Table 5.

Disorders and conditions as outcomes.

Study Details			UPF Exposure			Outcomes		Results
Publication Author(s) Year	Study Type (Year) Setting	Population (Number)	Extraction Level	Relative exposure [UPF Reference Year]	Data Collection Method	Health Outcome (Study Definition)	Data Collection Method	Key Findings
Gastrointestinal Disease
Schnabel 2018 [85]	Cross-sectional (2013) France	Age ≥ 18 years (mean 50.4) (n = 33,343)	Individual	UPF % total grams (quartiles) [NOVA.2018] [30]	3 × 24-h records	Functional gastrointestinal disorders (Rome III criteria)	Self-report *	UPF contributed to 16% of total food intake by weight; 33.0% by total E intake. Individuals in the highest quartile of UPF intake had significantly higher risk of IBS (OR = 1.25; 95% CI 1.12; 1.39) and FDy (OR = 1.25; CI 95% 1.05; 1.47) but not FDy alone, compared with those in the lowest quartile.
Vasseur 2020 [88]	Prospective cohort (2016) 2.3 years mean follow-up France	Adults ≥ 18 years (mean 43.3) (n = 105,832)	Individual	UPF % total grams (tertiles) [NOVA.2018] [30]	3 × 24 h records	Inflammatory bowel disease	Self-report **	UPF contributed 17% food intake by weight in grams. No significant association was found with UPF consumption and IBD (p = 0.03).
Depression
Adjibade 2019 [89]	Prospective Cohort (2012), 5.4 years mean follow-up France	Adults age 18–86 years (n= 26,730)	Individual	UPF % total grams (quartiles) [NOVA.2018] [30]	3 × 24 h records	Depression (CES-D scale)	Self-report *	UPF contributed 5% by weight in grams and 32% E intake. Individuals in the highest quartile of UPF intake had significantly higher risk of developing depressive symptoms (HR = 1.30; 95% CI 1.15–1.47) than those in the lowest quartile. Each 10% increase in UPF consumption was HR of 1.21 (95% CI, 1.15–1.27).
Gomez-Donoso, 2019 [90]	Prospective cohort (2016), 10.3 years median follow-up Spain	Adults (mean 36.7 years) (n = 14,907)	Individual	UPF energy adjusted kcal/day (quartiles) [NOVA.2016] [22]	136–item FFQ	Depression	Self-report **	Individuals in highest quartile UPF had significantly higher risk of depression (HR = 1.33; 95% CI 1.07–1.64); p trend = 0.004), than individuals in lowest quartile of consumption, after confounder adjustment.
Frailty
Sandoval-Insausti 2019 [93]	Prospective Cohort (2008–2010), 3.5 years median follow-up Spain	Adults ≥ 60 years (N = 1822)	Individual	UPF intake % total E (quartiles) [NOVA2018] [30]	Validated interview computerized diet history	Frailty (Fried’s criteria)	Trained personnel	UPF contributed mean of 19.3% total E intake. Individuals in the highest quartile of UPF intake had higher risk of frailty (OR = 3.67; 95% CI 2.00, 6.76) than those in the lowest quartile of intake.
Asthma (children and adolescents)
Melo et al. 2018 [80]	Cross-sectional (2012) Brazil	Grade 9 students (n = 109,104)	Individual	UPF score, intake per week (quintiles) [NOVA 2018] [30]	6-UPF sub-categories FFQ	Asthma, wheezing in past 12 months	Self-report *	Individuals in the highest quintile of the UPF intake score had higher odds of having asthma (OR = 1.27; 95% CI 1.15, 1.41) or wheezing (OR = 1.42; 95% CI 1.35 to 1.50), than those in the lowest quintile.
Azeredo 2020 [82]	Prospective Cohort (2004–2010) Brazil	Children mean age 6.8 years baseline; 11.0 years at follow-up (n = 2190)	Individual	UPF % total E intake (quintiles) [NOVA.2018] [30]	55 (age 6) and 88 items (age 11) FFQ.	Wheezing, whistling or asthma in past 12 months	Self-report *	UPF contribution to total E intake was 42.3% at 6 years, and 33.7% at 11 years. Consumption of UPF at age 6 was not significantly associated with wheeze, asthma or severe asthma at age 11.

Results are presented for adjusted associations for potential confounders and statistically significant associations. NOVA refers to the food classification system [21] or earlier versions, as referenced; food means foods and beverages; * self-report from questionnaire on condition, medical history, symptoms, medication use, and/or diagnosis by medical practitioner; ** questionnaire plus validation on sample laboratory test or interview; UPF: ultra-process food (includes food and beverages); E: energy in calories or kilojoules; OR: odds ratio; CI: confidence interval; IBS: irritable bowel syndrome; FDy: functional dyspepsia; IBD: inflammatory bowel disease; CES-D scale: Centre for Epidemiologic Studies Depression Scale; HR: hazards ratio; FFQ: food frequency questionnaire; HR: hazards ratio.