim for your fluid intake to consist of mainly water and other unsweetened drinks.
It is essential to note that during certain phases of life, such as when you are living with cancer, food choices may need to be a bit different than they were previously. Side effects such as nausea, loss of appetite, difficulty swallowing, or mouth sores may make it challenging to consume foods you previously may have eaten. Or you may be so fatigued that cooking is challenging during this time. Including processed foods that offer health benefits such as protein shakes, sports drinks, canned soup, or a frozen chicken pot pie can be a helpful complement to your diet during these periods.
Finding balance
Not all processed food is “bad.” Actually, the opposite is true. Many processed foods are very nutritious and can be healthy to consume more often. Some food processing is important to add needed nutrients to our food supply and to preserve foods. To reduce your risk for cancer and several other chronic health conditions, reduce your intake of ultra-processed foods (NOVA Group 4), and increase your intake of unprocessed, minimally unprocessed and some processed foods (NOVA Groups 1, 2, and 3) in your diet. It is helpful that these findings are consistent with and provide a helpful extension to current nutrition recommendations for cancer prevention and survivorship from the American Institute for Cancer Research and Dietary Guidelines for Americans.4,5 Remember, the foods that you consume most often will make the most significant impact on your health. What side of the spectrum of processed food does your scale tip towards?
Through LLS’s Nutrition Education Services Center patients and caregivers of all cancer types can receive a free nutrition consultation with a registered dietitian who has expertise in oncology nutrition.
If you have further questions or would like guidance making changes to your diet, consider asking your doctor for a referral to see a registered dietitian. The Academy of Nutrition and Dietetics can help you locate registered dietitians in your area that are specialized to meet your health needs, such as cancer care. Remember to verify the coverage details within your health plan to determine if registered dietitian services are included.
Resources:
Nutrition Handbook for Parents
References:
- Monteiro, C.A., Cannon, G., Lawrence, M., Costa Louzada, M.L. and Pereira Machado, P. 2019. Ultra-processed foods, diet quality, and health using the NOVA classification system. Rome, FAO.
- Paglial G., Dinu M., Madarena M. P., Bonaccio M., Iacoviello L., Sofi F. Consumption of ultra-processed foods and health status: a systematic review and meta analysis. British Journal of Nutrition. (2021) 125(3):308-318. https://doi.org/10.1017/S0007114520002688
- Lane M. M., Gamage E., Du S., Ashtree D. N., McGuinness A. J., Gauci S., Baker P., Lawrence M., Rebholz C. M., Srour B., Touvier M., Jacka F. N., O’Neil A., Segasby T., Marx W. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. British Medical Journal, (2024) 384:e077310. https://doi.org/10.1136/bmj-2023-077310
- How to Prevent Cancer: 10 Recommendations. (2024). American Institute for Cancer Research. https://www.aicr.org/cancer-prevention/how-to-prevent-cancer/
- Dietary Guidelines for Americans. (Retrieved May 27,2024) U.S. Department of Agriculture and U.S. Department of Health and Human Services. DietaryGuidelines.gov
