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Ultraprocessed Food Consumption and Behavioral Outcomes in Canadian Children
Meaghan E Kavanagh1,2, Zheng Hao Chen1, Sukhpreet K Tamana3
1Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Higher intake of ultraprocessed foods (UPF) in preschoolers is linked to increased behavioral and emotional symptoms. Replacing UPF with minimally processed foods (MPF) may support healthier development and long-term mental health.
Area of Science:
- Pediatric Nutrition and Development
- Behavioral Science
- Public Health
Background:
- Ultraprocessed foods (UPF) constitute a significant portion of energy intake in Canadian preschoolers.
- The impact of UPF on behavioral and emotional functioning in early childhood is not well understood.
- Understanding these associations is crucial for promoting healthy child development.
Purpose of the Study:
- To investigate the relationship between ultraprocessed food (UPF) consumption at age 3 and behavioral outcomes at age 5.
- To assess the potential benefits of substituting UPF with minimally processed foods (MPF) on child behavior.
Main Methods:
- A prospective cohort study utilizing data from the CHILD Cohort Study in Canada.
- Dietary intake of UPF at age 3 was assessed using a food frequency questionnaire and the NOVA classification.
- Behavioral outcomes at age 5 were measured using the Child Behavior Checklist (CBCL); multivariable regression models were employed.
Main Results:
- Increased UPF intake (per 10% energy) was significantly associated with higher internalizing, externalizing, and total behavior problem scores on the CBCL.
- Substitution of 10% energy from UPF with MPF was associated with lower scores across all CBCL behavioral measures.
- The study included 2077 preschoolers, with UPF contributing a mean of 45.5% of energy intake at age 3.
Conclusions:
- Higher UPF consumption in preschoolers is associated with adverse behavioral and emotional symptoms.
- Replacing UPF with MPF may promote healthier behavioral development and potentially benefit long-term mental health.
- Findings support public health policies and early-life dietary interventions to reduce UPF intake.
Importance:
Ultraprocessed foods (UPF) contribute to nearly half of energy intake among preschool-aged children in Canada, yet their impact on behavioral and emotional functioning remains underexplored.
Objective:
To examine the associations between UPF intake at age 3 years and behavioral outcomes at age 5 years.
Design, Setting, And Participants:
This cohort study included children with dietary and behavioral data from September 2011 to April 2018 in the CHILD Cohort Study, a prospective Canadian pregnancy cohort. Data analysis was done between February to July 2025.
Exposure:
UPF intake at age 3 years was assessed by a 112-item food frequency questionnaire and categorized using the NOVA system.
Main Outcomes And Measures:
Behavior was measured using the validated Child Behavior Checklist (CBCL; range 0-100; higher scores indicating more adverse symptoms). UPF intake measured as a continuous percentage of energy was examined using multivariable-adjusted linear regression models accounting for maternal diet, birth factors, infant feeding, and sociodemographic and early-childhood characteristics. A multivariable-adjusted substitution model estimated the association of statistically replacing 10% energy from UPF with minimally processed foods (MPF) among all children.
Results:
Among 2077 participants, 1092 (52.6%) were male; 1376 children (66.2%) were White, 480 children (23.1%) were multiracial, and 221 children (10.7%) were identified as another ethnic group. At age 3 years, UPF contributed a mean (SD) of 45.5% (11.6%) of total energy intake. At age 5 years, the mean (SD) CBCL scores were 44.6 (9.1) for internalizing, 39.6 (9.4) for externalizing, and 41.2 (9.0) for total behavior. Each 10% increase in energy from UPF was associated with higher CBCL internalizing (β = 0.81 [95% CI, 0.43 to 1.19]), externalizing (β = 0.47 [95% CI, 0.08 to 0.87]), and total (β = 0.64 [95% CI, 0.27 to 1.01]) scores. Substitution of 10% energy from UPF with MPF was associated with lower internalizing (β = -0.91 [95% CI, -1.33 to -0.49]), externalizing (β = -0.49 [95% CI, -0.93 to -0.06]), and total (β = -0.70 [95% CI, -1.12 to -0.29]) scores.
Conclusions And Relevance:
In this cohort study of preschoolers in Canada, higher UPF intake was associated with adverse behavioral and emotional symptoms by age 5 years. These findings suggest that replacing UPF with MPF during the preschool years may support healthier behavioral development, with potential benefits for long-term mental health. These findings also support ongoing policy actions that promote MPF and underscore the need for early-life dietary interventions.
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