Kozeta Miliku, MD, PhD, links ultra-processed foods to behavioral issues

In a recent study published in JAMA Network Open, Kozeta Miliku, MD, PhD, an assistant professor at the University of Toronto, and her colleagues identified a significant association between early childhood consumption of ultra-processed foods (UPFs) and the development of behavioral and emotional issues.^1,2

Miliku emphasized that the preschool years are a critical window for achieving developmental milestones and establishing lifelong dietary habits. The research used data from a cohort of over 2,000 children across Canada, assessing their diets at aged 3 years using the NOVA classification system and evaluating their behavior at aged 5 years through the caregiver-reported Child Behavior Checklist (CBCL).

The findings revealed that UPFs—which include industrial formulations such as sugar-sweetened beverages, ready-to-eat meals, and mass-produced breads—accounted for approximately 45.5% of the average preschooler’s energy intake. Miliku’s analysis showed that for every 10% increase in energy contribution from UPFs, children experienced significantly higher scores in internalizing and externalizing behaviors.

Conversely, when UPFs were substituted with minimally processed foods, such as whole fruits and vegetables, children showed lower CBCL scores, suggesting a protective effect on behavioral development. Specific subgroups, particularly sugar-sweetened beverages and ready-to-heat mixed dishes, were most strongly associated with increased behavioral risks.

The study underscores a growing public health concern regarding the quality of nutrition in early childhood. Miliku noted that these findings highlight a vital need for early-life interventions. These include professional dietary advice for parents, stricter nutrition standards for child care providers, and public health campaigns to reduce UPF consumption.

Furthermore, she advocated reformulating packaged foods to reduce additives and processing levels. Ultimately, the research suggests that steering children toward minimally processed diets can play a key role in supporting healthy emotional and behavioral trajectories during their formative years.

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No relevant disclosures.

References

1. Ultra-processed foods in preschool years associated with behavioural difficulties in childhood. News release. University of Toronto. March 3, 2026. Accessed March 11, 2026. https://www.eurekalert.org/news-releases/1118583
2. Kavanagh ME, Chen ZH, Tamana SK, et al. Ultraprocessed food consumption and behavioral outcomes in Canadian children. JAMA Netw Open. 2026;9(3):e260434. doi:10.1001/jamanetworkopen.2026.0434