Trends in food consumption by degree of processing and diet quality over 17 years: Results from the Framingham Offspring Study

Filippa Juul, Yong Lin, Andrea L. Deierlein, Georgeta Vaidean, Niyati Parekh

Research output: Contribution to journalArticlepeer-review


Ultra-processed foods provide the majority of calories in the American diet, yet little is known regarding consumption trends over time. We determined trends in diet processing level and diet quality from 1991-2008 within the prospective Framingham Offspring Cohort. Dietary intakes were collected by food frequency questionnaires quadrennially 1991-2008 (total of four examinations). The analytical sample included 2,893 adults with valid dietary data for ≥3 examinations (baseline mean age=54y). Based on the NOVA framework, we classified foods as: unprocessed/minimally processed foods; processed culinary ingredients (salt/sugar/fats/oils); processed foods; and ultra-processed foods. We evaluated diet quality using the Dietary Guidelines for Americans Adherence Index (DGAI) 2010. Trends in consumption of foods within each processing level (servings/day) and diet quality over the four examinations were evaluated using mixed effects models with subject-specific random intercepts. Analyses were stratified by sex, BMI (<25kg/m2, 25-29.9kg/m2, ≥30kg/m2) and smoking status. Over 17 years of follow-up, ultra-processed food consumption decreased from 7.5 to 6.0 servings/day and minimally processed food consumption decreased from 11.9 to 11.3 servings/day (p-trend<0.001). Changes in intakes of processed foods, culinary ingredients, and culinary preparations were minimal. Trends were similar by sex, BMI, and smoking status. DGAI-2010 score increased from 60.1 to 61.5, p<0.001. The current study uniquely describes trends in diet processing level in an aging U.S. population, highlighting the longstanding presence of ultra-processed foods in the American diet. Given the poor nutritional quality of ultra-processed foods, public health efforts should be designed to limit their consumption.

Original languageEnglish (US)
JournalBritish Journal of Nutrition
StateAccepted/In press - 2021


  • Diet quality
  • Dietary guidelines for americans adherence index
  • Framingham heart study
  • NOVA
  • Ultra-processed food

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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