Nutrient profiles and labelling practices of marketed packaged processed and ultra-processed foods in Uganda

Abstract

The consumption of processed and ultra-processed foods is increasing globally and has been associated with an increased risk of diet-related non-communicable diseases (NCDs), partly due to their adverse nutrient profiles. In Uganda, there is limited evidence on whether these products contain excessive levels of nutrients and ingredients of concern, including total fat, saturated fat, trans fats, free sugars, sodium, caffeine, and non-sugar sweeteners (NSS). Evidence is also limited on the nutrient profiles and labelling practices of these processed food products. This study aimed to assess the nutrient profiles and labelling practices of marketed packaged, processed and ultra-processed foods in Uganda. This was a cross-sectional observational study assessing processed and ultra-processed packaged foods in Uganda across 14 health regions, covering 17 towns and border areas. A multistage stratified sampling approach was used to select supermarkets and grocery stores, targeting 452 supermarkets and 85 grocery stores. A total of 3,736 products were collected, of which 1,083 with complete nutrition information were included. Data were collected by trained nutrition professionals using NOVA classification and KoboToolbox. Products were analysed per 100 g/100 ml using Uganda Nutrient Profile Model thresholds. Statistical analysis was conducted at a 95% confidence level. Binary logistic regression assessed nutrient excess by product type, while ordinal logistic regression examined factors associated with the number of warning labels. Among the 1,083 processed and ultra-processed food products assessed, ultra-processed foods predominated, accounting for 72.1% of the products sampled from selected supermarket shelves. Overall, 38% of products exceeded the threshold for total fat, 46% for saturated fat, 48% for free sugars, and 56% for sodium, while 8% exceeded the trans-fat threshold. Warning labels were required for 85% of processed meats, 78% of frozen dairy desserts, 75% of confectionery products, and 41% of sweetened beverages. Compared with processed foods, ultra-processed foods had significantly higher odds of exceeding the thresholds for total fat (2.41 times higher; aOR = 2.41, 95% CI: 1.55–3.76), saturated fat (3.22 times higher; aOR = 3.22, 95% CI: 2.01–5.17), free sugars (4.96 times higher; aOR = 4.96, 95% CI: 3.42–7.18), and sodium (1.89 times higher; aOR = 1.89, 95% CI: 1.32–2.73). They were also 2.78 times more likely to require multiple warning labels (aOR = 2.78, 95% CI: 1.95–3.97). Over 25% of the products lacked proper nutrition labelling. Overall, ultra-processed foods were prevalent and more likely to exceed critical nutrient thresholds, emphasising the need for stronger food labelling regulation in Uganda. Development and implementation of a national nutrient profile model, mandatory front-of-pack warning labels, effective enforcement, consumer education, and product reformulation are recommended to promote healthier food environments.