Public health messaging to avoid ultra-processed foods - the potential for unintended consequences for whole grain intake.

Background. Use of the NOVA food classification system has linked intake of ultra-processed foods (UPF) to non-communicable diseases. Fortified whole-grain products (predominately bread and breakfast cereal in Australia), are classified as UPF despite being core foods according to Australian Dietary Guidelines. In Australia, whole-grain intake already falls short of the suggested 48 g/day. Aim. To determine how whole-grain foods are classified within NOVA and review impacts on dietary intake if grain-based UPF were excluded. Design. A quantitative analysis of whole-grain and other nutrient intake based on dietary recalls from the National Nutrition and Physical Activity Survey 2011 to 12 (n=12 153) with and without the inclusion of grain-based UPF. Dietary modelling examined nutritional adequacy of a sample diet matching Australian Dietary Guidelines and another excluding grain-based UPF. Results. UPF exclusion reduced the theoretical median whole-grain intake from 24.1 to 9.3g. There was a significant decrease (all P <.05) in intake...