Submitted:
30 September 2025
Posted:
30 September 2025
You are already at the latest version
Abstract
Keywords:
1. Introduction
2. Materials and Methods
2.1. Framework Refinement and Development Process
2.2. Reliability Studies: User Testing of the HISS Classification System and AI Enabled Tool
3. Results
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
Abbreviations
| UPF | Ultra Processed Food |
| CHIPS | Combining Health, Intuition, Processing and Science |
| HISS | Human Interference Scoring System |
References
- Monteiro, C.A. , et al., The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public health nutrition 2018, 21, 5–17. [Google Scholar] [CrossRef]
- Monteiro, C.A. , et al., A new classification of foods based on the extent and purpose of their processing. Cadernos de saude publica 2010, 26, 2039–2049. [Google Scholar] [CrossRef] [PubMed]
- Moubarac, J.-C. , et al., Food classification systems based on food processing: significance and implications for policies and actions: a systematic literature review and assessment. Current obesity reports 2014, 3, 256–272. [Google Scholar] [CrossRef] [PubMed]
- Lane, M.M. , et al., Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. bmj 2024, 384. [Google Scholar]
- Lane, M.M. , et al., Ultra-processed food consumption and mental health: a systematic review and meta-analysis of observational studies. Nutrients 2022, 14, 2568. [Google Scholar] [CrossRef]
- Ferreiro, C.R. , et al., Ultra-processed food intake and all-cause mortality: DRECE cohort study. Public health nutrition 2022, 25, 1854–1863. [Google Scholar] [CrossRef]
- Monteiro, C.A. , et al., Ultra-processed foods: what they are and how to identify them. Public health nutrition 2019, 22, 936–941. [Google Scholar] [CrossRef]
- Menichetti, G. , et al., Machine learning prediction of the degree of food processing. Nature Communications 2023, 14, 2312. [Google Scholar] [CrossRef]
- Ravandi, B. , et al., Prevalence of processed foods in major US grocery stores. Nature Food 2025, 1–13. [Google Scholar]
- Hu, G. , et al., Accelerating the classification of NOVA food processing levels using a fine-tuned language model: A multi-country study. Nutrients 2023, 15, 4167. [Google Scholar] [CrossRef]
- Petrus, R.R. , et al., The NOVA classification system: a critical perspective in food science. Trends in Food Science & Technology 2021, 116, 603–608. [Google Scholar]
- Braesco, V. , et al., Ultra-processed foods: how functional is the NOVA system? European Journal of Clinical Nutrition 2022, 76, 1245–1253. [Google Scholar] [CrossRef]
- Hess, J.M. , et al., Dietary guidelines meet NOVA: developing a menu for a healthy dietary pattern using ultra-processed foods. The Journal of Nutrition 2023.
- Sadler, C.R. , et al., Processed food classification: Conceptualisation and challenges. Trends in Food Science & Technology 2021, 112, 149–162. [Google Scholar]
- Messina, M. , et al., Perspective: soy-based meat and dairy alternatives, despite classification as ultra-processed foods, deliver high-quality nutrition on par with unprocessed or minimally processed animal-based counterparts. Advances in nutrition 2022, 13, 726–738. [Google Scholar] [CrossRef] [PubMed]
- Astrup, A. and C. Monteiro, Does the concept of “ultra-processed foods” help inform dietary guidelines, beyond conventional classification systems? NO. The American Journal of Clinical Nutrition 2022, 116, 1482–1488. [Google Scholar] [CrossRef] [PubMed]
- Gibney, M.J. , Food technology and plant-based diets. The Journal of Nutrition 2021, 151, 1–2. [Google Scholar] [CrossRef]
- Katidi, A. , et al., Ultra-processed foods in the Mediterranean diet according to the NOVA classification system; a food level analysis of branded foods in Greece. Foods 2023, 12, 1520. [Google Scholar] [CrossRef]
- Wang, X. and Q. Sun, Ultra-Processed Foods and the Impact on Cardiometabolic Health: The Role of Diet Quality. Diabetes & metabolism journal 2024, 48, 1047–1055. [Google Scholar]
- Louie, J.C.Y. , Are all ultra-processed foods bad? A critical review of the NOVA classification system. The Proceedings of the Nutrition Society: p. 1-9.
- Eicher-Miller, H.A., V.L. Fulgoni III. Contributions of Processed Foods to Dietary Intake in the US from 20032008: A Report of the Food and Nutrition Science Solutions Joint Task Force of the Academy of Nutrition and Dietetics, American Society for Nutrition, Institute of Food Technologists, and International Food Information Council, 4. The Journal of nutrition 2012, 142, 2065S–2072S. [Google Scholar]
- Davidou, S. , et al., The holistico-reductionist Siga classification according to the degree of food processing: an evaluation of ultra-processed foods in French supermarkets. Food & function 2020, 11, 2026–2039. [Google Scholar]
- de Araújo, T.P. , et al., Ultra-Processed Food Literacy Intervention: A School Randomised Pilot Trial in Portugal. Biomedical Journal of Scientific & Technical Research 2023, 48, 39656–39667. [Google Scholar]
- Medin, A.C.; et al. Definitions of ultra-processed foods beyond NOVA: a systematic review and evaluation. Food & Nutrition Research 2025. [Google Scholar] [CrossRef] [PubMed]
- Malamatenios, O. , et al., The Human Interference Scoring System (HISS): A New Tool for Quantifying Food Quality Based on Its Level of Processing. Nutrients 2024, 16, 536. [Google Scholar] [CrossRef]
- Campbell, J.L.; et al. CHIPS AI tool Evaluation: AI Food Classification for Nutritional Literacy. Submitted for review 2025.
- Zinn, C.; et al. User Perceptions and Cultural Relevance of a CHIP-Based Food Classification AI tool. Submitted for review 2025.
- Rickman, J.C., D. M. Barrett, and C.M. Bruhn, Nutritional comparison of fresh, frozen and canned fruits and vegetables. Part 1. Vitamins C and B and phenolic compounds. Journal of the Science of Food and Agriculture 2007, 87, 930–944. [Google Scholar] [CrossRef]
- Miller, S.R. and W.A. Knudson, Nutrition and cost comparisons of select canned, frozen, and fresh fruits and vegetables. American Journal of Lifestyle Medicine 2014, 8, 430–437. [Google Scholar] [CrossRef]
- Angelino, D. , et al., Fruit and vegetable consumption and health outcomes: an umbrella review of observational studies. International journal of food sciences and nutrition 2019, 70, 652–667. [Google Scholar] [CrossRef]
- Hall, C., C. Hillen, and J. Garden Robinson, Composition, nutritional value, and health benefits of pulses. Cereal Chemistry 2017, 94, 11–31. [Google Scholar] [CrossRef]
- Mudryj, A.N., N. Yu, and H.M. Aukema, Nutritional and health benefits of pulses. Applied Physiology, Nutrition, and Metabolism 2014, 39, 1197–1204. [Google Scholar] [CrossRef]
- Al Tamimi, J.Z. , Effects of almond milk on body measurements and blood pressure. Food and Nutrition Sciences 2016, 7, 466. [Google Scholar] [CrossRef]
- Dhaver, S. , et al., Effect of Almond Milk Versus Cow Milk on Postprandial Glycemia, Lipidemia, and Gastrointestinal Hormones in Patients with Overweight or Obesity and Type 2 Diabetes: A Randomized Controlled Clinical Trial. Nutrients 2025, 17, 2092. [Google Scholar] [CrossRef]
- Gardner, C.D. , et al., Effect of two types of soy milk and dairy milk on plasma lipids in hypercholesterolemic adults: a randomized trial. J Am Coll Nutr 2007, 26, 669–677. [Google Scholar] [CrossRef] [PubMed]
- Jacobsen, B.K., S. F. Knutsen, and G.E. Fraser, Does high soy milk intake reduce prostate cancer incidence? The Adventist Health Study (United States). Cancer Causes Control 1998, 9, 553–557. [Google Scholar] [PubMed]
- Lydeking–Olsen, E. , et al., Soymilk or progesterone for prevention of bone loss: A 2 year randomized, placebo–controlled trial. European Journal of Nutrition 2004, 43, 246–257. [Google Scholar] [CrossRef] [PubMed]
- Önning, G. , et al., Effects of consumption of oat milk, soya milk, or cow’s milk on plasma lipids and antioxidative capacity in healthy subjects. Annals of nutrition and metabolism 1998, 42, 211–220. [Google Scholar] [CrossRef]
- Rivas, M. , et al., Soy milk lowers blood pressure in men and women with mild to moderate essential hypertension. The Journal of nutrition 2002, 132, 1900–1902. [Google Scholar] [CrossRef]
- Jayachandran, M. and B. Xu, An insight into the health benefits of fermented soy products. Food chemistry 2019, 271, 362–371. [Google Scholar] [CrossRef]
- Messina, M. , Soy and health update: evaluation of the clinical and epidemiologic literature. Nutrients 2016, 8, 754. [Google Scholar] [CrossRef]
- Rizzo, G. and L. Baroni, Soy, soy foods and their role in vegetarian diets. Nutrients 2018, 10, 43. [Google Scholar] [CrossRef]
- Gibbs, J. and G.-K. Leung, The effect of plant-based and mycoprotein-based meat substitute consumption on cardiometabolic risk factors: a systematic review and meta-analysis of controlled intervention trials. Dietetics 2023, 2, 104–122. [Google Scholar] [CrossRef]
- Bottin, J.H. , et al., Mycoprotein reduces energy intake and postprandial insulin release without altering glucagon-like peptide-1 and peptide tyrosine-tyrosine concentrations in healthy overweight and obese adults: a randomised-controlled trial. British Journal of Nutrition 2016, 116, 360–374. [Google Scholar] [CrossRef]
- Coelho, M.O. , et al., Daily mycoprotein consumption for 1 week does not affect insulin sensitivity or glycaemic control but modulates the plasma lipidome in healthy adults: a randomised controlled trial. British Journal of Nutrition 2021, 125, 147–160. [Google Scholar] [CrossRef]
- Dunlop, M.V. , et al., Mycoprotein represents a bioavailable and insulinotropic non-animal-derived dietary protein source: a dose–response study. British Journal of Nutrition 2017, 118, 673–685. [Google Scholar] [CrossRef] [PubMed]
- Ruxton, C.H. and B. McMillan, The impact of mycoprotein on blood cholesterol levels: a pilot study. British Food Journal 2010, 112, 1092–1101. [Google Scholar] [CrossRef]
- Turnbull, W.H., A. R. Leeds, and G.D. Edwards, Effect of mycoprotein on blood lipids. The American journal of clinical nutrition 1990, 52, 646–650. [Google Scholar] [CrossRef] [PubMed]
- Joel, N. , et al., Production and quality evaluation of cocoa products (plain cocoa powder and chocolate). American journal of food and nutrition 2013, 3, 31–38. [Google Scholar]
- Amoah, I. , et al., Effect of cocoa beverage and dark chocolate consumption on blood pressure in those with normal and elevated blood pressure: A systematic review and meta-analysis. Foods 2022, 11, 1962. [Google Scholar] [CrossRef]
- Tokede, O., J. Gaziano, and L. Djoussé, Effects of cocoa products/dark chocolate on serum lipids: a meta-analysis. European journal of clinical nutrition 2011, 65, 879–886. [Google Scholar] [CrossRef]
- West, S.G. , et al., Effects of dark chocolate and cocoa consumption on endothelial function and arterial stiffness in overweight adults. British journal of nutrition 2014, 111, 653–661. [Google Scholar] [CrossRef]
- Esser, D. , et al., Dark chocolate consumption improves leukocyte adhesion factors and vascular function in overweight men. The FASEB Journal 2014, 28, 1464–1473. [Google Scholar] [CrossRef]
- Rull, G. , et al., Effects of high flavanol dark chocolate on cardiovascular function and platelet aggregation. Vascular Pharmacology 2015, 71, 70–78. [Google Scholar] [CrossRef]
- Chen, Z. , et al., Ultra-processed food consumption and risk of type 2 diabetes: three large prospective US cohort studies. Diabetes Care 2023, 46, 1335–1344. [Google Scholar] [CrossRef]
- Mendoza, K. , et al., Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies. The Lancet Regional Health–Americas 2024, 37. [Google Scholar] [CrossRef] [PubMed]
- Aune, D. , et al., Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies. bmj 2016, 353. [Google Scholar]
- Slavin, J.L., D. Jacobs, and L. Marquart, Grain processing and nutrition. Critical Reviews in Food Science and Nutrition. 2000, 40, 309–326. [Google Scholar] [CrossRef] [PubMed]
- Dumas, A.-A. , et al., A systematic review of the effect of yogurt consumption on chronic diseases risk markers in adults. European Journal of Nutrition 2017, 56, 1375–1392. [Google Scholar] [CrossRef]
- Anchor Dairy. How is milk made? 2023 [cited 2025 27.08.25]; Available from: https://www.anchordairy.com/nz/en/about-us/our-quality-promise-trusted-goodness/how-is-the-milk-made.html.
- Li, M.-L. , et al., Improving sarcopenia in older adults: A systematic review and meta-analysis of randomized controlled trials of whey protein supplementation with or without resistance training. The Journal of nutrition, health and aging 2024, 28, 100184. [Google Scholar] [CrossRef]
- Antonio, J. , et al., A high protein diet has no harmful effects: a one-year crossover study in resistance-trained males. Journal of nutrition and metabolism 2016, 2016, 9104792. [Google Scholar] [CrossRef]
- Jäger, R. , et al., International society of sports nutrition position stand: protein and exercise. Journal of the International Society of Sports Nutrition 2017, 14, 20. [Google Scholar] [CrossRef]
- Nunes, E.A. , et al., Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults. Journal of cachexia, sarcopenia and muscle 2022, 13, 795–810. [Google Scholar] [CrossRef]
- World Health Organization, Global status report on alcohol and health 2018. 2019: World Health Organization.
- World Health Organization, Global status report on alcohol and health and treatment of substance use disorders. 2024: World Health Organization.
- Rumgay, H. , et al., Alcohol and cancer: epidemiology and biological mechanisms. Nutrients 2021, 13, 3173. [Google Scholar] [CrossRef]
- Rehm, J. Manthey, and K.D. Shield, Global health risk factors: alcohol consumption, in Handbook of global health. 2021, Springer. p. 679-717.
- Crimarco, A. , et al., Assessing the effects of alternative plant-based meats v. animal meats on biomarkers of inflammation: a secondary analysis of the SWAP-MEAT randomized crossover trial. Journal of Nutritional Science 2022, 11, e82. [Google Scholar] [CrossRef] [PubMed]
- Crimarco, A. , et al., A randomized crossover trial on the effect of plant-based compared with animal-based meat on trimethylamine-N-oxide and cardiovascular disease risk factors in generally healthy adults: Study With Appetizing Plantfood—Meat Eating Alternative Trial (SWAP-MEAT). The American journal of clinical nutrition 2020, 112, 1188–1199. [Google Scholar] [PubMed]
- Afonso, S. , et al., Non-Alcoholic Wines: Sensory Pleasantness and Health Benefits. Foods 2025, 14, 1356. [Google Scholar] [CrossRef] [PubMed]
- Sancén, M. , et al., Features of non-alcoholic beer on cardiovascular biomarkers. Can it be a substitute for conventional beer? Nutrients 2022, 15, 173. [Google Scholar]
- Haile, D. , et al., Health effects associated with consumption of processed meat, sugar-sweetened beverages and trans fatty acids: a Burden of Proof study. Nature Medicine 2025, 1–11. [Google Scholar]
- Maximova, K. , et al., Co-consumption of vegetables and fruit, whole grains, and fiber reduces the cancer risk of red and processed meat in a large prospective cohort of adults from Alberta’s Tomorrow Project. Nutrients 2020, 12, 2265. [Google Scholar] [CrossRef]
- Ungvari, Z. , et al., Association between red and processed meat consumption and colorectal cancer risk: a comprehensive meta-analysis of prospective studies. GeroScience 2025, 1–18. [Google Scholar]
- Te Morenga, L., S. Mallard. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. Bmj 2013, 346. [Google Scholar] [CrossRef]
- Vos, M.B. , et al., Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association. Circulation 2017, 135, e1017–e1034. [Google Scholar] [CrossRef]
- Malik, V.S. and F.B. Hu, The role of sugar-sweetened beverages in the global epidemics of obesity and chronic diseases. Nature Reviews Endocrinology 2022, 18, 205–218. [Google Scholar] [PubMed]
- Malik, V.S. , et al., Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. The American journal of clinical nutrition 2013, 98, 1084–1102. [Google Scholar] [CrossRef] [PubMed]
- Santos, L.P. , et al., Sugar sweetened beverages intake and risk of obesity and cardiometabolic diseases in longitudinal studies: a systematic review and meta-analysis with 1.5 million individuals. Clinical nutrition ESPEN 2022, 51, 128–142. [Google Scholar] [CrossRef] [PubMed]
- Reister, E.J., L. N. Belote, and H.J. Leidy, The benefits of including hummus and hummus ingredients into the American diet to promote diet quality and health: a comprehensive review. Nutrients 2020, 12, 3678. [Google Scholar] [CrossRef]
- Wallace, T.C., R. Murray, and K.M. Zelman, The nutritional value and health benefits of chickpeas and hummus. Nutrients 2016, 8, 766. [Google Scholar] [CrossRef]
- Dinu, M. , et al., Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. European journal of clinical nutrition 2018, 72, 30–43. [Google Scholar] [CrossRef]
- Lotti, S. , et al., The impact of the timing of pasta intake on sleep quality and health outcomes: a protocol for a randomized controlled trial. Trials 2025, 26, 150. [Google Scholar] [CrossRef]
- Yu, J. , et al., White rice, brown rice and the risk of type 2 diabetes: A systematic review and meta-analysis. BMJ open 2022, 12, e065426. [Google Scholar]
- Koios, D., P. Machado, and J. Lacy-Nichols, Representations of ultra-processed foods: a global analysis of how dietary guidelines refer to levels of food processing. International Journal of Health Policy and Management 2022, 11, 2588. [Google Scholar]
- Cordova, R. , et al., Consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study. The Lancet Regional Health–Europe.
- Dicken, S.J. , et al., Food consumption by degree of food processing and risk of type 2 diabetes mellitus: a prospective cohort analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC). The Lancet Regional Health–Europe 2024, 46. [Google Scholar]
- Gasser, C.E. , et al., Confectionery consumption and overweight, obesity, and related outcomes in children and adolescents: a systematic review and meta-analysis. The American journal of clinical nutrition 2016, 103, 1344–1356. [Google Scholar] [CrossRef]
- Pfrimer, K. , et al., Under-reporting of food intake and body fatness in independent older people: a doubly labelled water study. Age and ageing 2014, 44, 103–108. [Google Scholar] [CrossRef]
- Scagliusi, F.B. , et al., Underreporting of energy intake in Brazilian women varies according to dietary assessment: a cross-sectional study using doubly labeled water. Journal of the American Dietetic Association 2008, 108, 2031–2040. [Google Scholar] [CrossRef]
- Morgenstern, J.D. , et al., Perspective: Big data and machine learning could help advance nutritional epidemiology. Advances in Nutrition 2021, 12, 621–631. [Google Scholar] [CrossRef] [PubMed]
- Archer, E., G. Pavela, and C.J. Lavie, The inadmissibility of what we eat in America and NHANES dietary data in nutrition and obesity research and the scientific formulation of national dietary guidelines. Mayo Clinic Proceedings 2015, 90, 911–926. [Google Scholar] [CrossRef] [PubMed]
- Patel, A.I. , et al., The association of flavored milk consumption with milk and energy intake, and obesity: A systematic review. Preventive medicine 2018, 111, 151–162. [Google Scholar] [CrossRef] [PubMed]
- Chacko, E., I. McDuff, and R. Jackson, Replacing sugar-based soft drinks with sugar-free alternatives could slow the progress of the obesity epidemic: have your Coke® and drink it too. The New Zealand Medical Journal (Online).
- Katz, D.L., K. Doughty, and A. Ali, Cocoa and chocolate in human health and disease. Antioxidants & redox signaling 2011, 15, 2779–2811. [Google Scholar]
- Swinburn, B.A. , et al., The global obesity pandemic: shaped by global drivers and local environments. The lancet 2011, 378, 804–814. [Google Scholar] [CrossRef]
- Hall, K.D. , et al., Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell metabolism 2019, 30, 67–77.e3. [Google Scholar] [CrossRef]
- Katz, D.L. , The mass of humanity and the weight of the world: obesity and the environment at a confluence of causes. Current obesity reports 2016, 5, 386–388. [Google Scholar] [CrossRef]
- Hall, K.D. , From dearth to excess: the rise of obesity in an ultra-processed food system. Philosophical Transactions of the Royal Society B 2023, 378, 20220214. [Google Scholar] [CrossRef]
| Food categories (Groups) and definition | Examples |
|---|---|
|
Group 1: Unprocessed and minimally processed whole foods. Raw and whole foods that were alive recently with little or no processing. Foods that are fresh, chilled, canned, frozen, or dried to enhance nutrients and freshness at their peak. Unprocessed foods are of plant and animal origin. Minimally processed foods are natural foods that are altered with removal of inedible or unwanted parts and preserved for storage. |
Fruit and vegetables of all types including canned and frozen vegetables, pure juices and pure smoothies (whether fortified or not) and dried fruit; red and white meats (beef, chicken, lamb, pork, venison) and fish including canned and smoked fish (where meat or fish are breaded or battered, count the meat/fish in group 1 plus a serving of bread coating/batter from group 2/3); eggs; all legumes (beans, chickpeas, lentils) either dried or canned; natto, tofu & tempeh; all nuts and seeds (including desiccated coconut and ground nuts/seeds but not candy coated nuts); honey; water (including soda water); herbs and spices; grains that were traditionally available to pre industrial societies as whole kernels or groats (e.g. buckwheat groats, rye berries, millet, wheat berries, barley groats); tea, herbal tea, cacao and coffee (ground or instant but not pre-mixed sachets). |
|
Group 2. Processed foods Food products that were typically available for consumption in pre-industrial societies. Includes a wide variety of foods that may be domestically prepared or industrially prepared but that still resemble/ are recognizable as real foods. Foods may be processing (by culturing, preserving, heating etc.) or may be made by combining several ingredients from group 1 (e.g., lasagna- homemade or store bought). Other items that are widely regarded as being beneficial dietary supplements e.g. protein powder. |
Dairy products including butter, most cheeses (hard, soft or cream cheese but not processed slices) cream, and yogurts; milk of all types (plant and animal); coconut creams; alternative dairy products such as coconut or soy yogurt; most breads including rye, brown, wholewheat, sourdough, pitta, baguettes etc. (not including cake like products such as crumpets, muffins, scones and croissants or processed sliced white bread/burger buns etc); bread coatings on e.g. meat/fish; processed grains including corn tortillas; pasta; couscous; pearl barley; rice; polenta; noodles (not instant); oats and oatmeal; muesli; granolas; simple one ingredient cereals including shredded wheat/puffed spelt or corn; kombucha; miso paste; soups; ready meals; nut and seed butters; simple/traditional meat alternatives such as falafel, plain Quorn, and textured vegetable protein; hummus; pesto; aioli; pasta sauces; vegetable and seed oils of all types (flaxseed, sunflower etc.); animal fats (lard, butter); protein powders; cocoa and plain dark chocolate with >80% cocoa. |
Group 3: Ultra processed and junk foods
|
Cakes; biscuits; confectionary (chocolate, candy, candy coated nuts); ready mixed coffee sachets and frappes; ice cream; sweetened condensed milks; jams; sugar and syrups; cake-like bread products including scones, crumpets and croissants; savory crackers (for cheese, rice crackers etc.); packaged sliced white bread including hamburger buns and hot dog rolls; pies and pastry products such as spring rolls; batter coatings (e.g. on fish); breakfast cereals that are highly colored/flavored/molded into shapes where raw/constituent ingredients are not evident; processed breakfast cereal drinks; packaged snack products (e.g., crisps, pretzels etc.); chips and fries; soda (including diet soda) and energy drinks; sugar sweetened beverages including flavored milks and sugar sweetened juice drinks; powdered and packaged desserts; instant noodles; muesli bars; margarine; ready-to-drink alcoholic beverages; processed/cured/smoked meats and pre-prepared ready-to-heat meat products including poultry and fish ‘nuggets’ and ‘sticks;’ sausages, burgers, hot dogs, bacon, salami and other reconstituted meats; fast food (e.g. anything from McDonalds, Burger King, Taco Bell, KFC etc.); processed cheese slices/snacks. |
| Food Item | CHIPS Group | NOVA Group | Rationale for HISS Placement | Health Evidence Summary / processing notes | References |
|---|---|---|---|---|---|
| Canned fruits and vegetables | Group 1 | Group 3* | Minimally processed whole food; processing is primarily for preservation. Serve as nutritional options that can be more economical than fresh produce. | Fruits and vegetables are associated with a huge array of health benefits and canned varieties can contribute to individuals increasing their daily consumption. | [13,28,29,30] |
| Canned beans, lentils and chickpeas | Group 1 | Group 3* | Minimally processed whole food; processing is primarily for preservation. Canned pulses retain many of the same nutritional benefits as those cooked from dried. Even when canned in brine, most of this can be washed off when rinsing. | Pulses are associated with a wide variety of health benefits including reduced blood pressure, body weight, LDL cholesterol, and lower rates of cancer and heart disease. These benefits extend to canned pulses, not only those cooked from dried. | [31,32] |
| Soy and other plant milks (plain, fortified) | Group 2 | Group 4* | Industrially processed but shown to be neutral to beneficial for health and are used as a dairy alternative to fill nutritional gaps that may result for those avoiding dairy/animal products. Currently, NOVA penalises those eating plant-based which is not evidence based. | Neural to favourable effects on total and LDL cholesterol, bone health, body weight, blood pressure and glycaemic response compared to dairy milk. Possible anti-cancer benefits for some e.g. soy milk. Effects don’t seem to differ between milk made with whole soybean vs soy protein isolate. | [14,33,34,35,36,37,38,39] |
| Tofu, natto, miso and tempeh | Group 1 | Group 3/4 | Traditional, minimally processed soy product with consistent health associations. | Soy products including tofu and tempeh have been linked with reduced cancer risks, lower rates of cardiovascular disease, reduced blood pressure, LDL and total cholesterol, assistance with symptoms of menopause and several other health benefits. | [40,41,42] |
| Quorn (mycoprotein) and textured vegetable protein (TVP) | Group 2 | Group 4 | Nutritionally valuable meat alternatives for plant-based individuals, minimal additives, evidence of positive impact on health. | RCTs on mycoprotein show lower total cholesterol, lower LDL, lower triglycerides, neutral to positive effects on blood glucose and insulin responses, positive effects on satiety/energy balance, and positive effects on muscle protein synthesis. Few studies directly only TVP but there is plentiful evidence on the benefits of soy protein (see previous row). | [43,44,45,46,47,48] |
| Cacao | Group 1 | Group 4 | Comparable to coffee roasting, not an ultra-processed product but instead a traditional ingredient in e.g. Samoan Cuisine. | Plentiful evidence of health benefits of cacao products (see next row) but raw cacao is classified based on minimal processing. | [49] |
| Cocoa powder, and plain dark chocolate with over 80% cocoa | Group 2 | Group 4 | Can be moderately rather than ultra-processed with few ingredients. Neutral to beneficial for health and distinct from sugary hot chocolate powders and bars. | Neutral to beneficial impacts on cardiovascular health, through the reduction of blood pressure, reduced LDL and total cholesterol, improvement of vascular and endothelial health and reduction of platelet aggregation. | [50,51,52,53,54] |
| Wholegrain bread (including mass produced) | Group 2 | Group 3–4 | Despite being mass produced, wholewheat breads have been associated with beneficial rather than detrimental effects on health in many studies looking both specifically at UPFs, and those addressing whole grain consumption. | Whole grains including wholewheat bread are associated with lower risk of type 2 diabetes, coronary heart disease, cardiovascular disease, cancer, lower all-cause mortality and lower mortality from respiratory disease and diseases of the nervous system. | [55,56,57] |
| Processed grains (brown rice, white rice, quinoa, puffed millet, flaked millet, puffed teff, flaked teff, couscous, bulgur, pearl barley, rolled oats, instant oats, pasta, noodles, soba, udon, polenta, puffed quinoa, puffed wheat, flaked spelt, cracked wheat, semolina, polenta, pearled farro) | Group 2 | Group 1 | Separated from minimally processed grains (e.g. groats, berries and whole millet) due to additional levels of processing. | Grains are processed into flaked, puffed, pearled, cracked, rolled, or milled forms (sometimes cooked and dried, like pasta/couscous) compared to group 1 whole intact grains. Grains have been moved to group 2 based on processing rather than health outcomes**. | [58] |
| Flavoured and low-fat yoghurts | Group 2 | Group 4 | Fermented whole food with some added components; judged on healthfulness and base ingredients. | Yoghurts, including those classed as UPFs have been associated with lower incidence of type 2 diabetes, cardiovascular disease, and have favourable to neutral effects on metabolic markers. | [55,56,59] |
| Milk and plain yoghurt | Group 2 | Group 1 | Classified as group 2 rather than group 1 as modern milk is moderately processed including heat treatment and homogenisation before yogurt/butter/cheese production. | Milk is filtered, standardised, homogenised, heat-treated, possibly fortified, and then packaged. We believe this is better characterised as moderate processing. | [60] |
| Protein powder | Group 2 | Group 4 | Beneficial food supplement that can increase protein intake and digestibility. | No evidence of harm and overall evidence of being health supportive, especially for older adults, plant-based individuals, athletes, and people recovering from illness. | [61,62,63,64] |
| All alcohol | Group 3*** | Group 3*** | Regardless of fermentation method, alcohol is classified as Group 3 due to consistent evidence of harm. | In 2019, 2.6 million deaths were attributed to alcohol consumption. Evidence consistently shows harm, including increased risk of liver disease and several cancers. | [65,66,67,68] |
| Plant based meat alternatives (PBMA) | Group 3 | Group 4 | Lack of evidence regarding health means PBMA are left in CHIPS 3, however with a caveat in the AI tool and could be moved in future CHIPS versions. | From short term trials so far conducted, PBMA appear to be neutral to beneficial. However, long term data is absent. The AI tool will note that these can be useful sources of protein for those eating plant-based and the decision to choose PBMA or whole plant sources of protein is individual and based on e.g. protein requirements, body composition etc. | [43,69,70] |
| Zero alcohol beer and wine | Group 2 | Group 4 | Given the known harms associated with alcohol, these options represent a better choice than alcoholic beverages, while still containing beneficial compounds such as polyphenols and being lower sugar than sugar sweetened beverages. | Several trials have shown neutral to beneficial effects on oxidative markers (beer and wine), markers of inflammation (beer and wine) and infection (beer), blood pressure (wine) and gut health (wine). | [71,72] |
| Cured and smoked meats (processed meats) including bacon, ham, sausages, salami, luncheon meat etc | Group 3 | Group 3 (or 4 if when additives present) | Despite being only moderately processed and pre-industrial, there is abundant evidence of negative health impacts. | Increased risk of cancers, heart disease, type two diabetes and chronic obstructive pulmonary disease, even when controlling for confounding factors including fruit and vegetable intake. | [73,74,75] |
| Sugar (all types) | Group 3 | Group 2 | Despite being only moderately processed, evidence of negative impacts on health are clear. | High levels of free sugars in the diet are associated with increased energy intake, body fatness/weight gain, and worse cardiometabolic health. | [76,77] |
| Fruit drinks and juice with added sugar | Group 3 | Group 3 | Moderately processed but strong evidence of harm. | Sugar sweetened beverages are associated with increased body fatness/weight gain and cardiometabolic diseases. | [76,78,79,80] |
| Confectionary and cakes (including homemade) | Group 3 | Group 3 when homemade | Moderately processed but nevertheless clear that cakes and confectionary are associated with negative impacts on health. | High levels of free sugars in the diet (including from cakes and confectionary) are associated with increased energy intake, body fatness/weight gain, and worse cardiometabolic health. | [76,77] |
| Hummus, pesto, guacamole, pasta sauce and similar products, including when store bought | Group 2 | Group 4 | Traditional foods that are part of healthful eating patterns, despite potential for the presence of additives. This takes a pragmatic approach to eating. | Pulses, and ingredients such as olive oil, tomato, and avocado are associated with a wide range of health benefits and are staples in traditional diets such as Mediterranean. | [18,81,82,83] |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
