Skip to main content Accessibility help

The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing

  • Carlos Augusto Monteiro (a1) (a2), Geoffrey Cannon (a2), Jean-Claude Moubarac (a2) (a3), Renata Bertazzi Levy (a2) (a4), Maria Laura C Louzada (a2) and Patrícia Constante Jaime (a1) (a2)...


Given evident multiple threats to food systems and supplies, food security, human health and welfare, the living and physical world and the biosphere, the years 2016–2025 are now designated by the UN as the Decade of Nutrition, in support of the UN Sustainable Development Goals. For these initiatives to succeed, it is necessary to know which foods contribute to health and well-being, and which are unhealthy. The present commentary outlines the NOVA system of food classification based on the nature, extent and purpose of food processing. Evidence that NOVA effectively addresses the quality of diets and their impact on all forms of malnutrition, and also the sustainability of food systems, has now accumulated in a number of countries, as shown here. A singular feature of NOVA is its identification of ultra-processed food and drink products. These are not modified foods, but formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes (hence ‘ultra-processed’). All together, they are energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients. Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption. Studies based on NOVA show that ultra-processed products now dominate the food supplies of various high-income countries and are increasingly pervasive in lower-middle- and upper-middle-income countries. The evidence so far shows that displacement of minimally processed foods and freshly prepared dishes and meals by ultra-processed products is associated with unhealthy dietary nutrient profiles and several diet-related non-communicable diseases. Ultra-processed products are also troublesome from social, cultural, economic, political and environmental points of view. We conclude that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing
      Available formats


Corresponding author

* Corresponding author: Email


Hide All
1. Food and Agriculture Organization of the United Nations (2016) UN General Assembly proclaims Decade of Action on Nutrition. (accessed March 2017).
2. Global Panel on Agriculture and Food Systems for Nutrition (2016) Food Systems and Diets: Facing the Challenges of the 21st Century. London: Global Panel; available at
3. Pan American Health Organization of the World Health Organization (2015) Ultra-Processed Food and Drink Products in Latin America: Trends, Impact on Obesity, Policy Implications. Washington, DC: PAHO; available at
4. Monteiro, CA (2009) Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutr 12, 729731.
5. Food and Agriculture Organization of the United Nations (2015) Guidelines on the Collection of Information on Food Processing Through Food Consumption Surveys. Rome: FAO; available at
6. Food and Agriculture Organization of the United Nations & Food Climate Research Network (2016) Plates, Pyramids, Planet. Developments in National Healthy and Sustainable Dietary Guidelines: A State of Play Assessment. Rome/Oxford: FAO/University of Oxford; available at
7. Pan American Health Organization of the World Health Organization (2016) Nutrient Profile Model. Washington, DC: PAHO.
8. Ludwig, D (2011) Technology, diet, and the burden of chronic disease. JAMA 305, 13521353.
9. Moodie, R, Stuckler, D, Monteiro, CA et al. (2013) Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Non-communicable Diseases Series 4. Lancet 381, 670679.
10. Brazilian Ministry of Health (2014) Dietary Guidelines for the Brazilian Population. Brasília: Ministry of Health; available at
11. Monteiro, CA, Cannon, G, Moubarac, J-C et al. (2015) Dietary guidelines to nourish humanity and the planet in the twenty-first century. A blueprint from Brazil. Public Health Nutr 18, 23112322.
12. de Souza, R, Mente, A, Maroleanu, A et al. (2015) Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ 351, h3978.
13. World Health Organization (2003) Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series no. 916. Geneva: WHO; available at
14. World Cancer Research Fund/American Institute for Cancer Research (2007) Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. Washington, DC: AICR; available at
15. US Department of Agriculture & US Department of Health and Human Services (2010) Dietary Guidelines for Americans, 2010, 7th ed. Washington, DC: USDA/DHSS; available at
16. US Department of Agriculture & US Department of Health and Human Services (2015) 2015–2020 Dietary Guidelines for Americans, 8th ed. Washington DC: USDA/DHSS; available at
17. Monteiro, CA, Cannon, G, Levy, RB et al. (2012) The big issue for nutrition, disease, health, well-being. World Nutr 3, 527569.
18. Stuckler, D & Nestle, M (2012) Big food, food systems, and global health. PLoS Med 9, 6.
19. World Health Organization (2013) WHO Director-General addresses health promotion conference. (accessed March 2017).
20. Organisation for Economic Co-operation and Development (2002) Foreign Direct Investment for Development. Paris: OECD;
21. Organisation for Economic Co-operation and Development (2016) Foreign Direct Investment (FDI) Statistics – OECD Data, Analysis and Forecasts. Paris: OECD;
22. Wilkinson, J (2004) The food processing industry, globalization, and developing countries. Electron J Agric Dev Econ 1, 184201.
23. Hawkes, C (2005) The role of foreign direct investment in the nutrition transition. Public Health Nutr 8, 357365.
24. Monteiro, CA & Cannon, G (2012) The impact of transnational ‘Big Food’ companies on the South: a view from Brazil. PLoS Med 9, e1001252.
25. Greer, J & Singh, K (2000) A brief history of transnational corporations. Global Policy Forum. (accessed March 2017).
26. European Food Information Council (2010) The Greatest Thing Since Sliced Bread? A Review of the Benefits of Processed Foods. Brussels: EUFIC; available at:
27. International Food Information Council (2010) Understanding our Food Information Communications Tool Kit. Washington, DC: IFIC Foundation;
28. Eicher-Miller, H, Fulgoni, V & Keast, D (2012) Contributions of processed foods to dietary intake in the US from 2003–2008: a report of the Food and Nutrition Science Solutions Joint Task Force of the Academy of Nutrition and Dietetics, American Society for Nutrition, Institute of Food Technologists, and International Food Information Council. J Nutr 142, issue 11, 2065S2072S.
29. Dwyer, J, Fulgoni, V, Clemens, R et al. (2012) Is ‘processed’ a four-letter word? The role of processed foods in achieving dietary guidelines and nutrient recommendations. Adv Nutr 3, 536548.
30. Weaver, C, Dwyer, J, Fulgoni, V et al. (2014) Processed foods: contributions to nutrition. Scientific Statement from the American Society for Nutrition. Am J Clin Nutr 99, 15251542.
31. Eat Drink Politics, Simon, M (2015) Nutrition Scientists on the Take from Big Food. Has the American Society for Nutrition Lost All Credibility? Oakland, CA: Eat Drink Politics; available at
32. Monteiro, CA, Levy, RB, Claro, RM et al. (2010) A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica 26, 20392049.
33. Moubarac, J-C, Parra, D, Cannon, G et al. (2014) Food classification systems based on food processing: significance and implications for policies and actions: a systematic literature review and assessment. Curr Obes Rep 3, 256272.
34. Monteiro, CA, Cannon, G, Levy, RB et al. (2015) Ultra-processing and a new classification of foods. In Introduction to the US Food System: Public Health, Environment, and Equity, pp. 338339 [R Neff, editor]. San Francisco, CA: Jossey Bass/John Wiley.
35. Monteiro, CA, Cannon, G, Levy, RB et al. (2016) NOVA. The star shines bright. World Nutr 7, 2838.
36. Monteiro, CA, Levy, RB, Claro, RM et al. (2011) Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil. Public Health Nutr 14, 513.
37. Sparrenberger, K, Friedrich, R, Schiffner, M et al. (2015) Ultra-processed food consumption in children from a Basic Health Unit. J Pediatr (Rio J) 91, 535542.
38. Martins, AP, Levy, RB, Claro, RM et al. (2013) Increased contribution of ultra-processed food products in the Brazilian diet (1987–2009). Rev Saude Publica 47, 656665.
39. Louzada, ML, Martins, AP, Canella, DS et al. (2015) Ultra-processed foods and the nutritional dietary profile in Brazil. Rev Saude Publica 49, 38.
40. Barcelos, GT, Rauber, F & Vitolo, MR (2014) Processed and ultra-processed food products and nutrient intake in children. Rev Cienc Saude 7, 155161.
41. Bielemann, R, Santos Motta, J, Minten, G et al. (2015) Consumption of ultra-processed foods and their impact on the diet of young adults. Rev Saude Publica 49, 28.
42. Louzada, ML, Martins, AP, Canella, DS et al. (2015) Impact of ultra-processed foods on micronutrient content in the Brazilian diet. Rev Saude Publica 49, 45.
43. Canella, DS, Levy, RB, Martins, AP et al. (2014) Ultra-processed food products and obesity in Brazilian households (2008–2009). PLoS One 9, e92752.
44. Louzada, ML, Baraldi, LG, Martinez Steele, E et al. (2015) Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Prev Med 81, 915.
45. Tavares, L, Fonseca, S, Garcia Rosa, L et al. (2012) Relationship between ultra-processed foods and metabolic syndrome in adolescents from a Brazilian family doctor program. Public Health Nutr 15, 8287.
46. Rauber, F, Campagnolo, P, Hoffman, D et al. (2015) Consumption of ultra-processed food products and its effects on children’s lipid profiles: a longitudinal study. Nutr Metab Cardiovasc Dis 25, 116122.
47. Moubarac, J-C, Claro, RM, Baraldi, LG et al. (2013) International differences in cost and consumption of ready-to-consume food and drink products: United Kingdom and Brazil, 2008–2009. Glob Public Health 8, 845856.
48. Leite, FH, Oliveira, MA, Cremm, EC et al. (2012) Availability of processed foods in the perimeter of public schools in urban areas. J Pediatr (Rio J) 88, 328334.
49. Costa, JC, Claro, RM, Martins, AP et al. (2013) Food purchasing sites. Repercussions for healthy eating. Appetite 70, 99103.
50. Vedovato, GM, Trude, AC, Kharmats, AY et al. (2015) Degree of food processing of household acquisition patterns in a Brazilian urban area is related to food buying preferences and perceived food environment. Appetite 87, 296302.
51. Mallarino, C, Gomez, L, Gonzalez-Zapata, L et al. (2013) Advertising of ultra-processed foods and beverages: children as a vulnerable population. Rev Saude Publica 47, 10061010.
52. Franco, P, Rosa, G, Luiz, R et al. (2015) Assessment of the quality of hypoenergetic diet in overweight women. Int J Cardiovasc Sci 28, 244250.
53. Martinez Steele, E, Baraldi, LG, Louzada, ML et al. (2015) Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open 5, e009892.
54. Martinez Steele, E, Popkin, B, Swinburn, B et al. (2017) The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. Popul Health Metr 15, 6.
55. Martinez Steele, E & Monteiro, CA (2017) Association between dietary share of ultra-processed foods and urinary concentrations of phytoestrogens in the US population. Nutrients 9, 3.
56. Poti, JM, Mendez, MA, Ng, SW et al. (2015) Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households? Am J Clin Nutr 101, 12511262.
57. Poti, JM, Mendez, MA & Ng, SW (2016) Highly processed and ready-to-eat packaged food and beverage purchases differ by race/ethnicity among US households. J Nutr 146, 17221730.
58. Moubarac, J-C, Batal, M, Martins, AP et al. (2014) Processed and ultra-processed food products: consumption trends in Canada from 1938 to 2011. Can J Diet Pract Res 75, 1521.
59. Moubarac, J-C, Martins, AP, Claro, RM et al. (2013) Consumption of ultra-processed foods and likely impact on human health. Evidence from Canada. Public Health Nutr 16, 22402248.
60. Moubarac, J-C, Batal, M, Louzada, ML et al. (2017) Consumption of ultra-processed foods predicts diet quality in Canada. Appetite 108, 512520.
61. Moreira, P, Baraldi, LG, Moubarac, J-C et al. (2015) Comparing different policy scenarios to reduce the consumption of ultra-processed foods in UK: impact on cardiovascular disease mortality using a modelling approach. PLoS One 10, e0118353.
62. O’Halloran, SA, Grimes, CA, Lacy, KE et al. (2016) Dietary sources and sodium intake in a sample of Australian preschool children. BMJ Open 6, e008698.
63. Venn, D, Banwell, C & Dixon, J (2016) Australia’s evolving food practices: a risky mix of continuity and change. Public Health Nutr (Epublication ahead of print version).
64. Harray, AJ, Boushey, CJ, Pollard, CM et al. (2015) A novel dietary assessment method to measure a healthy and sustainable diet using the mobile food record: protocol and methodology. Nutrients 7, 53755395.
65. Crovetto, M, Uauy, R, Martins, AP et al. (2014) Household availability of ready-to-consume food and drink products in Chile: impact on nutritional quality of the diet. Rev Med Chile 142, 850858.
66. Cediel, G, Reyes, M, Louzada, MLC et al. (2017) Contribution of ultra-processed foods to total energy and added sugars in Chilean diet. Public Health Nutr (under review).
67. Marrón-Ponce, JA, Sánchez-Pimienta, T, Louzada, ML et al. (2017) Energy contribution of ultra-processed foods and sociodemographic determinants in the Mexican population. Public Health Nutr (under review).
68. Solberg, SL, Terragni, L & Granheim, SI (2016) Ultra-processed food purchases in Norway: a quantitative study on a representative sample of food retailers. Public Health Nutr 19, 19902001.
69. Luiten, C, Steenhuis, I, Eyles, H et al. (2016) Ultra-processed foods have the worst nutrient profile, yet they are the most available packaged products in a sample of New Zealand supermarkets. Public Health Nutr 19, 530538.
70. Juul, F & Hemmingsson, E (2015) Trends in consumption of ultra-processed foods and obesity in Sweden between 1960 and 2010. Public Health Nutr 18, 30963107.
71. Mendonça, R, Pimenta, A, Gea, A et al. (2016) Ultra-processed foods consumption and risk of overweight/obesity: the SUN cohort study. Am J Clin Nutr 104, 14331440.
72. Mendonça, R, Lopes, A, Pimenta, A et al. (2016) Ultra-processed food consumption and the incidence of hypertension in a Mediterranean cohort: the Seguimiento Universidad de Navarra Project. Am J Hypertens (Epublication ahead of print version).
73. Monteiro, CA, Moubarac, J-C, Cannon, G et al. (2013) Ultra-processed products are becoming dominant in the global food system. Obes Rev 14, Suppl. 2, 2128.
74. Baker, P, Kay, A & Walls, H (2014) Trade and investment liberalization and Asia’s noncommunicable disease epidemic: a synthesis of data and existing literature. Global Health 10, 66.
75. World Health Organization (2017) The Influence of Ultra-processed Foods on the Dietary Content of Free Sugars in the US, Canada, Brazil and Colombia. Geneva: WHO (In the Press).
76. Vandevijvere, S, Monteiro, CA, Krebs-Smith, S et al. (2013) Monitoring and benchmarking population diet quality globally: a step-wise approach. Obes Rev 14, Suppl. 1, 135149.
77. Ministerio de Salud (2016) Guía Alimentaria para la Población Uruguaya. (acessed March 2017).
78. Prentice, A & Jebb, S (2003) Fast foods, energy density and obesity: a possible mechanistic link. Obes Rev 4, 187194.
79. Fardet, A (2016) Minimally processed foods are more satiating and less hyperglycemic than ultra-processed foods: a preliminary study with 98 ready-to-eat foods. Food Funct 7, 23382346.
80. Brownell, K & Gold, M (2012) Food and Addiction. A Comprehensive Handbook. Oxford: Oxford University Press.
81. Gearhardt, A (2015) The science behind food and addiction and the potential effect on the food system. In Introduction to the US Food System: Public Health, Environment, and Equity, pp. 405406 [R Neff, editor]. San Francisco, CA: Jossey Bass/John Wiley.
82. La Fontaine, HA, Crowe, TC, Swinburn, BA et al. (2004) Two important exceptions to the relationship between energy density and fat content: foods with reduced-fat claims and high-fat vegetable based dishes. Public Health Nutr 7, 563568.
83. Scrinis, G (2016) Reformulation, fortification and functionalization: Big Food corporations’ nutritional engineering and marketing strategies. J Peasant Stud 43, 1737.
84. Chandon, P & Wansink, B (2012) Does food marketing need to make us fat? A review and solutions. Nutr Rev 70, 571593.
85. Taylor, A & Jacobson, M (2016) Carbonating the World: The Marketing and Health Impact of Sugar Drinks in Low- and Middle-Income Countries. Washington, DC: Center for Science in the Public Interest.
86. Cairns, G, Angus, K & Hastings, G (2009) The Extent, Nature and Effects of Food Promotion to Children: A Review of the Evidence to December, 2008. Geneva: WHO.
87. Global Burden of Disease Risk Factors Collaborators (2016) Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388, 16591724.
88. Wrangham, R (2009) Catching Fire: How Cooking Made Us Human. New York: Basic Books; available at[How%20Cooking%20Made%20Us%20Human]_djvu.txt
89. Garner, D (2009) Why are humans different from all other apes? It’s the cooking, stupid. The New York Times, 26 May. (accessed March 2017).
90. Pollan, M (2013) Cooked. A Natural History of Transformation. New York: The Penguin Press; available at
91. Schlosser, E (2000) Fast Food Nation. The Dark Side of the All-American Meal. New York: Houghton Mifflin; available at
92. Hawkes, C (2006) Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases. Global Health 2, 4.
93. Monteiro, CA, Gomes, F & Cannon, G (2010) The snack attack. Am J Public Health 100, 975981.
94. Story, M & French, S (2004) Food advertising and marketing directed at children and adolescents in the US. Int J Behav Nutr Phys Act 1, 3.
95. World Health Organization (2014) Protecting children from the harmful effects of food and drink marketing. (accessed March 2017).
96. Rockefeller Foundation (2013) Unhealthy Developing World Food Markets. New York: Rockefeller Foundation; available at
97. International Food Policy Research Institute (2016) Global Nutrition Report 2016. From Promise to Impact: Ending Malnutrition by 2030. Washington, DC: IFPRI.
98. Black, E (2016) Globalization of the Food Industry: Transnational Corporations, the Spread of Processed Food, and their Implications for Food Security and Nutrition. Independent Study Project (ISP) Collection no. 2353. Brattleboro, VT: SIT Graduate Institute; available at
99. Brown, L (2013) Good and cheap. Eat well on $4 a day. (accessed March 2017).
100. Monroe, J (2014) A Girl Called Jack. 100 Delicious Budget Recipes. London: Penguin.
101. Wiggins, S, Keats, S, Han, E et al. (2015) The Rising Cost of a Healthy Diet. Changing Relative Prices of Foods in High-income and Emerging Economies. London: Overseas Development Institute.
102. Claro, RM, Maia, EG, Costa, BVL et al. (2016) Preço dos alimentos no Brasil: prefira preparações culinárias a alimentos ultraprocessados (Food prices in Brazil: prefer cooking to ultra-processed foods). Cad Saude Publica 32, e00104715.
103. American Diabetes Association(2013) Economic costs of diabetes in the US in 2012. Diabetes Care 36, 10331046.
104. Institute of Food Technologists (2007) Food packaging and its environmental impact. Food Technol April issue, 46–50; available at
105. Natural Resources Defense Council (2007) Food Miles. How Far Your Food Travels has Serious Consequences for Your Health and the Climate. New York: NRDC; available at
106. Union of Concerned Scientists (2016) Hidden costs of industrial agriculture. (accessed January 2017).
107. Spanne, A (2014) Fighting climate change in Brazil isn’t just about the Amazon. The Daily Climate, 10 November. (accessed March 2017).
108. Rockstrom, J, Steffen, W, Noone, K et al. (2009) Planetary boundaries: exploring the safe operating space for humanity. Ecol Soc 14, 32.
109. Crutzen, P & Schwägerl, C (2011) Living in the Anthropocene: towards a new global ethos. (accessed March 2017).
110. Carrington, D (2016) The Anthropocene epoch: scientists declare dawn of human-influenced age. The Guardian, 29 August. (accessed March 2017).



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed