Higher Ultra-Processed Food Intake is Associated with Co-occurrence and Accumulation of Multiple Dietary Risk Behaviors in Korean Adults.

BACKGROUND: Ultra-processed food (UPF) intake and dietary risk behaviors, such as breakfast skipping, fast eating, overeating and nighttime snacking, have each been associated with adverse health outcomes. However, little is known about the associations between UPF intake and the co-occurrence of these dietary risk behaviors among Korean adults. OBJECTIVE: We examined the associations of combined and subgroup-specific UPF intake with dietary risk behaviors and their accumulation among Korean adults. METHODS: This cross-sectional analysis included 6,563 Korean adults aged 43-74 y in the Korean Genome and Epidemiology Study Ansan-Ansung cohort. Dietary intake was assessed using a semi-quantitative food frequency questionnaire, and UPFs were classified according to the NOVA definition. Dietary risk behaviors were assessed using self-reported questionnaires. A composite dietary risk behavior score was created by summing the number of dietary risk behaviors (0, 1, 2, and ≥3). Multivariable logistic regression models and multinomial logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for potential confounders. RESULTS: Higher UPF intake (highest vs. lowest quartiles) was positively associated with frequent breakfast skipping (OR [95% CI] = 3.42 [2.68, 4.36]), frequent overeating (1.33 [1.12, 1.57]), and frequent nighttime snacking (2.22 [1.90, 2.59]) but was not associated with fast eating (1.00 [0.85, 1.16]). All individual UPF subgroups were positively associated with both frequent breakfast skipping and nighttime snacking, while ready-to-eat/heat mixed dishes were additionally associated with frequent overeating. Higher UPF intake (highest vs. lowest quartiles) was progressively associated with greater number of dietary risk behaviors (1, 2, and ≥3 vs. 0 dietary risk behaviors: OR [95% CI] = 1.29 [1.04, 1.60], 2.07 [1.65, 2.60], 3.24 [2.46, 4.27], respectively). CONCLUSIONS: High UPF intake was positively associated with individual dietary risk behaviors and their accumulation, suggesting that UPF intake may be linked to broader unhealthy eating patterns.