Ultra-Processed Food Consumption, Additive Co-occurrence, and Associated Risk Factors Among University Students in Peru

Introduction

Ultra-processed foods (UPFs), pre-packaged products predominantly manufactured on an industrial scale, have come to dominate the food environment in both high- and low-income settings (Baric et al., 2025). In Latin America, their consumption has surged in recent years, particularly in the form of beverages. Uruguay has experienced a 146% increase in UPF sales, followed by Bolivia (130%) and Peru (107%). Similarly, Brazil and Peru have witnessed a 38.9% rise in fast food intake, often replacing more nutritious traditional diets (Instituto Nacional de Salud, 2023).

In Peru, Choque-Quispe et al. (2023) reported that 3.9% of adolescents aged 15 to 18 consume UPFs daily, while 75.5% consume them one to three times per month. Beverages were the most frequently consumed (30.4%), followed by processed meats and sweets (both 17.6%), and dairy products (12.7%). In Chile, students aged 17 to 24 showed higher consumption rates of sauces and spreads (78.4%), processed meats (76.3%), and beverages (74.8%), whereas intake of fast foods (28.1%), savoury snacks (35.3%), and cereal-based items (37.4%) was comparatively lower (Vilugrón et al., 2022). Among older adults (mean age: 47), UPF consumption was notably lower (24%), with a marked preference for minimally processed foods (51.6%) (Anjos et al., 2024). In Spain, Gearhardt et al. (2023) identified signs of UPF addiction in 14% of the adult population and 12% of children, characterised by impulsive behaviour, emotional dysregulation, and diminished quality of life.

UPFs can pose significant health risks when consumed excessively or without adherence to age-specific dietary recommendations. These products typically contain food additives, substances deliberately introduced to alter physical, chemical, biological, or sensory properties, predominantly used for technical purposes in industrial manufacturing (World Health Organization [WHO], 2023). They also tend to be rich in saturated fats, sugars, and sodium, all linked to an elevated risk of non-communicable diseases, including cancer, diabetes, and cardiovascular conditions. Notably, approximately 72% of daily sodium intake originates from added salt and food additives, with the remainder derived from natural sources (8%) and table salt (20%) (Carbajal & Moreno, 2023; Dicken et al., 2024; Lou et al., 2021). Furthermore, sugar-sweetened beverages have been associated with increased body weight, type 2 diabetes, and non-alcoholic fatty liver disease (Malik & Hu, 2022).

The widespread shift from home-cooked, natural foods to ready-to-eat UPFs represents a broader transformation in dietary practices (Aracta-Maquera, 2023; Choque-Quispe et al., 2023). These products—from soups and fizzy drinks to processed meats—are readily available, affordable, and increasingly perceived as convenient staples. However, their health consequences are often overlooked, despite regulatory efforts such as the Peruvian Healthy Eating Promotion Law for Children and Adolescents (Ley 30021, Congreso de la República del Perú, 2013), which mandates clear front-of-pack labelling for excessive contents of sodium, sugars, and saturated fats (FAO, 2024a; Avilés et al., 2017).

Generation Z, born between approximately 1995 and 2010, has matured within a highly digitised environment and faces challenges including nutritional autonomy, financial constraints, academic demands, and limited experience with meal planning. These conditions often lead to choices that prioritise convenience and visual appeal over nutritional value. Wanjohi et al. (2025) found that this demographic tends to view UPFs as modern, urban, and desirable, whereas traditional foods are often regarded as outdated or unappealing.

Diet remains a modifiable risk factor, and the presence of food additives may exacerbate health risks. Emulsifying polysaccharides, for example, have been implicated in inflammatory bowel diseases (Nickerson et al., 2015; Laudisi et al., 2019). Mono- and diglycerides of fatty acids (INS 471 and INS 472) have been linked to increased cardiovascular risk (Sellem et al., 2023), while sweeteners such as aspartame and acesulfame-K are under scrutiny for their potential carcinogenicity (Debras et al., 2022). A systematic review of cohort studies found associations between non-nutritive sweeteners—including aspartame, sucralose, and steviol glycosides—and increased body weight, waist circumference, obesity, hypertension, and metabolic syndrome (Azad et al., 2017).

In Peru, the General Directorate of Environmental Health and Food Safety (DIGESA), under the Codex Alimentarius framework, is responsible for enforcing these regulations. Its mandate includes preserving food quality, improving shelf stability, and facilitating processes such as manufacturing, preparation, packaging, and storage—provided that additives are not used to mask inferior raw materials or substandard practices (FAO, 2024a). Nonetheless, there remains a lack of targeted research on consumption patterns, risk perception, and additive exposure among Generation Z university students, a cohort particularly vulnerable to modern food environments and autonomous dietary choices (Barroso, 2020). This gap represents a barrier to designing effective interventions, particularly in light of the rising incidence of non-communicable diseases at increasingly early ages (Fedde et al., 2025). Addressing these factors is essential if public health systems are to succeed in promoting healthy lifestyles.

Accordingly, the present study aims to assess the consumption of ultra-processed foods among young individuals, with a particular focus on the co-occurrence of additives and their association with health-related risk factors.

Methods

Results

Clustering of food additives and UPF consumption by category

Within the category of meat products, sausages exhibited the highest consumption frequency, reaching 54.7%. Among beverages, carbonated soft drinks stood out at 59.6%. In the cereal group, pasta and noodles were consumed by 48.6% of the students. Regarding confectionery items, biscuits ranked first with 48.9%, while in the dairy category, milk in its various forms was the most preferred, with a consumption rate of 66.3% ( Table 1).

Table 1. Consumption patterns of ultra-processed beverages and products by category among university students, January – April 2024.

Group	Product	n°	Frequency (%)
Meat	Types of sausages1	180	54.7
	Hamburger	137	41.6
	Processed meats2	107	32.5
	Pork cracklings/Bacon	85	25.8
	Nuggets	47	14.3
	Pâté	6	1.8
	N/A (Not available)	93	28.3
Beverages	Soft drinks	196	59.6
	Packaged nectars/Industrialized juices	133	40.4
	Sports drinks/Energy drinks	129	39.2
	Flavored water	61	18.5
	Bottled teas	49	14.9
	None of the above	58	17.6
Cereal-based products	Pasta/Noodles	160	48.6
	Salty snacks	139	42.2
	Instant mixes	62	18.8
	None of the above	90	27.4
Confectionery products	Cookies	161	48.9
	Chocolates	150	45.6
	Pastries3	121	36.8
	Hard/Chewy candies4	143	43.5
	None of the above	57	17.3
Dairy products	Milk5	218	66.3
	Yogurt	180	54.7
	Cheese	139	42.2
	Soy milk	26	7.9
	Flavored dairy beverages	15	4.6
	None of the above	59	17.9

1 Hot dog, sausage, chorizo.

2 Luncheon meat, mortadella, ham.

3 Cakes, sponge cakes.

4 Gummy candies, chewing gum, lollipops, hard candies.

5 Milk: powdered, evaporated, condensed, cream-based.

Figure 1 illustrates how certain beverages (fruit-based, energy, and carbonated drinks) tend to cluster based on the colourings and acidity regulators they contain. In fruit-flavoured beverages, colourings INS 133 (Brilliant Blue FCF) and INS 150d (Caramel IV) were frequently found together (Figure 1A). In contrast, energy and carbonated drinks were more likely to contain other colourings such as INS 160 (Carotene), INS 170 (Calcium Carbonate), INS 132 (Indigotine), and INS 131 (Patent Blue V) (Figure 1B). Notably, when a product contained INS 160, it was commonly paired with INS 170, suggesting a frequent co-usage pattern. Similarly, in fruit-based drinks, the combination of INS 110 (Sunset Yellow FCF) and INS 160 was prevalent, while the most common pairing in energy and fizzy drinks was INS 110 and INS 150. However, these colourings were generally used independently of other additives. Colouring INS 102 (Tartrazine) appeared isolated in the dendrogram, suggesting relatively limited use in the analysed samples.

Figure 1. (A) Dendrogram of the most frequently used food colorants in fruit-based beverages, (B) Dendrogram of the most frequently used food colorants in energy and carbonated beverages, (C) Dendrogram of the most frequently used acidity regulators in fruit-based beverages, (D) Dendrogram of the most frequently used acidity regulators in energy and carbonated beverages.

Regarding acidity regulators, fruit-flavoured beverages frequently contained both INS 300 (Ascorbic Acid) and INS 327 (Sodium Lactate) (Figure 1C). In contrast, energy and carbonated drinks commonly featured INS 341 (Calcium Phosphates), INS 500 (Sodium Carbonates), INS 340 (Potassium Phosphates), and INS 296 (Malic Acid). One particular acidulant showed a clustering distance nearly 25 units greater than the others (Figure 1D), indicating infrequent co-use with other additives.

Dairy products were also clustered based on their acidity regulators, while meat products and oils and fats were grouped according to their antioxidant content. The commonly identified acidulants included INS 339i (Monosodium Phosphate), INS 452i (Sodium Polyphosphate), INS 331i (Monosodium Citrate), and INS 500i (Sodium Carbonate), the latter also appearing in carbonated and energy drinks (Figure 2A).

Figure 2. (A) Dendrogram of the most frequently used acidity regulators in dairy products, (B) Dendrogram of the most frequently used food antioxidants and preservatives in meat products, (C) Dendrogram of the most frequently used food antioxidants in oils and fats.

The antioxidant INS 330 (Citric Acid) was frequently found in both meat products and oils and fats. However, in the former, it was most often co-present with INS 304 (Ascorbyl Palmitate), while in the latter it was more commonly associated with INS 386 (Disodium EDTA). The antioxidants showing the greatest dissimilarity or least frequent use in these products were INS 300 (Ascorbic Acid) in meat products and INS 385 (Calcium Disodium EDTA) in oils and fats, respectively (Figures 2B and 2C).

Discussion

Carbonated soft drinks were the most preferred ultra-processed beverages, consumed by over 50% of the study population, whose mean age was 24.5 ± 0.01 years. Among solid products, between 41.6% and 66.4% of students reported consumption of items in the meat, dairy, and confectionery groups (including biscuits). These high levels of intake are consistent with the findings of Mamani-Urrutia et al. (2021), who reported elevated consumption of biscuits (56%) and dairy products (54.3%) among university students. A similar order of preference was observed by Choque-Quispe et al. (2023) in Peruvian adolescents aged 14 to 18 years; however, the reported values were lower: beverages (30.4%), meat products (17.4%), and confectionery (17.4%). In Brazil, according to Simões et al. (2020), the highest UPF consumption among adolescents aged 18 to 19 in the state of Maranhão corresponded to the cereal group, particularly biscuits, cakes, and industrially processed white bread (14.1%). These patterns may be attributed to the academic demands faced by young individuals, often reflected in meal-skipping behaviours, particularly breakfast (Maza-Ávila et al., 2022).

Milk, with a consumption rate of 66.3%, was the most consumed UPF in the evaluated population, exceeding the figures reported by Rojas et al. (2011), who found milk consumption at 42.5% and cheese at 53.8% among children aged 8.73 years. According to the National Institute of Health (2023), frequent dairy intake ensures adequate calcium supply, as milk and yoghurt have high bioavailability of this mineral. However, it is important to consider age-specific intake recommendations: 1300 mg for adolescents aged 14 to 18, and 1000 mg for adults aged 19 to 50 and children aged 4 to 8. Although milk consumption was high, so too was that of soft drinks, which may be counterproductive given that both contain sugars, increasing caloric intake without significant nutritional benefit. Moreover, high-phosphorus diets can reduce calcium bioavailability (Takeda et al., 2014).

A total of 54.7% of participants reported sausage consumption—higher than that observed by Kotopoulou et al. (2022) in a Greek population, where sausage consumption stood at 23.8%, although a high intake of pork (41.5%) and turkey-based (32.7%) processed meats was reported. In a study by Wang et al. (2022) in Canada, bisphenol A was detected in meat products, with the highest levels found in roasted beef (118.23 ng/g), followed by cured pork (0.14 ng/g), and cold cuts such as ham, mortadella, and sausages (0.18 ng/g). Notably, these products often contain additives such as nitrites, whose excessive intake may exceed the acceptable daily intake (ADI) of 0.07 mg/kg body weight/day, posing a health risk.

Dendrogram analysis confirmed that the main antioxidants and preservatives used in meat products sold in Peru were ascorbyl palmitate (INS 304) and sodium nitrite (INS 250), respectively. Citric acid (INS 330) was identified as a common antioxidant in meat products, oils, and fats. Additionally, the most frequently used acidulants in dairy products and beverages were INS 339i, INS 452i, INS 300, and INS 341. These findings are in line with Chazelas et al. (2020), who reported that the most frequent preservatives in French meat products were sodium nitrite (INS 250), potassium nitrate (INS 252), and sodium acetate (INS 262), with sodium lactate (INS 325) and INS 262 frequently co-occurring as antioxidant and preservative, respectively.

In the confectionery group, the most commonly used colourants in combination were Allura Red AC (INS 129), Tartrazine (INS 102), Sunset Yellow FCF (INS 110), Brilliant Blue FCF (INS 133), Indigotine (INS 132), and Titanium Dioxide (INS 171), while Carmine (INS 120) was less frequently used. This pattern was also observed in the analysed beverages, except for Tartrazine (INS 102), which appeared less often. It is important to note that some of these additives are banned in certain countries due to potential adverse health effects. For example, INS 133 is banned in China, and INS 110 in Norway, Sweden, and Finland (Vázquez et al., 2016). Furthermore, phosphates such as INS 340 and INS 341 require monitoring in individuals with kidney disease (Garcia et al., 2017). Although these additives are not consumed directly, their presence in food implies indirect intake, which should remain within the limits established by rigorous scientific evaluations, including biochemical and toxicological studies, to determine their ADI (WHO, 2023).

An analysis based on data from the “Pesquisa de Orçamentos Familiares” for the years 2008 and 2018 revealed that UPFs accounted for 19.7% of total caloric intake during 2017–2018. The study reported higher consumption among women than men (Louzada et al., 2018) and found an association between UPF-rich diets and an unfavourable cardiometabolic risk profile, which increases the likelihood of developing cardiovascular disease (Pagliai et al., 2021).

Excessive alcohol consumption also negatively affects dietary patterns and nutritional status. Alcohol abuse has been linked to deficiencies in essential micronutrients such as thiamine, riboflavin, niacin, pyridoxine, folic acid, vitamins A, C, D, E, and K, as well as magnesium, selenium, and zinc (Jeynes & Gibson, 2017). Alcohol also increases the preference for foods high in sugar and fat (Jeynes & Gibson, 2017; Schrieks et al., 2015). In a randomised clinical trial involving healthy men in the Netherlands, moderate alcohol intake was shown to increase spontaneous consumption of high-fat foods, such as pâté and salami (Schrieks et al., 2015).

In New Zealand, Parackal et al. (2020) found that women who consumed more than four alcoholic drinks on a typical day at least once a week had higher intakes of carbohydrates and fats (total, saturated, monounsaturated, and polyunsaturated). They also had lower serum folate levels compared to those who drank less frequently (≤ 4 drinks, once a month or less). In Spain, Escrivá-Martínez et al. (2023) observed a direct relationship between binge eating, high fat consumption, and alcohol abuse.

It is well established that diet quality and dietary factors play a key role in the prevention of non-communicable chronic diseases (Global Burden of Disease et al., 2019; Laudisi et al., 2019). High UPF consumption adversely affects nutritional status (Baroni et al., 2018), making it essential to maintain a healthy, balanced, and varied diet that is sustainable over time and contributes to healthy ageing.

Data availability