Adolescents in the highest category of a frequency-based proxy UPF score exhibited a broader pattern of academic, sleep-related, behavioral, and health characteristics, including a particularly strong association with constant tinnitus.
Key Findings
Results
Constant tinnitus showed one of the strongest adjusted associations with being in the highest ultra-processed food proxy score category among adolescents.
Adjusted odds ratio (aOR) for constant tinnitus = 2.55 (95% CI: 1.77–3.67)
This was among the strongest associations observed after adjustment for measured covariates
The relationship between UPF-related dietary patterns and tinnitus was described as 'particularly understudied'
The study design was cross-sectional, precluding causal inference about the tinnitus-UPF relationship
Results
Lower academic achievement was associated with higher odds of being in the highest proxy UPF score category.
aOR = 2.10 (95% CI: 1.38–3.21) after adjustment for measured covariates
Academic achievement was operationalized as a questionnaire-based variable among secondary school students aged 15–19 years
The association remained significant in multivariable logistic regression
Results
Waking tired compared with waking rested was associated with higher odds of being in the highest proxy UPF score category.
aOR = 1.58 (95% CI: 1.06–2.35) after adjustment for measured covariates
Sleep quality was assessed via self-reported waking state (tired vs. rested)
This finding contributes to evidence linking UPF consumption to sleep-related characteristics in adolescents
Results
Alcohol consumption was associated with higher odds of being in the highest proxy UPF score category.
aOR = 1.34 (95% CI: 1.04–1.74) after adjustment for measured covariates
Alcohol consumption was included as a behavioral covariate in multivariable logistic regression
The finding suggests UPF consumption clusters with other adverse behavioral patterns in adolescents
Results
Energy drink consumption frequency was independently associated with being in the highest proxy UPF score category.
Overall p < 0.001 after adjustment for measured covariates
Energy drink consumption was modeled as a frequency-based variable
The association was evaluated alongside other dietary and behavioral factors in multivariable logistic regression
Methods
A frequency-based proxy UPF score was constructed and validated for use in an adolescent Serbian population using seven questionnaire-based food categories.
The score was derived from seven food categories 'broadly consistent with UPF-related consumption patterns in the Serbian context'
Participants were grouped into three categories using empirical tertile cut-points
The highest tertile category was modeled as the binary outcome in logistic regression analyses
The study included 1,285 students aged 15–19 years from 12 four-year secondary schools in Belgrade, Serbia
Schools were selected using a stratified multistage cluster probability sampling design
Conclusions
The study found that high UPF proxy score is part of a broader cluster of adverse academic, sleep-related, behavioral, and health characteristics in adolescents.
Significant adjusted associations were identified across academic (lower achievement), behavioral (alcohol, energy drinks), sleep (waking tired), and health (constant tinnitus) domains
The cross-sectional design limits causal interpretation
Authors called for longitudinal research 'to clarify temporal relationships and underlying determinants'
What This Means
This research examined how frequently teenagers consume ultra-processed foods (UPFs) — such as fast food, sugary snacks, and highly packaged products — and what other lifestyle and health factors tend to go along with high UPF consumption. The study surveyed 1,285 high school students aged 15–19 in Belgrade, Serbia, and grouped them by how often they ate foods associated with ultra-processing. The researchers then looked at which academic, behavioral, sleep, and health characteristics were most common among students who ate the most UPFs.
The study found that teenagers in the highest UPF consumption group were more likely to have lower academic grades, drink alcohol, consume energy drinks frequently, and report waking up feeling tired rather than rested. Most strikingly, constant tinnitus (a persistent ringing or buzzing in the ears) was among the strongest factors associated with high UPF consumption — teenagers with constant tinnitus had about 2.5 times higher odds of being in the highest UPF group compared to those without tinnitus. This suggests that high UPF consumption does not occur in isolation but tends to cluster with a range of other concerning behaviors and health complaints in adolescents.
Because this was a cross-sectional study — meaning it captured a single snapshot in time — it cannot determine whether UPF consumption causes these outcomes or whether they simply tend to occur together. This research suggests that future studies should follow teenagers over time to better understand whether dietary patterns contribute to academic difficulties, sleep problems, or conditions like tinnitus, or whether shared underlying factors drive all of these patterns simultaneously. The findings highlight the importance of looking at diet as part of a broader picture of adolescent health and behavior.
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Tomanic M, Milovanović S, Stanojlović O, Mladenović D, Davidović D, Dobrić M, et al.. (2026). A Frequency-Based Proxy Score for Ultra-Processed Food Consumption Among Adolescents: Associations with Lifestyle Factors and Tinnitus.. Nutrients. https://doi.org/10.3390/nu18162603