Sugar intake has been associated with increased prevalence of childhood overweight/obesity; however, results remain controversial. The aim of this study was to examine the probability of overweight/obesity with higher sugar intakes, accounting for other dietary intakes. Data from 1165 children and adolescents aged ≥2–18 years (66.8% males) enrolled in the Hellenic National Nutrition and Health Survey (HNNHS) were used; specifically, 781 children aged 2–11 years and 384 adolescents 12–18 years. Total and added sugar intake were assessed using two 24 h recalls (24 hR). Foods were categorized into specific food groups to evaluate the main foods contributing to intakes. A significant proportion of children (18.7%) and adolescents (24.5%) exceeded the recommended cut-off of 10% of total energy intake from added sugars. Sweets (29.8%) and processed/refined grains and cereals (19.1%) were the main sources of added sugars in both age groups, while in adolescents, the third main contributor was sugar-sweetened beverages (20.6%). Being overweight or obese was 2.57 (p = 0.002) and 1.77 (p = 0.047) times more likely for intakes ≥10% of total energy from added sugars compared to less <10%, when accounting for food groups and macronutrient intakes, respectively. The predicted probability of becoming obese was also significant with higher total and added-sugar consumption. We conclude that high consumption of added sugars increased the probability for overweight/obesity among youth, irrespectively of other dietary or macronutrient intakes.

Context: Over the past few decades, traditional foods have been displaced by ultra-processed foods (UPFs), with the latter being associated with health problems. Objective: This scoping systematic review aimed to identify the relationship between UPF intake and overweight/obesity as well as other cardiometabolic risk factors during childhood and adolescence. Data Sources: The guidance for this protocol is the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). A systematic search was undertaken on PubMed, Scopus, and Cochrane Library electronic databases based on prespecified inclusion and exclusion criteria up to 6 February 2022. Data Extraction: A total of 17 observational studies—9 cross-sectional, 7 cohort-longitudinal, and 1 study reporting both cross-sectional and longitudinal outcomes—among children and adolescents aged ≤18 years were eligible for inclusion in this review. Fourteen studies evaluated the consumption of UPFs in association with overweight/obesity and 9 studies examined the association of UPF consumption and cardiometabolic-related risk factors. Data Analysis: Most studies (14/17) showed that an increase in UPFs was associated with a higher prevalence of overweight/obesity and cardiometabolic comorbidities among children and adolescents, whereas 4 of 17 studies (3 cross-sectional and 1 cohort) found no association. Most cohort and cross-sectional studies showed good quality according to the National Institutes of Health and Newcastle-Ottawa quality assessment, respectively. Conclusion: The positive association found between UPFs and overweight/obesity and cardiometabolic comorbidities among children and adolescents raises concerns for future health. Further investigation is recommended to explore the role of specific types of UPFs on cardiometabolic conditions and to identify the amount of daily intake that increase risk in order to shape appropriate public health policies. Systematic Review Registration: PROSPERO registration no. CRD42022316432.

Consumption of ultra‐processed foods (UPFs) is thought to play an important role in the development of childhood obesity worldwide. The aim of this study was to assess the main food groups contributing to UPF consumption and their association with weight status. Following exclusion of children with implausible intakes and misreporters, the final sample included 443 of 484 eligible (children and adolescents aged 2–18 years old) (91.5%), from the Hellenic National Nutrition and Health Survey (HNNHS). UPF items reported in 24‐h recalls were identified according to the NOVA4 system and the proportion of their contribution to the daily energy intake was calculated. Main UPF food contributors were derived for the total population and by weight status. The association between weight status and UPF intake for the main contributors was examined using generalised linear models. The average percentage of total daily energy provided by UPFs was 39.8%. Four major food groups were found to contribute > 10% of total UPF intake: ready‐to‐eat/heat dishes (36.2%), sweet grain products (21.4%), savoury snacks (15.4%) and sweets (12.9%). These provided 86% of the total UPF intake, with no significant differences between children's weight status. There was also no significant association between the total percentage of energy as UPF and obesity. The relatively high contribution of UPFs, however, to children's daily energy intake in Greece emphasises the need for public food awareness campaigns for health promotion. Evaluation of the contribution of different food groups and not only of total UPF intake is also important.

Background: Ultra-processed foods (UPFs) have emerged as a critical component of diet quality, yet data on the associations between UPF and nutrient intakes remain limited. This study aimed to evaluate nutrient consumption in relation to UPF intake and adherence to international dietary guidelines for non-communicable disease (NCD) prevention. Methods: Data from 469 individuals aged 2–18 years enrolled in the Hellenic National Nutrition and Health Survey (HNNHS) were analyzed. Intakes were assessed using two 24 h recalls, and foods were classified according to the NOVA system. Participants were categorized by UPF energy intake tertiles. Nutrient adequacy was assessed using Nordic Nutrition Recommendations, European Society of Cardiology guidelines for macronutrients, and the Institute of Medicine’s Estimated Average Requirements and Adequate Intake values for micronutrients. Results: Children in the highest UPF tertile had significantly higher intakes of energy, carbohydrates, added sugars, saturated fats, polyunsaturated fats, and cholesterol, but lower intakes of protein compared to those in the lowest tertile. Fiber intake remained inadequate across all tertiles, with no significant differences. Regarding adherence to NCD prevention guidelines, children in the 3rd UPF tertile had a 2.3 times higher prevalence ratio for exceeding added sugar recommendations, while their protein intake prevalence ratio was 0.8 times lower. For micronutrients, the highest UPF tertile showed significantly elevated intakes of vitamins E, B₁, folate, calcium, iron, copper, and sodium, but lower potassium intake compared to the lowest tertile. Conclusions: Our results underscore the need for effective public health strategies to improve diet quality in children and adolescents and prevent diet-related NCDs.