Ultraprocessed Food Consumption and Behavioral Outcomes in Canadian Children
Kavanagh ME, Chen ZH, Tamana SK, Moraes TJ, Simons E, Turvey SE, Subbarao P, Mandhane PJ, Miliku K
JAMA network open · 3 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Cohort study (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
- Intake measured by
- Food frequency questionnaire
Who paid for it
- Funding
- Independent funding
- University or hospital
- Children's Health Research Institute
- Government
- Genome Canada
- Nonprofit
- Cystic Fibrosis Canada
- Nonprofit
- Physicians' Services Incorporated Foundation
- Government
- Canadian Institutes of Health Research
Based on 5 listed funder(s).
Publication
- Published
- 2026-03-03 · JAMA Netw Open · vol. 9 · issue 3 · p. e260434
- Publisher
- American Medical Association
- Cited
- 3 citations · more than 99% of similar papers · 21.6× the field average
- Impact
- Top 10% most cited in its field
- References
- 76 works
- Access
- Open access (journal) · CC-BY
- Research areas
- Consumer Attitudes and Food Labeling · Nutritional Studies and Diet · Nutrition, Genetics, and Disease
- Keywords
- Consumption (sociology), Food consumption, Cohort, Mental health, Feeding behavior, Food intake
- MeSH
- humans, diet, cohort studies, prospective studies, feeding behavior, child behavior, energy intake, child, preschool, canada, female, male, food, processed
9 authors
From US, CA, MY
- Meaghan E KavanaghHarvard University; University of Toronto
- Zheng Hao ChenUniversity of Toronto
- Sukhpreet K. TamanaUniversity of British Columbia
- Theo J. MoraesUniversity of Toronto; Hospital for Sick Children
- Elinor SimonsUniversity of Manitoba
- Stuart E. TurveyUniversity of British Columbia
Abstract
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.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY).
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