Perspectives on ultra-processed foods as vehicles for food fortification

The rising popularity in low- and middle-income countries (LMICs) of ultra-processed foods (UPFs), defined by the Nova classification system, makes them an appealing option for food fortification initiatives to address micronutrient deficiencies in vulnerable populations. However, significant controversy surrounds this issue given that higher intake of UPFs is associated with a range of health risks including development of non-communicable diseases (NCDs). This paper investigates the utility and extent to which UPFs may be used as vehicles of fortification to improve population health. The underlying mechanisms linking UPFs with disease are discussed and evaluated compared to the potential risks of eliminating them from fortification initiatives. A summary of the four main arguments most commonly cited in the debate over UPFs and their fortification are then reviewed. The future of fortified UPFs needs more research to untangle the health effects of food processing, the involvement of the food industry in product reformulation, and a strengthening of regulation on production and labeling. This perspectives piece serves to stimulate further debate regarding the role processing should play in foods in general and how it should be considered by nutritional classification schemes to assess the healthfulness of foods.