Abstract
BACKGROUND: Ultra-processed foods (UPF) consumption has been linked to adverse health outcomes, but evidence in children and adolescents from longitudinal studies remains limited. This study aimed to investigate the prospective associations between exposure to an UPF pattern and the incidence of overweight and obesity among German children and adolescents. METHODS: We analyzed 4,762 participants aged 3-17 years from a national cohort with baseline dietary data and anthropometric measures, followed for an average of 11 years. UPF intake was estimated from a Food Frequency Questionnaire using the Nova classification. Logistic regression models assessed associations with incident overweight and obesity, adjusting for age, sex, socioeconomic status, physical activity, and baseline BMI z score. RESULTS: Each 10% increase in UPF consumption was associated with 12% higher odds of overweight (OR 1.12, 95% CI 1.03-1.23). Compared with the lowest quartile, participants in the highest quartile had 49% greater odds of overweight (OR 1.49, 95% CI 1.05-2.11). For obesity, odds were more than doubled in the third quartile (OR 2.32, 95% CI 1.38-3.88) and 74% higher in the fourth quartile (OR 1.74, 95% CI 1.06-2.84). CONCLUSIONS: Higher exposure to UPF in childhood and adolescence was associated with greater risk of developing overweight and obesity. Strategies to limit UPF exposure may contribute to obesity prevention in this age group and later in life.