Ultra-processed food (UPF) consumption and diet quality among Supplemental Nutrition Assistance Program (SNAP)...

Ultra-processed food (UPF) intake is linked to poor health, though some subgroups may offer affordable, nutritious options. Few studies have examined how UPF consumption-overall and by subgroup-relates to diet quality among populations with low income. We evaluated UPF subgroup intake and associations with diet quality among adults participating in the Supplemental Nutrition Assistance Program (SNAP). Rhode Island (RI) and Connecticut (CT) participants (n = 1244, 92% female, 58% food insecure) completed an online sociodemographic survey and food frequency questionnaire (FFQ). We categorized food codes (n = 301) using NOVA, and developed thirteen UPF subgroups within NOVA group 4. We calculated UPF intake (total %kcal and by subgroup) and evaluated diet quality using the Healthy Eating Index-2020 (HEI-2020). We performed Kruskal-Wallis and Jonckheere-Terpstra tests to compare total and UPF subgroup consumption across Total HEI-2020 tertiles. Mean Total HEI-2020 score was 63.9 ± 11.5. While higher total UPF intake was associated with lower Total HEI-2020 scores, associations between subgroups and diet quality differed. Ultra-processed refined grains, sugar-sweetened beverages, and ready-to-eat/heat mixed dishes were associated with lower Total HEI-2020 scores, whereas whole grains, yogurt, and plant-based products were associated with higher Total HEI-2020 scores. UPFs are heterogeneous, with select subgroups associated with higher diet quality in a sample of SNAP-participating adults. As policymakers consider SNAP UPF waivers and restrictions, accounting for subgroup differences will be imperative to avoid unintentionally restricting access to foods that support higher diet quality among individuals with low income.