ArticlePublic health nutrition2018
Ultra-processed foods, protein leverage and energy intake in the USA.
Article in Public health nutrition, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 67 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
67 citing papers in PubMed, 2 syntheses or guidelines pooled it, 141 citations in OpenAlex.
- Ultra-Processed Food Intakes and Health Outcomes in Adults Older Than 60 Years: A Systematic Review.Nutrition reviews · 2025Pooled it
- Food processing and cardiometabolic risk factors: a systematic review.Revista de saude publica · 2020Pooled it
- Short-term effects of high-protein, lower-carbohydrate ultra-processed foods on human energy balance.Nature metabolism · 2025Trial
- Trial
- Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake.Cell metabolism · 2019Trial
- Protein Decoys, Alcohol, and Energy Intake: Testing a Mechanistic-Ecological Model.Obesity reviews : an official journal of the International Association for the Study of Obesity · 2026Review
- Dietary guidelines adherence and pregnancy exposure to 10 classes of priority chemicals: an observational study in the Environmental influences on Child Health Outcomes Cohort.The American journal of clinical nutrition · 2026Observational
- Within-Person Variation in Ultra-Processed Food Consumption Is Associated with Total Daily Energy Intake.Nutrients · 2026Article
- Intermittency and Predictability of a Cafeteria Diet Shape Food Intake, Adiposity, and Neurobehavioral Outcomes in Rats.Nutrients · 2026Article
- Amino Acids as Metabokines in Hypercatabolic States: Rethinking Nutritional Protein-Based Strategies Beyond Caloric Support.Nutrients · 2026Review
- Ultra-processed food consumption and the prevalence of malnutrition and clinical weakness among hemodialysis patients: a single-center cross-sectional study.BMC nephrology · 2026Article
- Food Macronutrient Composition Influences Attentional Bias Toward Food Cues.Annals of the New York Academy of Sciences · 2026Article
- Ultra-Processed Foods and Metabolic Dysfunction: A Narrative Review of Dietary Processing, Behavioral Drivers and Chronic Disease Risk.Metabolites · 2025Review
- The role of ultra-processed food in obesity.Nature reviews. Endocrinology · 2025Review
- Dietary Macronutrient Composition and Protein Concentration for Weight Loss Maintenance.Obesity (Silver Spring, Md.) · 2025Article
- Meal Patterns and Protein Food Utilization in Public and Private Geriatric Long-term Care Hospitals.Clinical nutrition research · 2025Article
- Dietary macronutrient content and energy intake in the mouse: hedonic or homeostatic override?Obesity (Silver Spring, Md.) · 2025Article
- The impact of dietary interventions on cardiometabolic health.Cardiovascular diabetology · 2025Review
- The link between ultra-processed food consumption, fecal microbiota, and metabolomic profiles in older mediterranean adults at high cardiovascular risk.Nutrition journal · 2025Article
- More protein in ultra-processed foods: no shortcut to eating less.Nature metabolism · 2025Article
7 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveExperimental studies have shown that human macronutrient regulation minimizes variation in absolute protein intake and consequently energy intake varies passively with dietary protein density ('protein leverage'). According to the 'protein leverage hypothesis' (PLH), protein leverage interacts with a reduction in dietary protein density to drive energy overconsumption and obesity. Worldwide increase in consumption of ultra-processed foods (UPF) has been hypothesized to be an important determinant of dietary protein dilution, and consequently an ecological driving force of energy overconsumption and the obesity pandemic. The present study examined the relationships between dietary contribution of UPF, dietary proportional protein content and the absolute intakes of protein and energy.
designNational representative cross-sectional study.
settingNational Health and Nutrition Examination Survey 2009-2010. SUBJECTS: Participants (n 9042) aged ≥2 years with at least one day of 24 h dietary recall data.
resultsWe found a strong inverse relationship between consumption of UPF and dietary protein density, with mean protein content dropping from 18·2 to 13·3 % between the lowest and highest quintiles of dietary contribution of UPF. Consistent with the PLH, increase in the dietary contribution of UPF (previously shown to be inversely associated with protein density) was also associated with a rise in total energy intake, while absolute protein intake remained relatively constant.
conclusionsThe protein-diluting effect of UPF might be one mechanism accounting for their association with excess energy intake. Reducing UPF contribution in the US diet may be an effective way to increase its dietary protein concentration and prevent excessive energy intake.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.