Parental Factors Associated with US Youth Ultra-Processed Food Outcomes: A Systematic Review.

Ultra-processed food (UPF) comprises 67% of the average US youth diet, among the highest rates globally. Health burdens associated with youth UPF intake include overweight/obesity, glucose dysregulation, poor cardiovascular health, liver disease, microbiome disruption, dental problems, DNA damage, mental health concerns, and lower cognitive and academic performance. This systematic review investigates parental factors associated with US youth UPF intake, preference, selection, or access. A comprehensive literature review was conducted using PRISMA guidelines. PubMed, CINAHL, Scopus, and Web of Science databases were searched. Inclusion criteria required studies to examine youth (aged 0-19) UPF outcomes and parental factors. The Mixed Methods Appraisal Tool assessed study bias and quality. PROSPERO registration number: CRD420251248701. The search yielded 1727 articles, 888 after duplicates removed. Full text review resulted in 11 extracted articles: 9 quantitative and 2 qualitative. Parental factors associated with child UPF outcomes included education level, gender (female), UPF intake, more frequent soda and fast-food intake, belief in food advertising, reward-based eating drive, allowing youth to watch greater hours of TV, and the home food environment. Mixed findings were found with parental substance use, depending on prenatal, maternal, and paternal use, cigarette, alcohol, or illicit drugs, and child age. Notable null findings included parent age, living with a partner, household income, shared family meals, human milk exposure, and parent motivation, attitude, and self-efficacy to limit junk food and eat more fruits/vegetables. Further research around parental factors and US youth UPF intake is warranted. Intervening in identified target areas may help mitigate youth UPF outcomes.