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Public Health Nutr. 2018 Jan;21(1):18-26. doi: 10.1017/S1368980017001379. Epub 2017 Jul 17.

Household availability of ultra-processed foods and obesity in nineteen European countries.

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1Department of Nutrition,School of Public Health,University of São Paulo,Av. Dr Arnaldo 715,São Paulo,SP 01246-904,Brazil.
2Center for Epidemiological Research in Nutrition and Health,University of São Paulo,São Paulo,Brazil.



To assess household availability of NOVA food groups in nineteen European countries and to analyse the association between availability of ultra-processed foods and prevalence of obesity.


Ecological, cross-sectional study.




Estimates of ultra-processed foods calculated from national household budget surveys conducted between 1991 and 2008. Estimates of obesity prevalence obtained from national surveys undertaken near the budget survey time.


Across the nineteen countries, median average household availability amounted to 33·9 % of total purchased dietary energy for unprocessed or minimally processed foods, 20·3 % for processed culinary ingredients, 19·6 % for processed foods and 26·4 % for ultra-processed foods. The average household availability of ultra-processed foods ranged from 10·2 % in Portugal and 13·4 % in Italy to 46·2 % in Germany and 50·4 % in the UK. A significant positive association was found between national household availability of ultra-processed foods and national prevalence of obesity among adults. After adjustment for national income, prevalence of physical inactivity, prevalence of smoking, measured or self-reported prevalence of obesity, and time lag between estimates on household food availability and obesity, each percentage point increase in the household availability of ultra-processed foods resulted in an increase of 0·25 percentage points in obesity prevalence.


The study contributes to a growing literature showing that the consumption of ultra-processed foods is associated with an increased risk of diet-related non-communicable diseases. Its findings reinforce the need for public policies and actions that promote consumption of unprocessed or minimally processed foods and make ultra-processed foods less available and affordable.


DAFNE; European countries; Household budget surveys; Obesity; Ultra-processed foods

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