Are All Ultra-Processed Foods Created Equal? Descriptive Analysis of Nutritional Composition, Nutritional Quality, Energy Density and Hyperpalatability in Relation to Non-Communicable Disease Risk.

Ultra-processed foods (UPFs) are increasingly consumed worldwide, and higher consumption has been linked to higher risk of non-communicable diseases (NCDs). This study examined the nutritional composition and quality, energy density, and hyperpalatability of UPFs available in the Italian food market according to their literature-derived NCD-risk categories. Products were classified into main food groups and subgroups and further categorized according to reported associations with NCD risk: positive, negative, or no reported association. Differences between the main food groups were analyzed in RStudio using non-parametric tests, with results summarized using medians and interquartile ranges. A total of 13,025 UPF products were included in the analysis. UPFs showed substantial variation in nutritional composition, nutritional quality, nutrients-of-concern levels, energy density, and hyperpalatability across the main food groups and literature-derived NCD-risk categories. Snacks represented the largest UPF group and showed the most consistently unfavorable profile, including high median energy, carbohydrate, saturated fat, and sugar contents, a high proportion of Nutri-Score D and E products, and the highest proportion of medium- and high-energy-density products. Overall, 64.3% of UPFs were classified as Nutri-Score D or E, indicating generally lower nutritional quality. However, unfavorable nutritional characteristics were not limited to UPF subgroups reportedly associated with increased NCD risk; some subgroups reportedly associated with lower or no reported NCD risk also contained products with poor nutritional quality, high energy density, or hyperpalatable profiles. These findings suggest that UPFs are not nutritionally uniform and that assessment of UPF-related health relevance should consider food group, subgroup, nutrient profile, energy density, and hyperpalatability in addition to processing classification.