Narrative reviewindependent cross-checkabstract checked I-SUG-107 standard review
Sugar is a 'culinary ingredient' in the NOVA system
The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing.
Overview
Monteiro CA et al.. Public Health Nutr 2018 · PMID 28322183 · DOI 10.1017/S1368980017000234
The NOVA classification places table sugar with oils, butter, salt and honey as processed culinary ingredients made by refining; soft drinks and sweets are ultra-processed.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Explain the NOVA food classification.
- How was the study done?
Commentary with definitions and examples.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
Sugar is Group 2 (processed culinary ingredient); soft drinks and candies are Group 4 (ultra-processed).
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Sugar itself is not an ultra-processed food, but it is a refined product.
- What are the study's limitations?
NOVA classification is not always applied consistently.
- What does it say about Elawady's specific claim?
Partly supports the claim; the 'not industrial' part is not accurate because sugar is refined.
- Do the results apply to Germany and Europe?
Used in Europe and elsewhere.
- What can explicitly not be concluded from this study?
Says nothing about how much sugar is healthy.
Scientific in-depth review
1. Full reference
- Authors
- Monteiro CA et al.
- Journal
- Public Health Nutr
- Year
- 2018
- Identifier
- PMID 28322183 DOI 10.1017/S1368980017000234
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Not stated in abstract record
2. Research question
How does NOVA classify foods by the nature, extent and purpose of processing?
3. Study design and population
- Study design
- Narrative review – Commentary defining the NOVA food classification
- Population
Not applicable
- Country
International (Brazil-based authors)
- Period
2018
- Sample size
Not applicable
- Inclusion and exclusion criteria
Not applicable
4. Methods and endpoints
- Exposure / intervention
Food processing categories
- Comparator
Not applicable
- Endpoints
Classification definitions
- Statistical methods
Not applicable
5. Actual results
- Results
Full-text passage (PMC10261019, checked 2026-10-26): Group 2 'processed culinary ingredients, such as oils, butter, sugar and salt, are substances derived from Group 1 foods or from nature by processes that include pressing, refining, grinding, milling and drying'; Group 2 includes 'sugar and molasses obtained from cane or beet; honey extracted from combs'. Group 4 ultra-processed products include carbonated drinks, sweet packaged snacks, confectionery (candies).
- Absolute risks
not applicable
- Authors' conclusion
Ultra-processed products are formulations of industrial ingredients and additives; their rising consumption is a world crisis.
6. Strengths
- Primary source of the NOVA definitions
- Widely used classification
7. Weaknesses
- Classification reliability debated (I-UPF-02)
- Commentary, not empirical study
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Definitional source.
9. Assessment of the statistical interpretation
Not applicable.
10. Relevance to the specific claim
Confirms that table sugar is classed as a processed culinary ingredient (Group 2, same group as honey), not as an ultra-processed food; but NOVA explicitly describes it as produced by refining, i.e. a processed product. Carbonated drinks and confectionery are Group 4.
11. Independent contrary findings
I-UPF-02 reports only fair inter-rater agreement for NOVA classification.
12. Transferability to Germany and Europe
Classification applies internationally.
13. Overall methodological judgement
Supports the classification part of C-SUG-05 and shows the limitation: sugar is refined, and sweets/soft drinks made from it are ultra-processed.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
None.
15. Linked fact checks
- White sugar is not an industrial/manufactured product but an extract of plants, so it does not belong with processed foods. – Studies supporting the claim