Impact of ultra-processed food on type 2 diabetes incidence and related chronic diseases in Ghana and West Africa - A scoping review.

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Promise Edem Nukunu, Bhavna Fnu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9634039/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The nutrition shift, which increases ultra-processed food intake (UPFs; NOVA Group 4), is linked to the rise in type 2 diabetes (T2D) and non-communicable diseases in Ghana and West Africa. UPFs, with high added sugars, fats, sodium, and synthetic chemicals, replace whole-food meals, causing obesity, insulin resistance, inflammation, and metabolic dysfunction. This scoping review describes the availability and consumption of ultra-processed foods (UPF), their health effects—specifically type 2 diabetes (T2D), cardiovascular disease (CVD), and renal disease—and regional impediments and policy responses. Method Using Arksey and O'Malley's (2005) methodology and PRISMA-ScR recommendations, we searched PubMed, Scopus, Google Scholar, and other databases, grey literature, and Ghanaian repositories from 2016 to 2026. Quantitative, qualitative, and mixed-methods studies on ultra-processed foods (NOVA classification) and outcomes in Ghana and West Africa were eligible. Two reviewers independently assessed, selected, and documented data using standardized forms, using theme synthesis to identify key patterns, mechanisms, obstacles, and flaws. Quality was assessed using MMAT. Result 53 studies met inclusion criteria. In Greater Accra markets, ultra-processed foods (UPFs) make up 85% of shelf space and outnumber unprocessed products 5:1. Increased consumption, especially among urban and migrant populations, is associated with a dose-dependent risk of type 2 diabetes (RR 1.12–1.31), obesity, cardiovascular disease, and renal issues. The mechanisms are intestinal dysbiosis, endotoxemia, oxidative stress, and signaling pathway impairment. Cost, promotion, cultural misconceptions, food scarcity, and policy execution are obstacles. In longitudinal and intervention research, significant gaps remain. NOVA-based policies, taxation, and multi-sectoral activities must be implemented immediately. Food Science & Technology General Cell Biology & Physiology Immunology Cellular Metabolism Biotechnology and Bioengineering Internal Medicine Nutrition & Dietetics General Practice Epidemiology Preventive Medicine Ultra-processed foods Type 2 diabetes incidence cardiovascular diseases chronic kidney failure and fatty liver diseases or liver related disease conditions Barriers Impact Legal framework Ghana Nutrition transition Community-based approach Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background and Problem Statement The increasing prevalence of type 2 diabetes mellitus (T2DM) is a critical global public health dilemma, with the extensive intake of ultra-processed foods (UPFs) increasingly identified as a key dietary factor contributing to this growing issue. Ultra-processed foods (UPFs) are industrially produced formulations distinguished by elevated levels of added sugars, detrimental fats, salts, and chemical additives, prevalent in contemporary dietary habits in both high-income and low- to middle-income contexts (Khandpur et al., 2024). Ultra-processed foods (UPFs) replace nutritionally rich whole meals, causing excessive calorie consumption, obesity, and chronic systemic inflammation, which are risk factors for insulin resistance and hyperglycemia, the hallmark metabolic characteristics of type 2 diabetes mellitus (T2DM) (Levy et al., 2021 ). Type 2 diabetes mellitus (T2DM) is a chronic, preventable illness caused by insulin deficiency or improper use, resulting in hyperglycemia that damages organs. Health systems in low- and middle-income countries (LMICs) have failed to address the increased prevalence of this illness, which can be prevented by diet and exercise. Uncontrolled Type 2 Diabetes Mellitus has personal, family, and systemic effects. Clinically uncontrolled blood glucose causes peripheral neuropathy, retinopathy, nephropathy, cardiovascular disease, renal failure, and increased mortality, which lower quality of life and require long-term management by patients and healthcare systems. Type 2 Diabetes Mellitus strains healthcare systems due to treatment costs, hospitalization, and decreased productivity, especially in low- and middle-income countries where ultra-processed food use is rising (Li et al., 2024 ). These pressures worsen health inequities and threaten resource-constrained healthcare systems. The epidemiological impact is staggering. Over 537 million people worldwide have diabetes, and 783 million by 2045, with 90–95% of cases being Type 2 Diabetes Mellitus (T2DM) (International Diabetes Federation [IDF], 2021, as noted in EWG, 2025). About 14% of adults worldwide have diabetes, which kills 1.6 million annually (WHO, 2023). Since 1980, diabetes incidence in Sub-Saharan Africa has increased 490%, with over 80% of cases untreated (WHO, 2023). Prospective cohort studies show that ultra-processed food (UPF) consumption significantly affects health trends: incidence rates range from 113 to 166 cases per 100,000 person-years across UPF quartiles (Levy et al., 2021 ). A pooled meta-analysis of prospective cohorts found a 48% higher relative risk of type 2 diabetes mellitus (T2DM) among high UPF consumers than low UPF consumers (RR = 1.48, 95% CI 1.36–1.61), highlighting the dose-dependent relationship of this dietary factor (Chen et al., 2023 ). This issue is poorly addressed in sub-Saharan Africa's healthcare system. A cascade-of-care review of 12 sub-Saharan African nations found that only 11% of diabetics went from diagnosis to treatment, with over half remaining untreated (Atun et al., 2017 ). From 2007 to 2022, annual per capita UPF sales rose by 40% in lower-middle-income countries and 60% in Uganda, the only low-income country for which Euromonitor sales data is available, exacerbating these systemic failures (Monteiro et al., 2025). West African countries, especially Ghana, are in danger because to rising UPF availability and weak health infrastructure. Ghana is an example of nutritional transition and health system preparation issues. As urbanization and global food markets have increased, processed and ultra-processed foods have replaced Ghanaian diets rich in cereals, legumes, and vegetables. UPF consumption is high in urban Ghana, where diabetes prevalence is 39.8% (Gato et al., 2017 ). Retail audits in Greater Accra show that 85% of shelf space in modern food establishments is filled with unhealthy food, with a 5:1 ratio of ultra-processed to unprocessed products, mostly refined grain and sugar-sweetened beverages (Adjei et al., 2022 ). Obesogenic foods are mostly imported, while protective foods like fish, vegetables, and legumes have stronger local supply chains. However, 20% of households report weekly consumption of sugar-sweetened beverages (SSBs) and confectionery (Annan et al., 2025 ). RODAM-Pros longitudinal data show increased energy contributions from processed and ultra-processed meals, especially in urban and migrant Ghanaians (Yussif et al., 2025 ). Recent data links ultra-processed foods (UPF) to type 2 diabetes mellitus (T2DM) and its comorbidities in Ghana and West Africa. Globally, dose-dependent correlations between ultra-processed food consumption and type 2 diabetes mellitus are well documented (Delpino et al., 2022 ; Vitale, 2024), and ecological studies show a positive relationship between sugar-sweetened beverage sales and diabetes burden in Ghana (Karugu, 2025). Convenience food restaurants are linked to higher BMI in Ghanaians (Dake et al., 2016 ), and processed food increases metabolic risk. Ultra-processed food additives alter gut microbiota, increase endotoxaemia, and cause chronic inflammation, oxidative stress, and loss of nutrient-sensing pathways like mTOR, AMPK, and SIRT1, contributing to insulin resistance and metabolic disorders (Anih et al., 2025 ). Ultra-processed foods (UPFs) contribute to cardiovascular disease risk via obesity-induced dyslipidaemia (Boateng et al., 2018 , 2019 ) and renal impairment, which affects 70.2% of Ghanaian T2DM patients (Kpene et al., 2024 ). In the Ashanti region of Ghana, 38.7% of T2DM patients have depression, which is linked to poor dietary adherence and worse clinical outcomes (Duodu et al., 2025 ). It’s against this background we sort to explore the evidence available on the impact of ultra-processed foods particularly on Type 2 diabetes and related co-morbidities. Our purpose is to conduct a scoping review to reveal the available evidence. This review consolidates findings from studies published between 2016 and 2026, analyzing the availability and consumption patterns of ultra-processed foods (UPF) in Ghana, the effects of UPF intake, and the efficacy of dietary reduction strategies on type 2 diabetes mellitus (T2DM), cardiovascular disease, chronic kidney disease, and liver-related conditions from a community perspective. It also evaluates the impact of UPFs on cardiovascular, immune, and hormonal health, as well as the effectiveness of national policies and an assessment of leadership successes and failures in mitigating the chronic disease burden driven by UPFs in Ghana. The NOVA Food Classification System NOVA categorizes foods and beverages based on the extent and intent of their industrial processing, rather than their nutritional value. Established in 2009 by Professor Carlos Monteiro and associates at NUPENS, University of São Paulo, Brazil, the model was established through publications from 2010 to 2019. NOVA was motivated by the increasing prevalence of obesity and diet-related non-communicable diseases associated with swift alterations in food systems, particularly the emergence of industrially manufactured products. NOVA highlights that processing renders meals hyper-palatable, convenient, inexpensive to manufacture, and engineered for excessive consumption, hence displacing less processed foods and diminishing diet quality. The FAO and PAHO/WHO have recommended reducing ultra-processed foods in diet quality reviews, referencing the NOVA classification system. NOVA has been enormously employed in nutritional surveillance, including adjustments to NHANES data, and in policy formulation, such as front-of-pack labeling and taxation of sugary ultra-processed products. NOVA categorizes foods into four groups (G1–G4). The table below delineates each group, encompassing processing scope/purpose and illustrative instances (derived from official descriptions and reliable sources). Group Name Extent and Purpose of Processing Examples 1 Unprocessed or minimally processed foods Simple, substance-free procedures (such as cleaning, drying, crushing, freezing, pasteurization, and vacuum packaging). The goal is to make food edible while maintaining freshness. Fresh fruits/vegetables, whole grains, legumes, fresh meat/fish/poultry, eggs, milk, nuts/seeds (unsalted), plain yogurt (no additives), tea/coffee (plain). 2 Processed culinary ingredients Extraction/refining from Group 1 foods (e.g., pressing, grinding, refining). Used as parts in small-scale or home cooking; not eaten by themselves. Vegetable oils, butter, sugar, salt, honey, vinegar, lard, starches such as corn starch. 3 Processed foods Created by combining foods from Group 1 with items from Group 2 (sugar, oil, salt). Modified natural foods with minimal industrial processing and few ingredients are easily identifiable. Goal: increase durability and taste enhancement in food. Cheeses, freshly baked breads, salted/roasted nuts, smoked/salted fish or ham, and basic canned fish in oil are all examples of additive-free canned foods. 4 Ultra-processed foods (UPFs) Industrial formulations using food-derived or lab-synthesized flavors, colors, emulsifiers, and preservatives. Industrial methods: extrusion, molding, pre-frying, hydrogenation. Few intact Group 1 items; 5 + ingredients, many industrial. Goal: Make overconsumption-inducing, convenient, profitable, long-lasting products. Soft drinks, packaged snacks/chips, instant noodles, ready-to-heat meals, reconstituted meats (e.g., nuggets, sausages), most breakfast cereals, mass-produced breads with additives, ice cream, flavored yogurts, sugary confectionary, and energy drinks. The key features of UPFs (Group 4) are They are usually branded, actively marketed and engineered to be 'hyper-palatable' (very appealing through mixes of fat, sugar, salt and additives). Manufactured food can entail complex machinery and chemicals like high fructose corn syrup, modified starches, emulsifiers, artificial sweeteners or colors that are just not available to the home cook. There is no or negligible Group 1 food. Liquid foods can be ultra-processed too. The purpose and rationale for NOVA is that, NOVA redirects the analytical emphasis from the nutritious composition of foods ("what" they contain) to the characteristics of their production ("how" they are created). The primary argument posits that rigorous industrial processing modifies foods not only in terms of nutritious composition but also affects their physical structure, incorporates cosmetic additives, and is designed for convenience, prolonged shelf life, and economic gain. These characteristics lead to the disruption of conventional food patterns (mostly Groups 1–3) and promote obesogenic conditions. A randomized controlled trial provided evidence that participants ingested roughly 500 additional calories daily when offered an ultra-processed diet, in contrast to an unprocessed diet matched for caloric content, energy density, macronutrients, sugar, sodium, and fiber (Hall et al., 2019). Evidence of Health Effects A multitude of studies, encompassing meta-analyses and prospective cohorts, have associated elevated consumption of ultra-processed foods—frequently surpassing 50% of total caloric intake in high-income nations and escalating swiftly in low- and middle-income countries—with heightened risks of obesity, type 2 diabetes (relative risk generally 1.12–1.31), cardiovascular disease, specific cancers, depression, and overall mortality. Suggested mechanisms comprise: Insufficient nutrient density and replacement of protective, less processed foods. Hyper-palatable foods induce passive overeating. Additives and processing byproducts that may perturb gut microbiota, exacerbate inflammation, induce oxidative stress, and hinder metabolic signaling pathways (e.g., mTOR, AMPK, SIRT1). Possible contributions from packaging pollutants and the ultra-processing procedure itself. Retail audits in Ghana and West Africa indicate that ultra-processed foods comprise over 85% of supermarket shelf space in certain districts, correlating with urbanization, heightened imports, and an increase in non-communicable diseases (Adjei et al., 2022 ). Despite several limitations, NOVA has stimulated significant research about the impact of food processing on health outcomes, advancing the science beyond solely nutrient-focused frameworks. In resource-limited contexts like Ghana, the framework elucidates the infiltration of imported ultra-processed goods into informal markets and their hybridization of traditional diets, consequently intensifying the dual burden of malnutrition. Review question Could there be a link between ultra-processed food consumption and type 2 diabetes incidence in Ghana? What is the status of ultra-processed food consumption and type 2 diabetes incidence in Ghana? What is the impact and barriers to reducing ultra-processed food consumption on type 2 diabetes incidence in Ghana? Methodology and Strategy for data synthesis We followed Arksey and O’Malley’s framework for scoping reviews (2005) with the extensive exploration and mapping of the available literature on the study phenomena (Mak & Thomas, 2022). In particular, the aim of our scoping review was to identify the types and nature of evidence available for impact of ultra-processed food on type 2 diabetes incidence in Ghana and West Africa, explore the key prevailing characteristics and impact of ultra-processed food consumption on type 2 diabetes incidence in communities in Ghana and to identify gaps or barriers in the available literature. A scoping review enhances detailed quantitative, qualitative, and mixed methods for their conduct. We also searched for grey literature from government and university databases. We followed an iterative process that included identification of the review question, identification of relevant literature, selection of relevant studies, charting and collating data, and summarizing and reporting findings. We also followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist to ensure a coherent and transparent reporting of literature (Tricco et al., 2018). A synthesis of study characteristics was conducted for each included study according to Cochrane guidelines. The resultant summary table included characteristics of the study location, population, intervention, comparators, and outcomes of interest, as well as the metrics used in each study. Additionally, the table included the authors and date range of data collection. Search Strategies To identify relevant studies, we conducted an initial search in PubMed, and Prospero to ensure that similar studies have not been conducted or registered as an ongoing project. After confirming the novelty of our topic, we conducted an exhaustive search in electronic databases including PubMed, CINAHL, Scopus, Medline, ProQuest, science direct, EBSCOhost databases, Medrvix, Research Square, Cochrane library, and Google Scholar. The authors collaboratively developed an iterative search strategy and systematically searched the identified databases between February and March 2026 using key search terms and permutations in March 2026. Boolean operators ‘’OR’’ and ‘’AND’’ were used to supplement the search in databases to locate literature that is relevant to the research objectives. Search terms such as ‘’Impact of’’’ OR ‘’Effect’’ OR ‘’Evaluating’’ OR ‘’assessing’’ OR ‘’ exploring’’ AND ‘’ Ultra-processed food’’ OR ‘’ UPF’’ OR ‘’ Processed food’’ AND ‘’ Type 2 diabetes’’ OR ‘’T2D’’ ‘’Cardiovascular diseases’’ OR ‘’CVD’’ ‘’ Kidney diseases’’ ‘’liver related condition’’ AND ‘’Ghana’’ OR ‘’West Africa’’ were used across databases to search for literature. We extended our search to Ghanaian universities’ research repository and identified studies that potentially met our inclusion criteria. Eligibility Criteria Sources were included if they are peer-reviewed publications, reports, or reviews which focuses on populations in Ghana and West Africa sub region of any age, ethnicity, gender and health facilities. Populations from all regions of Ghana and West Africa sub region. 1. Addresses impact of Ultra processed food Type 2 diabetes. 2. Included if it addresses other diseases such as cardiovascular and kidney related diseases 3. if it’s both quantitative data (e.g., from the National Vital Statistics System, cross-sectional studies) or qualitative insights (e.g., focus groups) or mixed-methods designs; full-text availability; 4. were published between 2016 and 2026; Non-peer-reviewed articles, international research, studies done outside the geographic location in Ghana and West Africa, data-free editorials, duplicates, and those unrelated to type 2 diabetes, cardiovascular diseases, kidney related diseases outcomes were excluded. We focused on primary sources and varied designs (e.g., reviews, cross-sectional, qualitative), and All forms of community programs regarding ultra-processed food consumption and type 2 diabetes were also included. Context: No further context. All community-based programs in all literature or research involving various research design and methodology and meeting aforementioned inclusion and exclusion criteria were analyzed. Study Selection and Data Charting Two authors independently screened the titles and abstracts of the identified studies to determine their eligibility for inclusion. All the identified articles were stored in Zotero referencing management software. Full-text articles were obtained for studies that met the inclusion criteria, and two reviewers independently assessed them for eligibility. Any disagreements were resolved through discussion, and consultation with a standby third reviewer. The reference lists of the included articles were searched to identify potential articles for inclusion. Our inclusion Criteria include published journal articles, pre-print, and grey literature that explored or discussed ultra-processed food consumption and type 2 diabetes, or Cardiovascular diseases, chronic kidney failure and fatty liver diseases or liver related disease conditions in Ghana between January 2016 and March 2026 including interviewing experts and practitioners in the field of medicine, nutrition and diabetes in Ghana. Only articles published in the English language were included in the review. We excluded studies that focused on other countries other than Ghana and West Africa Sub region, studies that were conducted before the year 2016 and studies that were not written in English. Data extraction and charting were performed by two reviewers using a standardized form developed and pre-approved by all the authors. Additionally, main findings on impact and barriers/challenges of ultra-processed food consumption on type 2 diabetes incidence in Ghana were recorded. The reviewers convened to compare findings and combine the extracted data. If the reviewers disagreed and were unable to reach consensus, a third reviewer was engaged to adjudicate. In the case of binary data, we extracted the total number of participants and research population; focus groups or areas and recorded them. If unavailable, overall summary statistics were extracted. The form included the following information: Author and year of publication, study design, location of study, study population, objectives of the studies, and the main findings. The extracted data was stored in a spreadsheet table format. Risk of bias (quality) assessment: Two reviewers independently assess risk of bias using the MMAT (Mixed Methods Appraisal Tool) and in accordance with PRISMA-ScR Checklist for Scoping Reviews, methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis were assessed. Table 1.0: Table 1.0: Summary of Extracted data for Included studies. See Appendix A Figure 1 – Flow chart for identification of included Studies via databases and registers. Thematic Synthesis and Results We examined the effects of ultra-processed food on type 2 diabetes, cardiovascular disease, chronic kidney disease, barriers, policy frameworks in Ghana and West Africa, and some of the ultra-processed foods available in the markets. Themes were categorized by thematic areas. 1). UPF availability, consumption, and status in Ghana, including NOVA food classification from the article. 2). Evidence of the Link Between UPF Consumption and Type 2 Diabetes (T2D) Incidence, 3). Impact of UPF on Related Chronic Diseases (major objectives), sub-themes: Type 2 Diabetes (e.g., risk factors for UPF occurrence) CVD: Cardiovascular illnesses Chronic kidney failure/related disorders Liver-related conditions/fatty liver disorders 4. Main outcomes: UPF-T2D and Comorbidities Mechanisms; 5). Obstacles to Reducing UPF Consumption (review question 3); 6). Policy Frameworks, Leadership Successes/Fails, and Interventions; and 7). Literature Gaps and Implications. Availability, Consumption, and Status of Ghanaian Ultra-Processed Foods (UPF) and NOVA Food Classification NOVA categorizes ultra-processed foods (UPFs) as industrially produced items containing numerous additives and minimal whole-food components (Group 4). They prevail in Ghana's culinary culture and signify the nutritional transformation. In Greater Accra, cross-sectional market surveillance revealed that 85% of shelf space in supermarkets and mini-marts was allocated to unhealthy products, predominantly comprising refined grains/grain products (30%) and sugar-sweetened drinks (SSBs, 20.1%). The mean ratio of ultra-processed to unprocessed foods was 5:1. Household surveys indicated that supermarkets facilitate the acquisition of ultra-processed foods in urban South Africa, while informal outlets are more prevalent in Ghana, where the consumption of unprocessed foods is greater (41.8%). However, deprivation remains associated with inconsistent intake of both categories. Obesogenic foods are sourced from outside, whereas preventative foods (such as fish, vegetables, and legumes) possess more robust local supply chains (Annan et al., 2025 ). Twenty percent of Ghanaian households use sugar-sweetened beverages and confectionery on a weekly basis. Longitudinal evidence indicates that rural, urban, and migrant Ghanaians are increasingly consuming processed foods, particularly ultra-processed varieties (Yussif et al., 2025 ). Traditional marketplaces continue to be the primary purchasing venues due to their proximity and affordability, whereas processed goods are distributed through both formal and informal channels (Aryeetey et al., 2016 ). NOVA forecasts a predominance of plastic packaging, with processed and ultra-processed categories significantly linked to low-income retail transactions (Dzodzomenyo et al., 2023, 2025). Notwithstanding their industrial composition, urban adolescents link certain ultra-processed foods (UPFs) with "freshness" and vitality (Abubakar, 2023 ). Both formal (supermarkets) and informal food retail systems contain ultra-processed foods (UPFs). Supermarkets and contemporary retail establishments endorse ultra-processed products in metropolitan and peri-urban regions, whilst traditional markets and informal vendors offer refined grains, sugar-sweetened drinks (SSBs), instant noodles, candy, and packaged snacks. The energy contributions of processed and ultra-processed foods have risen, particularly among urban and migrant populations in Ghana (Yussif et al., 2025 ). In some instances, excessive consumption of ultra-processed foods (including detrimental commercial products) supplants nutrient-rich supplementary foods and constitutes 22–40% of non-breastmilk energy in young children (Vanderkooy et al., 2023 ). Urban teenagers in Ghana associate specific urban public facilities with "freshness" and vibrancy, despite their industrial characteristics, which enhance absorption (Abubakar, 2023 ). Processed (NOVA Group 3) and ultra-processed (Group 4) products predominantly occupy shelf space and packaging in low-income retail environments, frequently associated with plastic waste surveillance (Dzodzomenyo et al., 2023, 2025). Food systems in West Africa have transitioned from fiber-rich staples such as cassava, millet, legumes, and vegetables to energy-dense, highly processed diets (Sanni, 2025 ; Okoye et al., 2024 ). Urbanization, retail modernity, and dependence on imports have engendered a hybrid food system in Ghana, characterized by the fast expansion of traditional staples and NOVA Group 3 and 4 products. This availability and consumption profile signifies a sophisticated nutritional revolution, with ultra-processed foods (UPFs) firmly integrated into both formal and informal supply chains. 2. Evidence of the Link Between UPF Consumption and Type 2 Diabetes (T2D) Incidence There is strong longitudinal and meta-analytical evidence for a dose-dependent link between UPF intake and incidence T2D. A comprehensive review and meta-analysis of prospective cohorts indicated that moderate UPF consumption increased T2D risk by 12% (RR 1.12, 95% CI 1.06–1.17) and high intake by 31% (RR 1.31, 95% CI 1.21–1.42), with clear dose-response relationship (Delpino et al., 2022 ). Complementary meta-analyses reveal 37% greater diabetes risk with high UPF intake, however impact estimates are modulated by methodological variability (24-h recall vs. FFQ; Vitale et al., 2024 ). In Ghana and West Africa, dietary patterns high in rice, pasta, meat, and fish (often with processed items) are inversely associated with T2D when variety is high, but overall trends towards processed foods diminish protective effects (Danquah et al., 2018 ; Galbete et al., 2018 ). Longitudinal data from RODAM-Pros indicate growing energy intake from processed foods across Ghanaian sites, especially among migrants, mirroring anticipated T2D incidence patterns (Yussif et al., 2025 ). Ecological assessments link growth in sugar-sweetened beverage sales to the burden of T2D across African nations including Ghana, further emphasizing UPFs as a modifiable driver (Karugu et al., 2025 ). Together these studies establish UPFs as an independent risk factor beyond nutritional content alone. 3. Impact of Ultra-Processed Foods on Associated Chronic Diseases Type 2 Diabetes (Risk Factors Associated with UPF Incidence) The consumption of ultra-processed foods exacerbates the underlying risk factors for type 2 diabetes such as insulin resistance, obesity and poor glycaemic control through compositional and processing-related pathways. In Ghana, food environments among the urban poor characterized by the widespread presence of convenience stores and ready access to prepared foods independently predict an increased BMI (+ 0.2 kg/m2 with each additional store), a direct precursor of type 2 diabetes (Dake et al., 2016 ). Ghanaian individuals who face childhood socio-economic adversity and early dietary deficits are more exposed to adult abdominal obesity and type 2 diabetes (Danquah et al., 2019 ). Higher consumption of ultra-processed food is associated with lower nutrient density and higher sugar and fat content that directly promote metabolic dysregulation (Vanderkooy et al., 2023 ; Vitale et al., 2024 ). UPF and Cardiovascular diseases UPF-based diets enhance the predicted 10-year risk of atherosclerotic cardiovascular diseases (CVD). In the RODAM cohort, adherence to ”roots, tubers and plantain” dietary patterns, which are frequently less processed but energy dense, was positively associated with ASCVD risk, while mixed and rice/pasta/meat/fish patterns showed protective effects soon after correction (Boateng et al., 2019 ). There is wide variation in the performance of risk-prediction algorithms among populations of African origin, underlining the need for context-specific tools as exposure to ultra-processed foods increases (Boateng et al., 2018 ). A large SSA dataset connects imports of highly processed foods with obesity prevalence, a key mediator of cardiovascular illness (Boysen et al., 2018 ). Chronic Renal/Kidney Insufficiency / Renal diseases Direct data from Ghana establishes a relationship between T2D and kidney damage, which is worsened by UPFs. Suboptimal glycaemic control and hypertension, both caused by UPF-induced metabolic stress, are predictors of decreased eGFR in type 2 diabetes outpatients, according to CKD-EPI staging (Kpene et al., 2024 ). Microvascular complications, especially nephropathy, are common in SSA diabetes studies, and insulin resistance caused by UPF speeds up the disease's course (Atun et al., 2017 ). Disorders of the Liver / Hepatic Steatosis Although there is little direct evidence on non-alcoholic fatty liver disease in Ghana, there are persistent connections with obesity, dyslipidaemia, and metabolic syndrome—recognized precursors to hepatic steatosis—in comprehensive studies of ultra-processed foods (2024). As discussed in Theme 4, there is an elevated risk within Ghana's dual-burden scenario due to the molecular confluence of inflammation and insulin resistance (Popkin et al., 2020 ). 4. Mechanisms Linking UPF to T2D and Comorbidities Industrial chemicals or additives and ultra-processing disturb cellular equilibrium at several levels. Emulsifiers, sweeteners, and preservatives modify gut microbiota composition, compromise intestinal barrier integrity, and facilitate endotoxin translocation (lipopolysaccharide), thereby inducing chronic low-grade inflammation and oxidative stress (Anih et al., 2025 ). These alterations result in mitochondrial malfunction and hinder nutrient-sensing pathways (mTOR, AMPK, SIRT1), leading to insulin resistance, lipid dysregulation, and systemic metabolic disorders. Simultaneously, ultra-processed foods supplant nutrient-rich whole meals, intensifying micronutrient deficiencies and energy imbalances (Delpino et al., 2022 ; Vitale et al., 2024 ). The outcome is an expedited transition from obesity to type 2 diabetes, cardiovascular disease, and associated comorbidities, which challenges exclusively nutrient-focused models and underscores processing as a causal factor (Anih et al., 2025 ). 5. Barriers and Challenges to Reducing UPF Intake There are multi-layer barriers for UPF reduction. At the individual level, there are widespread concepts that associate health with uncooked or traditionally cooked foods, although preparation techniques (for example, frying) and convenience are often more important. Options are also constrained by financial limitations, psychological and physical states, and social mores (Boatema et al., 2018 ). At the community level, contributing factors include the high prevalence of hazardous advertising near educational institutions (57.6% of food commercials are unhealthy) and the high density of obesogenic retail outlets (Amevinya et al., 2020 , 2022 ; Dake et al., 2016 ). Structural barriers include poor enforcement of marketing restrictions, reliance on imported obesogenic products and cultural misperceptions describing ultra-processed foods as “fresh” or youthful (Abubakar, 2023 ; Laar et al., 2020 ). Policy fragmentation, poor multi-sectoral coordination and poor targeting of urban poor people and adolescents exacerbate these problems (Casu et al., 2022 ; Osei-Kwasi et al., 2020 ). There is a high level of food insecurity (about 47% in poor urban areas) which leads to the preference for cheap, energy-dense ultra-processed meals over nutrient-rich foods (Kushitor et al., 2025 ). 6. Policy Frameworks, Leadership Achievements/Shortcomings and Interventions Ghana and West Africa have partial policy integration with significant implementation gaps. Nutrition-related policies are more prone to use nutrition-specific framing than nutrition-sensitive framing, with less attention to equity, targeting of adolescents and urban regions, and coherence across multiple sectors (Casu et al., 2022 ). Expert ratings of government action on healthy food environments are considered inadequate in the domains of marketing regulation and retail incentives (Laar et al., 2020 ). The CARE Diabetes project protocol documents successful community engagement experiences, generating background data on food markets, healthcare access, and social norms in poor urban Accra to guide tailored treatments (Baatiema et al., 2024 ). Achievements include local producers taking part in protective food initiatives and school feeding programs; shortcomings are the unregulated promotion of ultra-processed foods, weak enforcement of single-use plastic bans (not as in Kenya) and limited tariff differentiation on highly processed imports (Boysen et al., 2018 ; Dzodzomenyo et al., 2025). We recommend the implementation of coordinated health systems strengthening and policy packages for both formal and informal outlets (Atun et al., 2017 ; Agyapong et al., 2024 ). The integration of nutrition-related policy in West Africa is variable. Nutrition-specific therapies are more explicit than nutrition-sensitive interventions on food settings or regulation of ultra-processed foods such as fortification and school feeding (Casu et al., 2022 ). Deficiencies include insufficient equitable targeting, weak multi-sectoral coordination, and lack of attention to urban populations or teenagers (Casu, et al., 2022). Experts’ assessments suggest a lack of appropriate government action on the legislation of a healthy food environment, including restrictions on marketing and incentives in retailing (Laar et al., 2020 ). Examples of promising elements include differential tariffs on heavily processed imports (Boysen et al., 2018 ) and community-based protocols such as CARE Diabetes which generate contextual data for tailored therapy in urban poor settings (Baatiema et al., 2024 ). However, poor enforcement and the cultural marketing of ultra-processed foods (UPFs) as “fresh” or convenient undermine the initiatives (Abubakar, 2023 ; Sanni, 2025 ). 7. Gaps in the Literature and Impact There remain important gaps in longitudinal Ghana-specific UPF-T2D data, consistent use of NOVA across different retail settings, and research of interventions that explore processing-oriented policies. Mechanistic data are mainly global and local studies on biomarkers or microbiota are scarce (Anih et al., 2025 ). Qualitative understanding of cultural variables are largely confined to urban poor situations and so do not reflect rural and adolescent understandings (Boatema et al., 2018 ; Manyara et al., 2024 ). Policy evaluations do not include complete impact assessments on obesity and undernutrition outcomes (Casu et al., 2022 ). The CARE Diabetes protocol and similar mixed methods frameworks highlight the importance of contextualized, community-based research to link quantitative dietary data with experiential realities (Baatiema et al., 2024 ). Implications include a focus on NOVA-based surveillance, culturally sensitive initiatives that draw on lay beliefs, differential taxation on ultra-processed foods (UPFs), and multi-sectoral policies that address the dual burden without exacerbating food insecurity. These shortcomings need to be addressed to avert a fully established UPF caused metabolic illness pandemic in Ghana and West Africa (Popkin & Laar, 2025 ; Sanni, 2025 ). Key gaps in the literature are the absence of longitudinal, multi-national studies in West Africa that consistently employ NOVA classification; the scarcity of mechanistic studies using local biomarkers; the inadequate representation of the rural and adolescent perspective; and the absence of rigorous evaluation of ultra-processed food-specific interventions targeting both overnutrition and undernutrition outcomes (Sanni, 2025 ; Casu et al., 2022 ; Manyara et al., 2024 ). The CARE Diabetes project and its mixed methodologies frameworks underline the significance of context-specific, community-oriented research (Baatiema et al., 2024 ). Holistic, regional approaches are needed to address the proliferation of UPFs in West Africa: strengthening NOVA-based surveillance, differential taxation and marketing policies on UPFs, local protective food value chains, nutrition education that draws on lay beliefs, and multi-sectoral policies to address the double burden of malnutrition simultaneously (Sanni, 2025 ; Popkin & Laar, 2025 ; Okoye et al., 2024 ; Reardon et al., 2021 ). If urgent action is not taken, a pandemic of metabolic disorders that threaten health, productivity and sustainable development in the region may become entrenched. Mechanisms of metabolic dysfunction driven by ultra-processed food additives Ultra-processed foods (UPFs; NOVA Group 4) are industrial formulations composed of numerous additives such as emulsifiers (e.g., carboxymethylcellulose [CMC], polysorbate 80 [P80]), artificial sweeteners (e.g., sucralose), preservatives, stabilizers, colorants, and flavor enhancers that extend beyond mere nutrient compositions and are detrimental to cellular and systemic physiology. These additives work through interconnected pathways including the gut microbiota, intestinal barrier integrity, inflammation, oxidative stress, mitochondrial function and nutrient-sensing signaling ultimately causing insulin resistance, lipid dysregulation and metabolic diseases (Anih et al., 2025 ). Composition and Function of Gut Microbiota Impairment UPF additions cause dramatic disruption and changes in the gut microbial ecosystem with loss of overall diversity and shifts in community structure toward pro-inflammatory pathobionts, depleting beneficial short-chain fatty acid (SCFA)-producing taxa. Emulsifiers and sweeteners increase mucus-degrading bacteria selectively and decrease short-chain fatty acid synthesis, which normally maintains epithelial health and anti-inflammatory signaling. This dysbiosis is not just compositional, but also disrupts microbial metabolite production, so triggering a cascade of downstream effects. Preservatives exacerbate these alterations through the production of reactive oxygen species (ROS) during metabolism hence increasing microbial stress (Anih et al., 2025 ). Thus, one major downstream impact is increased intestinal permeability. Emulsifiers, by their nature as surfactants, directly destroy tight-junction proteins in the intestinal epithelium. This allows transport of bacterial endotoxins, particularly lipopolysaccharide (LPS), from the intestinal lumen to the systemic circulation, a phenomenon known as metabolic endotoxemia. The subsequent low-grade chronic inflammation induces immunological signaling (e.g., via Toll-like receptor 4) with systemic effects such as hepatic steatosis, adipose inflammation, and impaired glucose homeostasis. Sweeteners and other additives contribute indirectly to dysbiosis, which further affects barrier function (Anih et al., 2025 ). Ultra-processed foods (UPF) cause oxidative stress and mitochondrial dysfunction, as UPF ingredients activate cellular oxidative stress via several routes. Sweeteners and preservatives increase the generation of reactive oxygen species (ROS) as metabolic by-products. Emulsifiers indirectly increase the ROS in virtue of inflammation caused by endotoxemia. Mitochondria are particularly vulnerable: addenda inhibit the activity of the electron transport chain (ETC), increase the formation of reactive oxygen species (ROS) and damage mitochondrial bioenergetics. This leads to energy depletion at the cellular level, lipid peroxidation and death in metabolically active organs (e.g. liver, muscle, β-cells). Studies in animals and human pilots have linked several substances (such CMC/P80 emulsifiers and sucralose) to mitochondrial damage (Anih et al., 2025 ). Therefore, long-term exposure to ultra-processed meals induces changes in basic cellular nutrient-sensing pathways and networks. mTOR: Inflammatory signals + altered availability of amino acids hyperactivate mTOR → anabolic excess + insulin resistance. AMPK: Inhibition due to energy imbalance and reactive oxygen species decreases fatty acid oxidation and glucose uptake. SIRT1: Decreased expression of SIRT1 influences mitochondrial biogenesis, reduces antioxidant defense and alters anti-inflammatory response. These pathway alterations create a vicious loop of metabolic excess linking gut generated signals to peripheral tissue dysfunction (Anih et al., 2025 ). A General Framework and Empirical Evidence The UPF processes comprise a coherent pathway: additive-induced dysbiosis → barrier disruption and endotoxemia → inflammation and oxidative stress → mitochondrial dysfunction and nutrient-sensing impairment → insulin resistance, dyslipidemia and metabolic diseases. This concept is supported by epidemiological, clinical and experimental data gathered in mechanistic reviews, evaluating the effects of ultra-processed vs unprocessed foods even with similar nutrient profiles (Anih et al., 2025 ; Delpino et al., 2022 ; Vitale et al., 2024 ). Cellular disruptions in Ghana and West Africa are exacerbating the nutrition transition, as increased access to ultra-processed foods (e.g. imported processed products and obesogenic retail environments) is accelerating the dual burden of malnutrition and non-communicable diseases (Anih et al., 2025 ; Okoye et al., 2024 ). The traditional criteria of nutrients are not sufficient. Policy must include NOVA classification and re-evaluate additive safety to address these industrial factors to cellular disease. Patterns, Influences and Health Consequences of Ultra-Processed Foods (UPF) in the context of West Africa. In West Africa, there is a fast nutritional transition defined by increased consumption of ultra-processed foods (UPFs; NOVA Group 4). UPFs are meals that are industrially processed with several chemicals, few whole-food ingredients and high levels of added sugars, fats and salt. This transition, fueled by urbanization, globalization, economic escalation, and shifting lifestyles, aggravates the historical problems of undernutrition in the region, adding to a serious “double burden” of malnutrition (Sanni, 2025 ; Popkin et al., 2020 ; Okoye et al., 2024 ). The literature is over-represented with Ghana-based evidence which could signal research density. However, the regional patterns of Benin, Burkina Faso, Côte d’Ivoire, Ghana, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo show a uniform increase in availability and consumption of UPFs (Casu et al., 2022 ; Sanni, 2025 ). The key structural determinants are: Urbanization and globalization: Rapid urban growth increases availability to supermarkets and imported ultra-processed foods (UPFs) but decreases time for traditional meal preparation (Sanni, 2025 ; Ecker & Fang, 2016 ). Food systems transformation: The “processed food revolution” involves multinational investment in the production and distribution of ultra-processed products reducing the relative price of obesogenic foods (Reardon et al., 2021 ; Okoye et al., 2024 ). Economic and policy determinants: As income increases, people may afford more convenience foods; tariff differences tend to favor highly processed imports over local unprocessed staples (Boysen et al., 2018 ). This is compounded by a lack of multi-sectoral policy coherence (Casu et al., 2022 ). Socio-cultural changes: prevailing attitudes, marketing, and convenience supersede traditional nutritional norms, with UPFs perceived as modern or desirable (Boatema et al., 2018 ; Abubakar, 2023 ). These variables disproportionately harm populations of urban poor, women, children and adolescents (Sanni, 2025 ; Popkin & Laar, 2025 ). The discovered health Implications are real such that diet-related NCDs with persistent undernutrition increase with ultra-processed food (UPF) consumption. Epidemiological studies and meta-analyses have shown that higher consumption of ultra-processed foods (UPF) is associated with a dose-dependent increase in type 2 diabetes (T2D) risk (Delpino et al., 2022 ; Vitale et al., 2024 ) and obesity, hypertension, dyslipidemia, and cardiovascular disease (CVD) risk factors (Lane et al., 2024 ; Karugu et al., 2025 ). West Africa is seeing a rise in type 2 diabetes (T2D) and microvascular consequences such nephropathy due to delayed diagnosis, poor glycaemic control, and metabolic stress from ultra-processed foods (Atun et al., 2017 ; Kpene, 2024). Additives alter gut microbiota, intestinal barrier integrity, endotoxemia, chronic inflammation, mitochondrial function, and nutrient-sensing pathways (mTOR, AMPK, SIRT1), accelerating insulin resistance and related comorbidities (Anih et al., 2025 ). Ultra-processed foods (UPF) harm preschoolers' metabolic and cognitive health (Popkin & Laar, 2025 ; Vanderkooy et al., 2023 ). Underweight/stunting and overweight/obesity coexist in disadvantaged urban areas (Popkin et al., 2020 ; Sanni, 2025 ). Discussion This scoping study examines the influence of ultra-processed foods (UPFs) on type 2 diabetes (T2D) and associated non-communicable diseases in Ghana and West Africa sub-region by investigating the UPF retail landscape, consumption patterns, policy framework, health implications, marketing strategies, and obstacles to dietary enhancement. The swift urbanization, economic growth, proliferation of supermarkets and mini-marts, and globalization have resulted in the creation of obesogenic food retail environments in Ghana. Traditional primary food sources like cassava, plantains, yams, and beans are being supplanted by energy-dense imported foods high in refined sugars, fats, and sodium. Retail audits, household surveys, value-chain analyses, and longitudinal studies consistently demonstrate (i) the prevalence of ultra-processed foods (NOVA Group 4), (ii) their price and accessibility, and (iii) a systematic shift towards market purchases and increased caloric density, particularly in metropolitan environments. Unhealthy products are disproportionately prevalent in modern shopping environments. Adjei et al. ( 2022 ) examined 67 establishments in Greater Accra and discovered that 86.6% were mini-marts, with 85% of shelf space allocated to detrimental products. Detrimental products comprised refined grains (30%) and sugar-sweetened beverages (20.1%), yielding an unhealthy-to-healthy eating ratio of 5:1. Mockshell et al. ( 2022 ) conducted swift audits in Accra, Cape Coast, and Koforidua, which verified that ultra-processed foods (UPFs) were equally accessible and economical as unprocessed foods in all retail formats. Aryeetey et al. ( 2016 ) demonstrated consistent exposure across both informal and formal retail categories. The geographical scope of these observations has been broadened by Annan et al. ( 2025 ) and Agyapong et al. ( 2024 ). They observe that informal retail channels are widespread in Ghana and influence household purchasing behaviors, in contrast to the supermarket-centric systems in South Africa. Households in poverty consumed preventative foods (fish 74.5%, vegetables 53.1%, legumes 22.8%) and obesogenic goods, with 20% indicating weekly intake of sugar-sweetened beverages and confectionery, while nearly 80% failed to differentiate between food groups. Consumption patterns indicate dietary hybridization or modification. Kushitor et al. ( 2023 ) examined low-income districts of Accra from 2011 to 2013 and discovered that the proportion of products in NOVA Groups 2–4 and adherence to snack patterns rose from 35% to 41%. Kushitor et al. ( 2025 ) reported in Ga Mashie a mixture of traditional and contemporary staple foods, specifically rice (67%), sugar-sweetened beverages (SSBs) (21%), instant noodles (6%), and Milo (21%), alongside poor dietary diversification (3.8 ± 1.5 food groups) and a family food insecurity rate of 47%. Ecker and Fang ( 2016 ) identified national trends indicating that urban diets are becoming more westernized, whereas rural diets remain dependent on basic foods. According to Sanni ( 2025 ) and Okoye et al. ( 2024 ), urbanization, rising affluence, and the proliferation of supermarkets that enhance the consumption of fats, sugars, and processed foods while exacerbating malnutrition are associated with Ghana's development. Urban-rural gradients: Variations. Ultra-processed foods (UPFs) are predominantly consumed by urban, educated, and younger demographics (Annan et al., 2025 ; Kushitor, 2023). Convenience stores and supermarkets exhibit a stronger predictive capacity for BMI and obesogenic intake in the urban poor of Accra compared to South African townships (Agyapong et al., 2024 ). Dzodzomenyo et al. (2023, 2025) utilize packaging as a proxy for ultra-processed foods (UPF), revealing that the NOVA-processed categories encourage greater plastic consumption in Ghana (94%) compared to Kenya (56.7%), a disparity alleviated by regulatory interventions such as Kenya's carrier-bag prohibition. Advertising promotes detrimental consuming habits. Amevinya et al. ( 2020 ) discovered that 47.3% of campus advertisements promoted food or beverages, with 57.6% classified as unhealthy and 37% as sugar-sweetened beverages (SSBs). Amevinya et al. ( 2022 ) identified 5,887 outdoor advertisements near schools in Greater Accra, of which 70% marketed detrimental products and 50% ultra-processed items, employing celebrity endorsements and emotional appeals. These advertisements have been linked to the eating behaviors of impoverished populations in Ghana and Kenya (Holdsworth et al., 2020 ), illustrating an obesogenic consuming environment influenced by contextual variables such as urban-rural disparities and retail formality. The policy review identifies significant implementation issues. Casu et al. ( 2022 ) revealed inconsistent integration of nutrition in West African programs, characterized by inadequate multi-sectoral coherence and minimal equitable targeting. Laar et al. ( 2020 ) determined that three-quarters of the Ghana Food-EPI indicators were categorized as having 'low/very little' implementation. Boysen et al. ( 2018 ) discovered that varying taxes on highly processed imports diminish obesity rates, particularly among women and higher-income demographics. Reardon et al. ( 2021 ) and Popkin and Laar ( 2025 ) endorse "double-duty" initiatives, including SSB levies, front-of-pack labeling, and the promotion of nutritious weaning foods. Manyara et al. ( 2024 ) and Boatema et al. ( 2018 ) have emphasized the significance of connecting therapies to cultural beliefs and socio-ecological contexts. The issues of campus dining and the oversight of informal vendors require attention. UPFs may affect non-communicable diseases through many biological mechanisms. UPF additives, including emulsifiers, artificial sweeteners, and preservatives, alter mTOR, AMPK, and SIRT1 signaling, resulting in dysbiosis and intestinal barrier compromise, facilitating endotoxin translocation, chronic inflammation, insulin resistance, and metabolic disorders (Anih et al., 2025 ). Additional data (Delpino et al., 2022 ; Lane et al., 2024 ; Vitale, 2024) indicates dose-dependent cardiometabolic hazards influenced by inflammation, dyslipidemia, and obesity. The consumption of ultra-processed foods elevates the risk of Type 2 Diabetes by converging processes. Moderate consumption of ultra-processed foods (UPF) correlated with a 12% heightened risk of type 2 diabetes (RR = 1.12), while high UPF consumption correlated with a 31% heightened risk of type 2 diabetes (RR = 1.31), demonstrating a dose-response gradient (Delpino et al. 2022 ). Karugu et al. ( 2025 ) correlated the increase of SSB sales in nine African nations, including Ghana (β = 0.41), with the rising prevalence of T2D. The RODAM cohort studies (Galbete et al., 2018 ; Danquah et al., 2018 ) demonstrate a correlation between increased dietary variety and a reduced risk of Type 2 Diabetes (T2D). The pattern presents a combination of signals, incorporating protective elements like legumes and fish. Compliance with dietary self-management in T2D patients reduces the risk of depression (AOR 0.28), indicating that behavioral interventions can alleviate subsequent effects (Duodu et al., 2025 ). Mixed diets comprising rice, pasta, meat, and fish reduce the 10-year risk of atherosclerotic cardiovascular disease (prevalence ratio Q5 vs. Q1 = 0.70) for cardiovascular disease. UPF components facilitate detrimental pathways (Lane et al., 2024 ). UPF-induced metabolic excess establishes molecular connections to fatty liver disease (Anih et al., 2025 ; Vitale et al., 2024 ; Popkin et al., 2020 ; Reardon, 2021). Renal impairment was observed in 70.2% of Ghanaian patients with type 2 diabetes in tertiary care. Multiple tiers of obstacles exist to the reduction of UPF. Knowledge gaps and misconceptions regarding UPF-vitality persist (Abubakar, 2023 ; Vuvor & Harrison, 2017 ). Consumption is influenced by social sharing and familial norms (Vanderkooy et al., 2023 ; Boatema, 2018). Structural hurdles encompass 47% food insecurity, poverty, inadequate enforcement, and the predominance of imported ultra-processed foods (Kushitor et al., 2025 ; Annan, 2025; Laar, 2020). The challenges are exacerbated by disjointed coordination (Casu, 2022) and inadequate Food-EPI implementation (Laar et al., 2020 ). The nutrition transition in Ghana must be reversed by preserving the protective aspects of traditional dietary patterns (Annan et al., 2025 ; Laar, 2020; Casu, 2022). This necessitates urgent, coherent, equity-sensitive, multi-level policies that emphasize value chains, regulation of marketing, and food environments aligned with Agenda 2030. Recommendations There is a need for a concerted multi-level effort to alleviate the growing burden of ultra-processed food (UPF)-related type 2 diabetes (T2D) and chronic disease in Ghana and West Africa. Mandatory NOVA-based surveillance in both formal and informal retail settings should be institutionalised to obtain consistent dietary exposure data for policymakers (Sanni, 2025 ; Casu et al., 2022 ). Urgent differential fiscal policies, such as excise levies on sugar-sweetened beverages and heavily processed imports, should be imposed, given evidence that targeted taxation reduces obesogenic consumption (Boysen et al., 2018 ; Karugu et al., 2025 ). Enforcement of marketing regulations near schools is necessary, since 70% of ads in proximity are for unhealthy products (Amevinya et al., 2022 ; Laar et al., 2020 ). Investments in local protective food value chains should be complementary to UPF reduction (Annan et al., 2025 ). Culturally appropriate nutrition education should include UPF-vitality misunderstandings (Abubakar, 2023 ; Boatema et al., 2018 ) and integrated multi-sectoral frameworks are needed to manage the twofold burden (Popkin & Laar, 2025 ). Conclusion This scoping review presents strong evidence for UPF consumption as an important and increasing public health issue in Ghana and West Africa with consistent mechanistic, epidemiological and policy-level evidence of UPF intake and T2D and related cardiometabolic comorbidities. NOVA-based retail monitoring indicates that goods from NOVA Groups 3 and 4 dominate both formal and informal food settings, displacing traditional nutrient-dense staples (Aryeetey et al., 2016 ; Dzodzomenyo et al., 2023). Meta-analyses show a dose-dependent association between UPF consumption and T2D risk, with relative risks ranging from 1.12 to 1.31 (Delpino et al., 2022 ; Vitale et al., 2024 ). Mechanistic evidence indicates the role of gut dysbiosis induced by additives, chronic inflammation, mitochondrial dysfunction, and disruption of nutrient-sensing pathways (Anih et al., 2025 ). There are also significant gaps in longitudinal, Ghana-specific research and rigorous policy impact evaluation (Casu et al., 2022 ; Manyara et al., 2024 ). Without quick and coordinated intervention, a UPF-driven metabolic illness pandemic risks becoming entrenched in the sub-region (Popkin & Laar, 2025 ; Sanni, 2025 ). Declarations Funding This research was self-funded. The authors or researchers of this paper therefore did not receive any specific funding for this project or studies from any external sources. Author Contributions PEN: Project Administration, Review, Conceptualization, Methodology - Selection process, data curation, Charting, Supervision, writing of draft and final manuscript. BF: Methodology, review, editing, project validation, writing, Visualization, formal analysis, writing of draft and final manuscript. Ethical Consideration No human subjects were involved in the study; therefore, no ethical approval is required. 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Food Policy 93 Article 101907. https://doi.org/10.1016/j.foodpol.2020.101907 Levy RB, Rauber F, Chang K, Louzada MLDC, Monteiro CA, Millett C, Vamos EP (2021) Ultra-processed food consumption and type 2 diabetes incidence: A prospective cohort study. Clin Nutr 40(5):3608–3614. https://doi.org/10.1016/j.clnu.2020.12.018 Li Y, Wang Y, Liu J, Chen Q, Zhang H, Wang Z, Chen J, Cheng L, Lu J, Guo W (2024) Ultra-processed food intake and risk of type 2 diabetes mellitus: A systematic review and meta-analysis of prospective cohort studies. Diabetes Metabolism J 48(4):668–682. https://doi.org/10.4093/dmj.2023.0275 Manyara AM et al (2024) Knowledge, perceptions and practices towards diabetes risk in sub-Saharan Africa: A mixed-methods scoping review. Public Health Nutr 27(1) Article e104. https://doi.org/10.1017/S1368980024000752 Mensah DO (2021) The epidemiology and drivers of healthy, sustainable diets in sub-Saharan Africa [Doctoral thesis, University of Warwick]. https://wrap.warwick.ac.uk/id/eprint/165189/1/WRAP_Theses_Mensah_2021.pdf Mockshell J et al (2022) How healthy and food secure is the urban food environment in Ghana? World Dev Perspect 26., Article 100427. https://doi.org/10.1016/j.wdp.2022.100427 Okoye CU et al (2024) Impact of food systems transformation on dietary patterns and public health in Africa: A mini review. Asian J Food Res Nutr 3(3):747–756. https://journalajfrn.com/index.php/AJFRN/article/view/171 Osei-Kwasi H et al (2020) Factors influencing dietary behaviours in urban food environments in Africa: A systematic mapping review. Public Health Nutr 23(14):2584–2601. https://doi.org/10.1017/S1368980019005305 Popkin BM et al (2020) Dynamics of the double burden of malnutrition and the changing nutrition reality. Lancet 395(10217):65–74. https://doi.org/10.1016/S0140-6736(19)32497-3 Popkin BM, Laar A (2025) Nutrition transition’s latest stage: Are ultra-processed food increases in low- and middle-income countries dooming our preschoolers’ diets and future health? Pediatr Obes https://doi.org/10.1111/ijpo.xxxx (PMC12001308 Reardon T et al (2021) The processed food revolution in African food systems and the double burden of malnutrition. Global Food Secur 28:100466. https://doi.org/10.1016/j.gfs.2020.100466 Sambu WC et al (2024) Food systems thinking unpacked: A scoping review on industrial diets among adolescents in Ghana. Food Secur. https://doi.org/10.1007/s12571-023-01408-x Sanni SM (2025) Nutrition transition in West Africa: Public health challenges, socioeconomic impacts, and regional policy interventions. Cent Sci Press J. https://doi.org/10.65591/g5pqee60 Vanderkooy A et al (2023) High unhealthy food and beverage consumption is associated with poor diet quality among 12–35-month-olds in Guédiawaye Department, Senegal. Front Nutr 10:1125827. https://doi.org/10.3389/fnut.2023.1125827 Vitale M, Costabile G, Testa R et al (2024) Ultra-processed food consumption and cardiometabolic risk factors: A systematic review and meta-analysis. [Prospective cohorts; journal details via PubMed/PMC]. Vuvor F, Harrison O (2017) Knowledge, practice and perception of taking soft drinks with food and the metabolic effects on high school students in Ghana. J Nutr Food Sci. https://www.imedpub.com/articles/knowledge-practice-and-perception-of-taking-soft-drinks-with-food-and-themetabolic-effects-on-high-school-students-in-ghana.php?aid=20268 World Health Organization, Diabetes (2023) updated November Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes Yussif MT et al (2025) Longitudinal changes in processed food intake and their daily caloric contribution among Ghanaian populations living in Ghana and Europe: Findings from the prospective Research on Obesity and Diabetes among African Migrants (RODAM-Pros) study. [PMC12763962]. Abubakar G (2023) Unravelling the fresh misconception of ultra-processed foods in Ghana. ANH Acad Blog. https://www.anh-academy.org/community/blogs/unravelling-the-fresh-misconception-of-ultra-processed-foods-in-ghana Tables Table 1 is available in the Supplementary Files section. Additional Declarations The authors declare no competing interests. Supplementary Files Table1Summaryofextracteddatafortotalincludedarticles.docx Table 1.0: Summary of Extracted data for Included studies. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9634039","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":636292500,"identity":"e83092f1-0fd6-41ee-ac38-d630bb410563","order_by":0,"name":"Promise Edem Nukunu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYHACAzApASI+ADEbOylaGGeAtDCTooWZB8QipMWcvXnjoxsMdxJnzsg9Jm3za5s8HzMD44ePObi1WPYcKzbOYXiWOFsiL006t++2YRszA7PkzG14XHUjx0w6h+Fw4jwJICO35zYjUAsbMy8+LfffmP+Ga7HsuW1PWMsNHjNmkJbZIC0MP24nEtRi2ZNWLJ1jcNh4Zs8bY8vehtvJbcyMzXj9Ys5+eOPnnIrDsjOO5xje+PHntu389uaDHz7icxgSCYzLNjDZgFs9kmIo+INX8SgYBaNgFIxQAADMwEzvG+PS3gAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0000-2458-6534","institution":"Monroe University","correspondingAuthor":true,"prefix":"","firstName":"Promise","middleName":"Edem","lastName":"Nukunu","suffix":""},{"id":636292863,"identity":"122d777f-5452-46b7-9489-5163e869ab00","order_by":1,"name":"Bhavna Fnu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYDCCAzxsYJqNmbHhwAcQg51YLXzszI0HZ4D1EqtFjp+9+TAPiEVIC9/ts8ce/Gy7Iw9y2GGbX9vk+ZgZGD98zMGtRfJcXrphb9szwzaQlty+20AGA7PkzG24tRic4TGT4DlzmBGipec2kAH0Di8BLZJ/zhy2B2ux7LltT5QWaZ6Kw4lgLQw/bicS1CJ5hi9NWqbicDJIy8HehtsgRjNev/Cd4T0m+cbgsO38/uOPP/z4c9t2fnvzwQ8f8WhBBYxtYLKBWPUg8IcUxaNgFIyCUTBSAABbY1KE2RnbXAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0001-5248-3441","institution":"Monroe University","correspondingAuthor":true,"prefix":"","firstName":"Bhavna","middleName":"","lastName":"Fnu","suffix":""}],"badges":[],"createdAt":"2026-05-06 18:00:03","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-9634039/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9634039/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108769632,"identity":"06a1c5db-f324-4352-a5a7-a8f21b8a6757","added_by":"auto","created_at":"2026-05-08 08:11:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37398,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chart for identification of included Studies via databases and registers.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9634039/v1/5bc0c3a2e02dd029170f7c3f.png"},{"id":108769666,"identity":"8ce42f7c-09ab-4ba4-83e1-7e5ab2a4674b","added_by":"auto","created_at":"2026-05-08 08:12:03","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":391636,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePathophysiological mechanisms linking carrageenan consumption to T2DM development. Abbreviations: IL-6: intereleukin-6; T2DM: type 2 diabetes mellitus; TNF-α: tumor necrosis factor-alpha. Created in BioRender. Kounatidis, D. (2025) https://app.biorender.com/citation/678283bae851d7f466ccd3fb Accessed on April 26, 2026.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9634039/v1/78151e9e20e2c7d630127e56.png"},{"id":108769633,"identity":"712d7fb1-d32e-4af1-9a8a-bd279682e0e1","added_by":"auto","created_at":"2026-05-08 08:11:56","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":568279,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eCausal pathway of UPF to T2D (Nukunu and Bhavna, 2026)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9634039/v1/670b6c7a89dffd1a978ad164.png"},{"id":108769668,"identity":"ca46ad6d-e1b2-4f5e-938a-2fdcaaa49a02","added_by":"auto","created_at":"2026-05-08 08:12:03","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":311682,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMechanisms Linking UPF to T2D and Comorbidities.\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCreated in BioRender. Promise E.N (2026). \u003c/em\u003e\u003cstrong\u003ehttps://app.biorender.com/illustrations/69f0a6c07525ef24c62bebe6?slideId=3af904f3-b1c7-410b-a434-7ce234ffc8df \u0026nbsp;\u003c/strong\u003e\u003cem\u003eAccessed on May 2026.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-9634039/v1/afa2d9cc6f99aabac0fb1ae2.png"},{"id":108976784,"identity":"93c4ed3c-7fa4-499d-a2ce-84497f548e17","added_by":"auto","created_at":"2026-05-11 11:28:36","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":537139,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eUltra-Processed Food consumption and Cardiometablic Risk Fact\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(González-Palacios et al., 2023) accessed on April 26, 2026\u003c/em\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-9634039/v1/86b75bf2f7dc930b9cc97902.png"},{"id":108769636,"identity":"87cd041b-66a5-4418-8d4a-ba0f6162886e","added_by":"auto","created_at":"2026-05-08 08:11:57","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":261557,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eA - Mechanisms Linking UPF to T2D and Comorbidities.\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCreated in BioRender. Promise E.N (2026). \u003c/em\u003e\u003cstrong\u003ehttps://app.biorender.com/illustrations/69f0a6c07525ef24c62bebe6?slideId=3af904f3-b1c7-410b-a434-7ce234ffc8df \u0026nbsp;\u003c/strong\u003e\u003cem\u003eAccessed on May 2026.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-9634039/v1/c7e0beb1b35e8eb3d222a72f.png"},{"id":108769638,"identity":"81c18b05-ee60-4748-80f0-acc039963137","added_by":"auto","created_at":"2026-05-08 08:11:58","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":175772,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Background and Problem Statement section.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFigure A -NOVA Classification System: categorizing foods based on the degree of processing. Abbreviations: UPFs: Ultra-processed foods. Created in BioRender. Kounatidis, D. (2025) https://app.biorender.com/citation/67827dbb029bac6c0552d59e Accessed on April 26, 2026.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Fig.A.png","url":"https://assets-eu.researchsquare.com/files/rs-9634039/v1/1ba9553a2156063b6838e685.png"},{"id":108979687,"identity":"95442bae-85b6-4e4b-bbfd-dc75473e911a","added_by":"auto","created_at":"2026-05-11 12:00:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2608702,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9634039/v1/caa314ba-5a7e-4d67-b99a-f102111b15e4.pdf"},{"id":108769643,"identity":"8d1594bb-250c-4d65-8db8-8169b98b3e3e","added_by":"auto","created_at":"2026-05-08 08:11:59","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":45500,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 1.0: Summary of Extracted data for Included studies.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Table1Summaryofextracteddatafortotalincludedarticles.docx","url":"https://assets-eu.researchsquare.com/files/rs-9634039/v1/59ee2311f22f3e02bc1d82d3.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eImpact of ultra-processed food on type 2 diabetes incidence and related chronic diseases in Ghana and West Africa - A scoping review.\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background and Problem Statement","content":"\u003cp\u003eThe increasing prevalence of type 2 diabetes mellitus (T2DM) is a critical global public health dilemma, with the extensive intake of ultra-processed foods (UPFs) increasingly identified as a key dietary factor contributing to this growing issue. Ultra-processed foods (UPFs) are industrially produced formulations distinguished by elevated levels of added sugars, detrimental fats, salts, and chemical additives, prevalent in contemporary dietary habits in both high-income and low- to middle-income contexts (Khandpur et al., 2024). Ultra-processed foods (UPFs) replace nutritionally rich whole meals, causing excessive calorie consumption, obesity, and chronic systemic inflammation, which are risk factors for insulin resistance and hyperglycemia, the hallmark metabolic characteristics of type 2 diabetes mellitus (T2DM) (Levy et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Type 2 diabetes mellitus (T2DM) is a chronic, preventable illness caused by insulin deficiency or improper use, resulting in hyperglycemia that damages organs. Health systems in low- and middle-income countries (LMICs) have failed to address the increased prevalence of this illness, which can be prevented by diet and exercise.\u003c/p\u003e \u003cp\u003eUncontrolled Type 2 Diabetes Mellitus has personal, family, and systemic effects. Clinically uncontrolled blood glucose causes peripheral neuropathy, retinopathy, nephropathy, cardiovascular disease, renal failure, and increased mortality, which lower quality of life and require long-term management by patients and healthcare systems. Type 2 Diabetes Mellitus strains healthcare systems due to treatment costs, hospitalization, and decreased productivity, especially in low- and middle-income countries where ultra-processed food use is rising (Li et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). These pressures worsen health inequities and threaten resource-constrained healthcare systems.\u003c/p\u003e \u003cp\u003eThe epidemiological impact is staggering. Over 537\u0026nbsp;million people worldwide have diabetes, and 783\u0026nbsp;million by 2045, with 90\u0026ndash;95% of cases being Type 2 Diabetes Mellitus (T2DM) (International Diabetes Federation [IDF], 2021, as noted in EWG, 2025). About 14% of adults worldwide have diabetes, which kills 1.6\u0026nbsp;million annually (WHO, 2023). Since 1980, diabetes incidence in Sub-Saharan Africa has increased 490%, with over 80% of cases untreated (WHO, 2023). Prospective cohort studies show that ultra-processed food (UPF) consumption significantly affects health trends: incidence rates range from 113 to 166 cases per 100,000 person-years across UPF quartiles (Levy et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). A pooled meta-analysis of prospective cohorts found a 48% higher relative risk of type 2 diabetes mellitus (T2DM) among high UPF consumers than low UPF consumers (RR\u0026thinsp;=\u0026thinsp;1.48, 95% CI 1.36\u0026ndash;1.61), highlighting the dose-dependent relationship of this dietary factor (Chen et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis issue is poorly addressed in sub-Saharan Africa's healthcare system. A cascade-of-care review of 12 sub-Saharan African nations found that only 11% of diabetics went from diagnosis to treatment, with over half remaining untreated (Atun et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). From 2007 to 2022, annual per capita UPF sales rose by 40% in lower-middle-income countries and 60% in Uganda, the only low-income country for which Euromonitor sales data is available, exacerbating these systemic failures (Monteiro et al., 2025). West African countries, especially Ghana, are in danger because to rising UPF availability and weak health infrastructure.\u003c/p\u003e \u003cp\u003eGhana is an example of nutritional transition and health system preparation issues. As urbanization and global food markets have increased, processed and ultra-processed foods have replaced Ghanaian diets rich in cereals, legumes, and vegetables. UPF consumption is high in urban Ghana, where diabetes prevalence is 39.8% (Gato et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Retail audits in Greater Accra show that 85% of shelf space in modern food establishments is filled with unhealthy food, with a 5:1 ratio of ultra-processed to unprocessed products, mostly refined grain and sugar-sweetened beverages (Adjei et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Obesogenic foods are mostly imported, while protective foods like fish, vegetables, and legumes have stronger local supply chains. However, 20% of households report weekly consumption of sugar-sweetened beverages (SSBs) and confectionery (Annan et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). RODAM-Pros longitudinal data show increased energy contributions from processed and ultra-processed meals, especially in urban and migrant Ghanaians (Yussif et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecent data links ultra-processed foods (UPF) to type 2 diabetes mellitus (T2DM) and its comorbidities in Ghana and West Africa. Globally, dose-dependent correlations between ultra-processed food consumption and type 2 diabetes mellitus are well documented (Delpino et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Vitale, 2024), and ecological studies show a positive relationship between sugar-sweetened beverage sales and diabetes burden in Ghana (Karugu, 2025). Convenience food restaurants are linked to higher BMI in Ghanaians (Dake et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), and processed food increases metabolic risk. Ultra-processed food additives alter gut microbiota, increase endotoxaemia, and cause chronic inflammation, oxidative stress, and loss of nutrient-sensing pathways like mTOR, AMPK, and SIRT1, contributing to insulin resistance and metabolic disorders (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Ultra-processed foods (UPFs) contribute to cardiovascular disease risk via obesity-induced dyslipidaemia (Boateng et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) and renal impairment, which affects 70.2% of Ghanaian T2DM patients (Kpene et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In the Ashanti region of Ghana, 38.7% of T2DM patients have depression, which is linked to poor dietary adherence and worse clinical outcomes (Duodu et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt\u0026rsquo;s against this background we sort to explore the evidence available on the impact of ultra-processed foods particularly on Type 2 diabetes and related co-morbidities. Our purpose is to conduct a scoping review to reveal the available evidence. This review consolidates findings from studies published between 2016 and 2026, analyzing the availability and consumption patterns of ultra-processed foods (UPF) in Ghana, the effects of UPF intake, and the efficacy of dietary reduction strategies on type 2 diabetes mellitus (T2DM), cardiovascular disease, chronic kidney disease, and liver-related conditions from a community perspective. It also evaluates the impact of UPFs on cardiovascular, immune, and hormonal health, as well as the effectiveness of national policies and an assessment of leadership successes and failures in mitigating the chronic disease burden driven by UPFs in Ghana.\u003c/p\u003e\n\u003ch3\u003eThe NOVA Food Classification System\u003c/h3\u003e\n\u003cp\u003eNOVA categorizes foods and beverages based on the extent and intent of their industrial processing, rather than their nutritional value. Established in 2009 by Professor Carlos Monteiro and associates at NUPENS, University of S\u0026atilde;o Paulo, Brazil, the model was established through publications from 2010 to 2019. NOVA was motivated by the increasing prevalence of obesity and diet-related non-communicable diseases associated with swift alterations in food systems, particularly the emergence of industrially manufactured products. NOVA highlights that processing renders meals hyper-palatable, convenient, inexpensive to manufacture, and engineered for excessive consumption, hence displacing less processed foods and diminishing diet quality. The FAO and PAHO/WHO have recommended reducing ultra-processed foods in diet quality reviews, referencing the NOVA classification system. NOVA has been enormously employed in nutritional surveillance, including adjustments to NHANES data, and in policy formulation, such as front-of-pack labeling and taxation of sugary ultra-processed products.\u003c/p\u003e \u003cp\u003eNOVA categorizes foods into four groups (G1\u0026ndash;G4). The table below delineates each group, encompassing processing scope/purpose and illustrative instances (derived from official descriptions and reliable sources).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eName\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExtent and Purpose of Processing\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExamples\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnprocessed or minimally processed foods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSimple, substance-free procedures (such as cleaning, drying, crushing, freezing, pasteurization, and vacuum packaging). The goal is to make food edible while maintaining freshness.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFresh fruits/vegetables, whole grains, legumes, fresh meat/fish/poultry, eggs, milk, nuts/seeds (unsalted), plain yogurt (no additives), tea/coffee (plain).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProcessed culinary ingredients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExtraction/refining from Group 1 foods (e.g., pressing, grinding, refining). Used as parts in small-scale or home cooking; not eaten by themselves.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVegetable oils, butter, sugar, salt, honey, vinegar, lard, starches such as corn starch.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProcessed foods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCreated by combining foods from Group 1 with items from Group 2 (sugar, oil, salt). Modified natural foods with minimal industrial processing and few ingredients are easily identifiable. Goal: increase durability\u0026nbsp;and taste enhancement in food.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCheeses, freshly baked breads, salted/roasted nuts, smoked/salted fish or ham, and basic canned fish in oil are all examples of additive-free canned foods.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUltra-processed foods (UPFs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIndustrial formulations using food-derived or lab-synthesized flavors, colors, emulsifiers, and preservatives. Industrial methods: extrusion, molding, pre-frying, hydrogenation. Few intact Group 1 items; 5\u0026thinsp;+\u0026thinsp;ingredients, many industrial. Goal: Make overconsumption-inducing, convenient, profitable, long-lasting products.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSoft drinks, packaged snacks/chips, instant noodles, ready-to-heat meals, reconstituted meats (e.g., nuggets, sausages), most breakfast cereals, mass-produced breads with additives, ice cream, flavored yogurts, sugary confectionary, and energy drinks.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eThe key features of UPFs (Group 4) are\u003c/strong\u003e \u003cp\u003eThey are usually branded, actively marketed and engineered to be 'hyper-palatable' (very appealing through mixes of fat, sugar, salt and additives). Manufactured food can entail complex machinery and chemicals like high fructose corn syrup, modified starches, emulsifiers, artificial sweeteners or colors that are just not available to the home cook. There is no or negligible Group 1 food. Liquid foods can be ultra-processed too.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe purpose and rationale for NOVA is that, NOVA redirects the analytical emphasis from the nutritious composition of foods (\"what\" they contain) to the characteristics of their production (\"how\" they are created). The primary argument posits that rigorous industrial processing modifies foods not only in terms of nutritious composition but also affects their physical structure, incorporates cosmetic additives, and is designed for convenience, prolonged shelf life, and economic gain. These characteristics lead to the disruption of conventional food patterns (mostly Groups 1\u0026ndash;3) and promote obesogenic conditions.\u003c/p\u003e \u003cp\u003eA randomized controlled trial provided evidence that participants ingested roughly 500 additional calories daily when offered an ultra-processed diet, in contrast to an unprocessed diet matched for caloric content, energy density, macronutrients, sugar, sodium, and fiber (Hall et al., 2019).\u003c/p\u003e \u003cp\u003eEvidence of Health Effects\u003c/p\u003e \u003cp\u003eA multitude of studies, encompassing meta-analyses and prospective cohorts, have associated elevated consumption of ultra-processed foods\u0026mdash;frequently surpassing 50% of total caloric intake in high-income nations and escalating swiftly in low- and middle-income countries\u0026mdash;with heightened risks of obesity, type 2 diabetes (relative risk generally 1.12\u0026ndash;1.31), cardiovascular disease, specific cancers, depression, and overall mortality. Suggested mechanisms comprise:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eInsufficient nutrient density and replacement of protective, less processed foods.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHyper-palatable foods induce passive overeating.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAdditives and processing byproducts that may perturb gut microbiota, exacerbate inflammation, induce oxidative stress, and hinder metabolic signaling pathways (e.g., mTOR, AMPK, SIRT1).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePossible contributions from packaging pollutants and the ultra-processing procedure itself.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eRetail audits in Ghana and West Africa indicate that ultra-processed foods comprise over 85% of supermarket shelf space in certain districts, correlating with urbanization, heightened imports, and an increase in non-communicable diseases (Adjei et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite several limitations, NOVA has stimulated significant research about the impact of food processing on health outcomes, advancing the science beyond solely nutrient-focused frameworks. In resource-limited contexts like Ghana, the framework elucidates the infiltration of imported ultra-processed goods into informal markets and their hybridization of traditional diets, consequently intensifying the dual burden of malnutrition.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eReview question\u003c/h2\u003e \u003cp\u003eCould there be a link between ultra-processed food consumption and type 2 diabetes incidence in Ghana? What is the status of ultra-processed food consumption and type 2 diabetes incidence in Ghana? What is the impact and barriers to reducing ultra-processed food consumption on type 2 diabetes incidence in Ghana?\u003c/p\u003e \u003c/div\u003e"},{"header":"Methodology and Strategy for data synthesis","content":"\u003cp\u003eWe followed Arksey and O\u0026rsquo;Malley\u0026rsquo;s framework for scoping reviews (2005) with the extensive exploration and mapping of the available literature on the study phenomena (Mak \u0026amp; Thomas, 2022). In particular, the aim of our scoping review was to identify the types and nature of evidence available for impact of ultra-processed food on type 2 diabetes incidence in Ghana and West Africa, explore the key prevailing characteristics and impact of ultra-processed food consumption on type 2 diabetes incidence in communities in Ghana and to identify gaps or barriers in the available literature. A scoping review enhances detailed quantitative, qualitative, and mixed methods for their conduct. We also searched for grey literature from government and university databases. We followed an iterative process that included identification of the review question, identification of relevant literature, selection of relevant studies, charting and collating data, and summarizing and reporting findings. We also followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist to ensure a coherent and transparent reporting of literature (Tricco et al., 2018). A synthesis of study characteristics was conducted for each included study according to Cochrane guidelines. The resultant summary table included characteristics of the study location, population, intervention, comparators, and outcomes of interest, as well as the metrics used in each study. Additionally, the table included the authors and date range of data collection.\u003c/p\u003e\n\u003ch3\u003eSearch Strategies\u003c/h3\u003e\n\u003cp\u003eTo identify relevant studies, we conducted an initial search in PubMed, and Prospero to ensure that similar studies have not been conducted or registered as an ongoing project. After confirming the novelty of our topic, we conducted an exhaustive search in electronic databases including PubMed, CINAHL, Scopus, Medline, ProQuest, science direct, EBSCOhost databases, Medrvix, Research Square, Cochrane library, and Google Scholar. The authors collaboratively developed an iterative search strategy and systematically searched the identified databases between February and March 2026 using key search terms and permutations in March 2026. Boolean operators \u0026lsquo;\u0026rsquo;OR\u0026rsquo;\u0026rsquo; and \u0026lsquo;\u0026rsquo;AND\u0026rsquo;\u0026rsquo; were used to supplement the search in databases to locate literature that is relevant to the research objectives. Search terms such as \u0026lsquo;\u0026rsquo;Impact of\u0026rsquo;\u0026rsquo;\u0026rsquo; OR \u0026lsquo;\u0026rsquo;Effect\u0026rsquo;\u0026rsquo; OR \u0026lsquo;\u0026rsquo;Evaluating\u0026rsquo;\u0026rsquo; OR \u0026lsquo;\u0026rsquo;assessing\u0026rsquo;\u0026rsquo; OR \u0026lsquo;\u0026rsquo; exploring\u0026rsquo;\u0026rsquo; AND \u0026lsquo;\u0026rsquo; Ultra-processed food\u0026rsquo;\u0026rsquo; OR \u0026lsquo;\u0026rsquo; UPF\u0026rsquo;\u0026rsquo; OR \u0026lsquo;\u0026rsquo; Processed food\u0026rsquo;\u0026rsquo; AND \u0026lsquo;\u0026rsquo; Type 2 diabetes\u0026rsquo;\u0026rsquo; OR \u0026lsquo;\u0026rsquo;T2D\u0026rsquo;\u0026rsquo; \u0026lsquo;\u0026rsquo;Cardiovascular diseases\u0026rsquo;\u0026rsquo; OR \u0026lsquo;\u0026rsquo;CVD\u0026rsquo;\u0026rsquo; \u0026lsquo;\u0026rsquo; Kidney diseases\u0026rsquo;\u0026rsquo; \u0026lsquo;\u0026rsquo;liver related condition\u0026rsquo;\u0026rsquo; AND \u0026lsquo;\u0026rsquo;Ghana\u0026rsquo;\u0026rsquo; OR \u0026lsquo;\u0026rsquo;West Africa\u0026rsquo;\u0026rsquo; were used across databases to search for literature. We extended our search to Ghanaian universities\u0026rsquo; research repository and identified studies that potentially met our inclusion criteria.\u003c/p\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cp\u003eSources were included if they are peer-reviewed publications, reports, or reviews which focuses on populations in Ghana and West Africa sub region of any age, ethnicity, gender and health facilities. Populations from all regions of Ghana and West Africa sub region. 1. Addresses impact of Ultra processed food Type 2 diabetes. 2. Included if it addresses other diseases such as cardiovascular and kidney related diseases 3. if it\u0026rsquo;s both quantitative data (e.g., from the National Vital Statistics System, cross-sectional studies) or qualitative insights (e.g., focus groups) or mixed-methods designs; full-text availability; 4. were published between 2016 and 2026; Non-peer-reviewed articles, international research, studies done outside the geographic location in Ghana and West Africa, data-free editorials, duplicates, and those unrelated to type 2 diabetes, cardiovascular diseases, kidney related diseases outcomes were excluded. We focused on primary sources and varied designs (e.g., reviews, cross-sectional, qualitative), and All forms of community programs regarding ultra-processed food consumption and type 2 diabetes were also included.\u003c/p\u003e \u003cp\u003eContext: No further context. All community-based programs in all literature or research involving various research design and methodology and meeting aforementioned inclusion and exclusion criteria were analyzed.\u003c/p\u003e\n\u003ch3\u003eStudy Selection and Data Charting\u003c/h3\u003e\n\u003cp\u003eTwo authors independently screened the titles and abstracts of the identified studies to determine their eligibility for inclusion. All the identified articles were stored in Zotero referencing management software. Full-text articles were obtained for studies that met the inclusion criteria, and two reviewers independently assessed them for eligibility. Any disagreements were resolved through discussion, and consultation with a standby third reviewer. The reference lists of the included articles were searched to identify potential articles for inclusion. Our inclusion Criteria include published journal articles, pre-print, and grey literature that explored or discussed ultra-processed food consumption and type 2 diabetes, or Cardiovascular diseases, chronic kidney failure and fatty liver diseases or liver related disease conditions in Ghana between January 2016 and March 2026 including interviewing experts and practitioners in the field of medicine, nutrition and diabetes in Ghana. Only articles published in the English language were included in the review. We excluded studies that focused on other countries other than Ghana and West Africa Sub region, studies that were conducted before the year 2016 and studies that were not written in English. Data extraction and charting were performed by two reviewers using a standardized form developed and pre-approved by all the authors. Additionally, main findings on impact and barriers/challenges of ultra-processed food consumption on type 2 diabetes incidence in Ghana were recorded. The reviewers convened to compare findings and combine the extracted data. If the reviewers disagreed and were unable to reach consensus, a third reviewer was engaged to adjudicate. In the case of binary data, we extracted the total number of participants and research population; focus groups or areas and recorded them. If unavailable, overall summary statistics were extracted.\u003c/p\u003e \u003cp\u003eThe form included the following information: Author and year of publication, study design, location of study, study population, objectives of the studies, and the main findings. The extracted data was stored in a spreadsheet table format. Risk of bias (quality) assessment: Two reviewers independently assess risk of bias using the MMAT (Mixed Methods Appraisal Tool) and in accordance with PRISMA-ScR Checklist for Scoping Reviews, methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis were assessed.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;1.0: Table\u0026nbsp;1.0: Summary of Extracted data for Included studies.\u003c/b\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSee Appendix A\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cb\u003e\u0026ndash; Flow chart for identification of included Studies via databases and registers.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThematic Synthesis and Results\u003c/h3\u003e\n\u003cp\u003eWe examined the effects of ultra-processed food on type 2 diabetes, cardiovascular disease, chronic kidney disease, barriers, policy frameworks in Ghana and West Africa, and some of the ultra-processed foods available in the markets. Themes were categorized by thematic areas. 1). UPF availability, consumption, and status in Ghana, including NOVA food classification from the article. 2). Evidence of the Link Between UPF Consumption and Type 2 Diabetes (T2D) Incidence, 3). Impact of UPF on Related Chronic Diseases (major objectives), sub-themes:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eType 2 Diabetes (e.g., risk factors for UPF occurrence)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCVD: Cardiovascular illnesses\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eChronic kidney failure/related disorders\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLiver-related conditions/fatty liver disorders\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e4. Main outcomes: UPF-T2D and Comorbidities Mechanisms; 5). Obstacles to Reducing UPF Consumption (review question 3); 6). Policy Frameworks, Leadership Successes/Fails, and Interventions; and 7). Literature Gaps and Implications.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eAvailability, Consumption, and Status of Ghanaian Ultra-Processed Foods (UPF) and NOVA Food Classification\u003c/h2\u003e \u003cp\u003eNOVA categorizes ultra-processed foods (UPFs) as industrially produced items containing numerous additives and minimal whole-food components (Group 4). They prevail in Ghana's culinary culture and signify the nutritional transformation. In Greater Accra, cross-sectional market surveillance revealed that 85% of shelf space in supermarkets and mini-marts was allocated to unhealthy products, predominantly comprising refined grains/grain products (30%) and sugar-sweetened drinks (SSBs, 20.1%). The mean ratio of ultra-processed to unprocessed foods was 5:1. Household surveys indicated that supermarkets facilitate the acquisition of ultra-processed foods in urban South Africa, while informal outlets are more prevalent in Ghana, where the consumption of unprocessed foods is greater (41.8%). However, deprivation remains associated with inconsistent intake of both categories.\u003c/p\u003e \u003cp\u003eObesogenic foods are sourced from outside, whereas preventative foods (such as fish, vegetables, and legumes) possess more robust local supply chains (Annan et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Twenty percent of Ghanaian households use sugar-sweetened beverages and confectionery on a weekly basis. Longitudinal evidence indicates that rural, urban, and migrant Ghanaians are increasingly consuming processed foods, particularly ultra-processed varieties (Yussif et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Traditional marketplaces continue to be the primary purchasing venues due to their proximity and affordability, whereas processed goods are distributed through both formal and informal channels (Aryeetey et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). NOVA forecasts a predominance of plastic packaging, with processed and ultra-processed categories significantly linked to low-income retail transactions (Dzodzomenyo et al., 2023, 2025). Notwithstanding their industrial composition, urban adolescents link certain ultra-processed foods (UPFs) with \"freshness\" and vitality (Abubakar, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBoth formal (supermarkets) and informal food retail systems contain ultra-processed foods (UPFs). Supermarkets and contemporary retail establishments endorse ultra-processed products in metropolitan and peri-urban regions, whilst traditional markets and informal vendors offer refined grains, sugar-sweetened drinks (SSBs), instant noodles, candy, and packaged snacks. The energy contributions of processed and ultra-processed foods have risen, particularly among urban and migrant populations in Ghana (Yussif et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). In some instances, excessive consumption of ultra-processed foods (including detrimental commercial products) supplants nutrient-rich supplementary foods and constitutes 22\u0026ndash;40% of non-breastmilk energy in young children (Vanderkooy et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Urban teenagers in Ghana associate specific urban public facilities with \"freshness\" and vibrancy, despite their industrial characteristics, which enhance absorption (Abubakar, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eProcessed (NOVA Group 3) and ultra-processed (Group 4) products predominantly occupy shelf space and packaging in low-income retail environments, frequently associated with plastic waste surveillance (Dzodzomenyo et al., 2023, 2025). Food systems in West Africa have transitioned from fiber-rich staples such as cassava, millet, legumes, and vegetables to energy-dense, highly processed diets (Sanni, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Okoye et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUrbanization, retail modernity, and dependence on imports have engendered a hybrid food system in Ghana, characterized by the fast expansion of traditional staples and NOVA Group 3 and 4 products. This availability and consumption profile signifies a sophisticated nutritional revolution, with ultra-processed foods (UPFs) firmly integrated into both formal and informal supply chains.\u003c/p\u003e \u003cp\u003e \u003cb\u003e2. Evidence of the Link Between UPF Consumption and Type 2 Diabetes (T2D) Incidence\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThere is strong longitudinal and meta-analytical evidence for a dose-dependent link between UPF intake and incidence T2D. A comprehensive review and meta-analysis of prospective cohorts indicated that moderate UPF consumption increased T2D risk by 12% (RR 1.12, 95% CI 1.06\u0026ndash;1.17) and high intake by 31% (RR 1.31, 95% CI 1.21\u0026ndash;1.42), with clear dose-response relationship (Delpino et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Complementary meta-analyses reveal 37% greater diabetes risk with high UPF intake, however impact estimates are modulated by methodological variability (24-h recall vs. FFQ; Vitale et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In Ghana and West Africa, dietary patterns high in rice, pasta, meat, and fish (often with processed items) are inversely associated with T2D when variety is high, but overall trends towards processed foods diminish protective effects (Danquah et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Galbete et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Longitudinal data from RODAM-Pros indicate growing energy intake from processed foods across Ghanaian sites, especially among migrants, mirroring anticipated T2D incidence patterns (Yussif et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Ecological assessments link growth in sugar-sweetened beverage sales to the burden of T2D across African nations including Ghana, further emphasizing UPFs as a modifiable driver (Karugu et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Together these studies establish UPFs as an independent risk factor beyond nutritional content alone.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e3. \u003cb\u003eImpact of Ultra-Processed Foods on Associated Chronic Diseases\u003c/b\u003e\u003c/p\u003e \u003cp\u003eType 2 Diabetes (Risk Factors Associated with UPF Incidence) The consumption of ultra-processed foods exacerbates the underlying risk factors for type 2 diabetes such as insulin resistance, obesity and poor glycaemic control through compositional and processing-related pathways. In Ghana, food environments among the urban poor characterized by the widespread presence of convenience stores and ready access to prepared foods independently predict an increased BMI (+\u0026thinsp;0.2 kg/m2 with each additional store), a direct precursor of type 2 diabetes (Dake et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Ghanaian individuals who face childhood socio-economic adversity and early dietary deficits are more exposed to adult abdominal obesity and type 2 diabetes (Danquah et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Higher consumption of ultra-processed food is associated with lower nutrient density and higher sugar and fat content that directly promote metabolic dysregulation (Vanderkooy et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Vitale et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eUPF and Cardiovascular diseases\u003c/strong\u003e \u003cp\u003eUPF-based diets enhance the predicted 10-year risk of atherosclerotic cardiovascular diseases (CVD). In the RODAM cohort, adherence to \u0026rdquo;roots, tubers and plantain\u0026rdquo; dietary patterns, which are frequently less processed but energy dense, was positively associated with ASCVD risk, while mixed and rice/pasta/meat/fish patterns showed protective effects soon after correction (Boateng et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). There is wide variation in the performance of risk-prediction algorithms among populations of African origin, underlining the need for context-specific tools as exposure to ultra-processed foods increases (Boateng et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). A large SSA dataset connects imports of highly processed foods with obesity prevalence, a key mediator of cardiovascular illness (Boysen et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eChronic Renal/Kidney Insufficiency / Renal diseases\u003c/strong\u003e \u003cp\u003eDirect data from Ghana establishes a relationship between T2D and kidney damage, which is worsened by UPFs. Suboptimal glycaemic control and hypertension, both caused by UPF-induced metabolic stress, are predictors of decreased eGFR in type 2 diabetes outpatients, according to CKD-EPI staging (Kpene et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Microvascular complications, especially nephropathy, are common in SSA diabetes studies, and insulin resistance caused by UPF speeds up the disease's course (Atun et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDisorders of the Liver / Hepatic Steatosis\u003c/strong\u003e \u003cp\u003eAlthough there is little direct evidence on non-alcoholic fatty liver disease in Ghana, there are persistent connections with obesity, dyslipidaemia, and metabolic syndrome\u0026mdash;recognized precursors to hepatic steatosis\u0026mdash;in comprehensive studies of ultra-processed foods (2024). As discussed in Theme 4, there is an elevated risk within Ghana's dual-burden scenario due to the molecular confluence of inflammation and insulin resistance (Popkin et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e4. Mechanisms Linking UPF to T2D and Comorbidities\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIndustrial chemicals or additives and ultra-processing disturb cellular equilibrium at several levels. Emulsifiers, sweeteners, and preservatives modify gut microbiota composition, compromise intestinal barrier integrity, and facilitate endotoxin translocation (lipopolysaccharide), thereby inducing chronic low-grade inflammation and oxidative stress (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). These alterations result in mitochondrial malfunction and hinder nutrient-sensing pathways (mTOR, AMPK, SIRT1), leading to insulin resistance, lipid dysregulation, and systemic metabolic disorders. Simultaneously, ultra-processed foods supplant nutrient-rich whole meals, intensifying micronutrient deficiencies and energy imbalances (Delpino et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Vitale et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The outcome is an expedited transition from obesity to type 2\u003c/p\u003e \u003cp\u003ediabetes, cardiovascular disease, and associated comorbidities, which challenges exclusively nutrient-focused models and underscores processing as a causal factor (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e5. Barriers and Challenges to Reducing UPF Intake\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThere are multi-layer barriers for UPF reduction. At the individual level, there are widespread concepts that associate health with uncooked or traditionally cooked foods, although preparation techniques (for example, frying) and convenience are often more important. Options are also constrained by financial limitations, psychological and physical states, and social mores (Boatema et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). At the community level, contributing factors include the high prevalence of hazardous advertising near educational institutions (57.6% of food commercials are unhealthy) and the high density of obesogenic retail outlets (Amevinya et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Dake et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Structural barriers include poor enforcement of marketing restrictions, reliance on imported obesogenic products and cultural misperceptions describing ultra-processed foods as \u0026ldquo;fresh\u0026rdquo; or youthful (Abubakar, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Laar et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Policy fragmentation, poor multi-sectoral coordination and poor targeting of urban poor people and adolescents exacerbate these problems (Casu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Osei-Kwasi et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). There is a high level of food insecurity (about 47% in poor urban areas) which leads to the preference for cheap, energy-dense ultra-processed meals over nutrient-rich foods (Kushitor et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003e6. Policy Frameworks, Leadership Achievements/Shortcomings and Interventions\u003c/b\u003e \u003c/p\u003e \u003cp\u003eGhana and West Africa have partial policy integration with significant implementation gaps. Nutrition-related policies are more prone to use nutrition-specific framing than nutrition-sensitive framing, with less attention to equity, targeting of adolescents and urban regions, and coherence across multiple sectors (Casu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Expert ratings of government action on healthy food environments are considered inadequate in the domains of marketing regulation and retail incentives (Laar et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The CARE Diabetes project protocol documents successful community engagement experiences, generating background data on food markets, healthcare access, and social norms in poor urban Accra to guide tailored treatments (Baatiema et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Achievements include local producers taking part in protective food initiatives and school feeding programs; shortcomings are the unregulated promotion of ultra-processed foods, weak enforcement of single-use plastic bans (not as in Kenya) and limited tariff differentiation on highly processed imports (Boysen et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Dzodzomenyo et al., 2025). We recommend the implementation of coordinated health systems strengthening and policy packages for both formal and informal outlets (Atun et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Agyapong et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe integration of nutrition-related policy in West Africa is variable. Nutrition-specific therapies are more explicit than nutrition-sensitive interventions on food settings or regulation of ultra-processed foods such as fortification and school feeding (Casu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Deficiencies include insufficient equitable targeting, weak multi-sectoral coordination, and lack of attention to urban populations or teenagers (Casu, et al., 2022). Experts\u0026rsquo; assessments suggest a lack of appropriate government action on the legislation of a healthy food environment, including restrictions on marketing and incentives in retailing (Laar et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Examples of promising elements include differential tariffs on heavily processed imports (Boysen et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and community-based protocols such as CARE Diabetes which generate contextual data for tailored therapy in urban poor settings (Baatiema et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). However, poor enforcement and the cultural marketing of ultra-processed foods (UPFs) as \u0026ldquo;fresh\u0026rdquo; or convenient undermine the initiatives (Abubakar, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Sanni, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003e7. Gaps in the Literature and Impact\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThere remain important gaps in longitudinal Ghana-specific UPF-T2D data, consistent use of NOVA across different retail settings, and research of interventions that explore processing-oriented policies. Mechanistic data are mainly global and local studies on biomarkers or microbiota are scarce (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Qualitative understanding of cultural variables are largely confined to urban poor situations and so do not reflect rural and adolescent understandings (Boatema et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Manyara et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Policy evaluations do not include complete impact assessments on obesity and undernutrition outcomes (Casu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The CARE Diabetes protocol and similar mixed methods frameworks highlight the importance of contextualized, community-based research to link quantitative dietary data with experiential realities (Baatiema et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Implications include a focus on NOVA-based surveillance, culturally sensitive initiatives that draw on lay beliefs, differential taxation on ultra-processed foods (UPFs), and multi-sectoral policies that address the dual burden without exacerbating food insecurity. These shortcomings need to be addressed to avert a fully established UPF caused metabolic illness pandemic in Ghana and West Africa (Popkin \u0026amp; Laar, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Sanni, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eKey gaps in the literature are the absence of longitudinal, multi-national studies in West Africa that consistently employ NOVA classification; the scarcity of mechanistic studies using local biomarkers; the inadequate representation of the rural and adolescent perspective; and the absence of rigorous evaluation of ultra-processed food-specific interventions targeting both overnutrition and undernutrition outcomes (Sanni, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Casu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Manyara et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The CARE Diabetes project and its mixed methodologies frameworks underline the significance of context-specific, community-oriented research (Baatiema et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHolistic, regional approaches are needed to address the proliferation of UPFs in West Africa: strengthening NOVA-based surveillance, differential taxation and marketing policies on UPFs, local protective food value chains, nutrition education that draws on lay beliefs, and multi-sectoral policies to address the double burden of malnutrition simultaneously (Sanni, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Popkin \u0026amp; Laar, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Okoye et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Reardon et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). If urgent action is not taken, a pandemic of metabolic disorders that threaten health, productivity and sustainable development in the region may become entrenched.\u003c/p\u003e \u003cp\u003eMechanisms of metabolic dysfunction driven by ultra-processed food additives\u003c/p\u003e \u003cp\u003eUltra-processed foods (UPFs; NOVA Group 4) are industrial formulations composed of numerous additives such as emulsifiers (e.g., carboxymethylcellulose [CMC], polysorbate 80 [P80]), artificial sweeteners (e.g., sucralose), preservatives, stabilizers, colorants, and flavor enhancers that extend beyond mere nutrient compositions and are detrimental to cellular and systemic physiology. These additives work through interconnected pathways including the gut microbiota, intestinal barrier integrity, inflammation, oxidative stress, mitochondrial function and nutrient-sensing signaling ultimately causing insulin resistance, lipid dysregulation and metabolic diseases (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eComposition and Function of Gut Microbiota Impairment\u003c/p\u003e \u003cp\u003eUPF additions cause dramatic disruption and changes in the gut microbial ecosystem with loss of overall diversity and shifts in community structure toward pro-inflammatory pathobionts, depleting beneficial short-chain fatty acid (SCFA)-producing taxa. Emulsifiers and sweeteners increase mucus-degrading bacteria selectively and decrease short-chain fatty acid synthesis, which normally maintains epithelial health and anti-inflammatory signaling. This dysbiosis is not just compositional, but also disrupts microbial metabolite production, so triggering a cascade of downstream effects. Preservatives exacerbate these alterations through the production of reactive oxygen species (ROS) during metabolism hence increasing microbial stress (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThus, one major downstream impact is increased intestinal permeability. Emulsifiers, by their nature as surfactants, directly destroy tight-junction proteins in the intestinal epithelium. This allows transport of bacterial endotoxins, particularly lipopolysaccharide (LPS), from the intestinal lumen to the systemic circulation, a phenomenon known as metabolic endotoxemia. The subsequent low-grade chronic inflammation induces immunological signaling (e.g., via Toll-like receptor 4) with systemic effects such as hepatic steatosis, adipose inflammation, and impaired glucose homeostasis. Sweeteners and other additives contribute indirectly to dysbiosis, which further affects barrier function (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUltra-processed foods (UPF) cause oxidative stress and mitochondrial dysfunction, as UPF ingredients activate cellular oxidative stress via several routes. Sweeteners and preservatives increase the generation of reactive oxygen species (ROS) as metabolic by-products. Emulsifiers indirectly increase the ROS in virtue of inflammation caused by endotoxemia. Mitochondria are particularly vulnerable: addenda inhibit the activity of the electron transport chain (ETC), increase the formation of reactive oxygen species (ROS) and damage mitochondrial bioenergetics. This leads to energy depletion at the cellular level, lipid peroxidation and death in metabolically active organs (e.g. liver, muscle, β-cells). Studies in animals and human pilots have linked several substances (such CMC/P80 emulsifiers and sucralose) to mitochondrial damage (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTherefore, long-term exposure to ultra-processed meals induces changes in basic cellular nutrient-sensing pathways and networks.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003emTOR: Inflammatory signals\u0026thinsp;+\u0026thinsp;altered availability of amino acids hyperactivate mTOR \u0026rarr; anabolic excess\u0026thinsp;+\u0026thinsp;insulin resistance.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAMPK: Inhibition due to energy imbalance and reactive oxygen species decreases fatty acid oxidation and glucose uptake.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSIRT1: Decreased expression of SIRT1 influences mitochondrial biogenesis, reduces antioxidant defense and alters anti-inflammatory response.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThese pathway alterations create a vicious loop of metabolic excess linking gut generated signals to peripheral tissue dysfunction (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eA General Framework and Empirical Evidence\u003c/h2\u003e \u003cp\u003eThe UPF processes comprise a coherent pathway: additive-induced dysbiosis \u0026rarr; barrier disruption and endotoxemia \u0026rarr; inflammation and oxidative stress \u0026rarr; mitochondrial dysfunction and nutrient-sensing impairment \u0026rarr; insulin resistance, dyslipidemia and metabolic diseases. This concept is supported by epidemiological, clinical and experimental data gathered in mechanistic reviews, evaluating the effects of ultra-processed vs unprocessed foods even with similar nutrient profiles (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Delpino et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Vitale et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCellular disruptions in Ghana and West Africa are exacerbating the nutrition transition, as increased access to ultra-processed foods (e.g. imported processed products and obesogenic retail environments) is accelerating the dual burden of malnutrition and non-communicable diseases (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Okoye et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The traditional criteria of nutrients are not sufficient. Policy must include NOVA classification and re-evaluate additive safety to address these industrial factors to cellular disease.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePatterns, Influences and Health Consequences of Ultra-Processed Foods (UPF) in the context of West Africa.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn West Africa, there is a fast nutritional transition defined by increased consumption of ultra-processed foods (UPFs; NOVA Group 4). UPFs are meals that are industrially processed with several chemicals, few whole-food ingredients and high levels of added sugars, fats and salt. This transition, fueled by urbanization, globalization, economic escalation, and shifting lifestyles, aggravates the historical problems of undernutrition in the region, adding to a serious \u0026ldquo;double burden\u0026rdquo; of malnutrition (Sanni, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Popkin et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Okoye et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The literature is over-represented with Ghana-based evidence which could signal research density. However, the regional patterns of Benin, Burkina Faso, C\u0026ocirc;te d\u0026rsquo;Ivoire, Ghana, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo show a uniform increase in availability and consumption of UPFs (Casu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Sanni, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe key structural determinants are:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eUrbanization and globalization: Rapid urban growth increases availability to supermarkets and imported ultra-processed foods (UPFs) but decreases time for traditional meal preparation (Sanni, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Ecker \u0026amp; Fang, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFood systems transformation: The \u0026ldquo;processed food revolution\u0026rdquo; involves multinational investment in the production and distribution of ultra-processed products reducing the relative price of obesogenic foods (Reardon et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Okoye et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEconomic and policy determinants: As income increases, people may afford more convenience foods; tariff differences tend to favor highly processed imports over local unprocessed staples (Boysen et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). This is compounded by a lack of multi-sectoral policy coherence (Casu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSocio-cultural changes: prevailing attitudes, marketing, and convenience supersede traditional nutritional norms, with UPFs perceived as modern or desirable (Boatema et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Abubakar, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThese variables disproportionately harm populations of urban poor, women, children and adolescents (Sanni, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Popkin \u0026amp; Laar, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe discovered health Implications are real such that diet-related NCDs with persistent undernutrition increase with ultra-processed food (UPF) consumption. Epidemiological studies and meta-analyses have shown that higher consumption of ultra-processed foods (UPF) is associated with a dose-dependent increase in type 2 diabetes (T2D) risk (Delpino et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Vitale et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) and obesity, hypertension, dyslipidemia, and cardiovascular disease (CVD) risk factors (Lane et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Karugu et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). West Africa is seeing a rise in type 2 diabetes (T2D) and microvascular consequences such nephropathy due to delayed diagnosis, poor glycaemic control, and metabolic stress from ultra-processed foods (Atun et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Kpene, 2024). Additives alter gut microbiota, intestinal barrier integrity, endotoxemia, chronic inflammation, mitochondrial function, and nutrient-sensing pathways (mTOR, AMPK, SIRT1), accelerating insulin resistance and related comorbidities (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Ultra-processed foods (UPF) harm preschoolers' metabolic and cognitive health (Popkin \u0026amp; Laar, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Vanderkooy et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Underweight/stunting and overweight/obesity coexist in disadvantaged urban areas (Popkin et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Sanni, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis scoping study examines the influence of ultra-processed foods (UPFs) on type 2 diabetes (T2D) and associated non-communicable diseases in Ghana and West Africa sub-region by investigating the UPF retail landscape, consumption patterns, policy framework, health implications, marketing strategies, and obstacles to dietary enhancement.\u003c/p\u003e \u003cp\u003eThe swift urbanization, economic growth, proliferation of supermarkets and mini-marts, and globalization have resulted in the creation of obesogenic food retail environments in Ghana. Traditional primary food sources like cassava, plantains, yams, and beans are being supplanted by energy-dense imported foods high in refined sugars, fats, and sodium. Retail audits, household surveys, value-chain analyses, and longitudinal studies consistently demonstrate (i) the prevalence of ultra-processed foods (NOVA Group 4), (ii) their price and accessibility, and (iii) a systematic shift towards market purchases and increased caloric density, particularly in metropolitan environments.\u003c/p\u003e \u003cp\u003eUnhealthy products are disproportionately prevalent in modern shopping environments. Adjei et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) examined 67 establishments in Greater Accra and discovered that 86.6% were mini-marts, with 85% of shelf space allocated to detrimental products. Detrimental products comprised refined grains (30%) and sugar-sweetened beverages (20.1%), yielding an unhealthy-to-healthy eating ratio of 5:1. Mockshell et al. (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) conducted swift audits in Accra, Cape Coast, and Koforidua, which verified that ultra-processed foods (UPFs) were equally accessible and economical as unprocessed foods in all retail formats. Aryeetey et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) demonstrated consistent exposure across both informal and formal retail categories. The geographical scope of these observations has been broadened by Annan et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) and Agyapong et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). They observe that informal retail channels are widespread in Ghana and influence household purchasing behaviors, in contrast to the supermarket-centric systems in South Africa. Households in poverty consumed preventative foods (fish 74.5%, vegetables 53.1%, legumes 22.8%) and obesogenic goods, with 20% indicating weekly intake of sugar-sweetened beverages and confectionery, while nearly 80% failed to differentiate between food groups.\u003c/p\u003e \u003cp\u003eConsumption patterns indicate dietary hybridization or modification. Kushitor et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) examined low-income districts of Accra from 2011 to 2013 and discovered that the proportion of products in NOVA Groups 2\u0026ndash;4 and adherence to snack patterns rose from 35% to 41%. Kushitor et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) reported in Ga Mashie a mixture of traditional and contemporary staple foods, specifically rice (67%), sugar-sweetened beverages (SSBs) (21%), instant noodles (6%), and Milo (21%), alongside poor dietary diversification (3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 food groups) and a family food insecurity rate of 47%. Ecker and Fang (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) identified national trends indicating that urban diets are becoming more westernized, whereas rural diets remain dependent on basic foods. According to Sanni (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) and Okoye et al. (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), urbanization, rising affluence, and the proliferation of supermarkets that enhance the consumption of fats, sugars, and processed foods while exacerbating malnutrition are associated with Ghana's development.\u003c/p\u003e \u003cp\u003eUrban-rural gradients: Variations. Ultra-processed foods (UPFs) are predominantly consumed by urban, educated, and younger demographics (Annan et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Kushitor, 2023). Convenience stores and supermarkets exhibit a stronger predictive capacity for BMI and obesogenic intake in the urban poor of Accra compared to South African townships (Agyapong et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Dzodzomenyo et al. (2023, 2025) utilize packaging as a proxy for ultra-processed foods (UPF), revealing that the NOVA-processed categories encourage greater plastic consumption in Ghana (94%) compared to Kenya (56.7%), a disparity alleviated by regulatory interventions such as Kenya's carrier-bag prohibition.\u003c/p\u003e \u003cp\u003eAdvertising promotes detrimental consuming habits. Amevinya et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) discovered that 47.3% of campus advertisements promoted food or beverages, with 57.6% classified as unhealthy and 37% as sugar-sweetened beverages (SSBs). Amevinya et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) identified 5,887 outdoor advertisements near schools in Greater Accra, of which 70% marketed detrimental products and 50% ultra-processed items, employing celebrity endorsements and emotional appeals. These advertisements have been linked to the eating behaviors of impoverished populations in Ghana and Kenya (Holdsworth et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), illustrating an obesogenic consuming environment influenced by contextual variables such as urban-rural disparities and retail formality.\u003c/p\u003e \u003cp\u003eThe policy review identifies significant implementation issues. Casu et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) revealed inconsistent integration of nutrition in West African programs, characterized by inadequate multi-sectoral coherence and minimal equitable targeting. Laar et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) determined that three-quarters of the Ghana Food-EPI indicators were categorized as having 'low/very little' implementation. Boysen et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) discovered that varying taxes on highly processed imports diminish obesity rates, particularly among women and higher-income demographics. Reardon et al. (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and Popkin and Laar (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) endorse \"double-duty\" initiatives, including SSB levies, front-of-pack labeling, and the promotion of nutritious weaning foods. Manyara et al. (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) and Boatema et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) have emphasized the significance of connecting therapies to cultural beliefs and socio-ecological contexts. The issues of campus dining and the oversight of informal vendors require attention. UPFs may affect non-communicable diseases through many biological mechanisms. UPF additives, including emulsifiers, artificial sweeteners, and preservatives, alter mTOR, AMPK, and SIRT1 signaling, resulting in dysbiosis and intestinal barrier compromise, facilitating endotoxin translocation, chronic inflammation, insulin resistance, and metabolic disorders (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Additional data (Delpino et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Lane et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Vitale, 2024) indicates dose-dependent cardiometabolic hazards influenced by inflammation, dyslipidemia, and obesity.\u003c/p\u003e \u003cp\u003eThe consumption of ultra-processed foods elevates the risk of Type 2 Diabetes by converging processes. Moderate consumption of ultra-processed foods (UPF) correlated with a 12% heightened risk of type 2 diabetes (RR\u0026thinsp;=\u0026thinsp;1.12), while high UPF consumption correlated with a 31% heightened risk of type 2 diabetes (RR\u0026thinsp;=\u0026thinsp;1.31), demonstrating a dose-response gradient (Delpino et al. \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Karugu et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) correlated the increase of SSB sales in nine African nations, including Ghana (β\u0026thinsp;=\u0026thinsp;0.41), with the rising prevalence of T2D. The RODAM cohort studies (Galbete et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Danquah et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) demonstrate a correlation between increased dietary variety and a reduced risk of Type 2 Diabetes (T2D). The pattern presents a combination of signals, incorporating protective elements like legumes and fish. Compliance with dietary self-management in T2D patients reduces the risk of depression (AOR 0.28), indicating that behavioral interventions can alleviate subsequent effects (Duodu et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Mixed diets comprising rice, pasta, meat, and fish reduce the 10-year risk of atherosclerotic cardiovascular disease (prevalence ratio Q5 vs. Q1\u0026thinsp;=\u0026thinsp;0.70) for cardiovascular disease. UPF components facilitate detrimental pathways (Lane et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). UPF-induced metabolic excess establishes molecular connections to fatty liver disease (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Vitale et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Popkin et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Reardon, 2021). Renal impairment was observed in 70.2% of Ghanaian patients with type 2 diabetes in tertiary care.\u003c/p\u003e \u003cp\u003eMultiple tiers of obstacles exist to the reduction of UPF. Knowledge gaps and misconceptions regarding UPF-vitality persist (Abubakar, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Vuvor \u0026amp; Harrison, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Consumption is influenced by social sharing and familial norms (Vanderkooy et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Boatema, 2018). Structural hurdles encompass 47% food insecurity, poverty, inadequate enforcement, and the predominance of imported ultra-processed foods (Kushitor et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Annan, 2025; Laar, 2020). The challenges are exacerbated by disjointed coordination (Casu, 2022) and inadequate Food-EPI implementation (Laar et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The nutrition transition in Ghana must be reversed by preserving the protective aspects of traditional dietary patterns (Annan et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Laar, 2020; Casu, 2022). This necessitates urgent, coherent, equity-sensitive, multi-level policies that emphasize value chains, regulation of marketing, and food environments aligned with Agenda 2030.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eThere is a need for a concerted multi-level effort to alleviate the growing burden of ultra-processed food (UPF)-related type 2 diabetes (T2D) and chronic disease in Ghana and West Africa. Mandatory NOVA-based surveillance in both formal and informal retail settings should be institutionalised to obtain consistent dietary exposure data for policymakers (Sanni, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Casu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Urgent differential fiscal policies, such as excise levies on sugar-sweetened beverages and heavily processed imports, should be imposed, given evidence that targeted taxation reduces obesogenic consumption (Boysen et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Karugu et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Enforcement of marketing regulations near schools is necessary, since 70% of ads in proximity are for unhealthy products (Amevinya et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Laar et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Investments in local protective food value chains should be complementary to UPF reduction (Annan et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Culturally appropriate nutrition education should include UPF-vitality misunderstandings (Abubakar, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Boatema et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and integrated multi-sectoral frameworks are needed to manage the twofold burden (Popkin \u0026amp; Laar, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis scoping review presents strong evidence for UPF consumption as an important and increasing public health issue in Ghana and West Africa with consistent mechanistic, epidemiological and policy-level evidence of UPF intake and T2D and related cardiometabolic comorbidities. NOVA-based retail monitoring indicates that goods from NOVA Groups 3 and 4 dominate both formal and informal food settings, displacing traditional nutrient-dense staples (Aryeetey et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Dzodzomenyo et al., 2023). Meta-analyses show a dose-dependent association between UPF consumption and T2D risk, with relative risks ranging from 1.12 to 1.31 (Delpino et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Vitale et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Mechanistic evidence indicates the role of gut dysbiosis induced by additives, chronic inflammation, mitochondrial dysfunction, and disruption of nutrient-sensing pathways (Anih et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). There are also significant gaps in longitudinal, Ghana-specific research and rigorous policy impact evaluation (Casu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Manyara et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Without quick and coordinated intervention, a UPF-driven metabolic illness pandemic risks becoming entrenched in the sub-region (Popkin \u0026amp; Laar, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Sanni, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was self-funded. The authors or researchers of this paper therefore did not receive any specific funding for this project or studies from any external sources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePEN: Project Administration, Review, Conceptualization, Methodology - Selection process, data curation, Charting, Supervision, writing of draft and final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBF: Methodology, review, editing, project validation, writing, Visualization, formal analysis, writing of draft and final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Consideration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo human subjects were involved in the study; therefore, no ethical approval is required.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eContact details and Organizational affiliation of the reviewers;\u003c/p\u003e\n\u003cp\u003ePromise Edem Nukunu\u0026nbsp;\u003c/p\u003e\n\u003cp\[email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMonroe University\u003c/p\u003e\n\u003cp\u003eBhavna F\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003eMonroe University\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdjei AP, Amevinya GS, Quarpong W, Tandoh A, Aryeetey R, Holdsworth M, Agyemang C, Zotor F, Laar ME, Mensah K, Addo P, Laryea D, Asiki G, Sellen D, Vandevijvere S, Laar A (2022) Availability of healthy and unhealthy foods in modern retail outlets located in selected districts of Greater Accra Region, Ghana. 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J Nutr Food Sci. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.imedpub.com/articles/knowledge-practice-and-perception-of-taking-soft-drinks-with-food-and-themetabolic-effects-on-high-school-students-in-ghana.php?aid=20268\u003c/span\u003e\u003cspan address=\"https://www.imedpub.com/articles/knowledge-practice-and-perception-of-taking-soft-drinks-with-food-and-themetabolic-effects-on-high-school-students-in-ghana.php?aid=20268\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization, Diabetes (2023) updated November Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/diabetes\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/diabetes\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYussif MT et al (2025) Longitudinal changes in processed food intake and their daily caloric contribution among Ghanaian populations living in Ghana and Europe: Findings from the prospective Research on Obesity and Diabetes among African Migrants (RODAM-Pros) study. [PMC12763962].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbubakar G (2023) Unravelling the fresh misconception of ultra-processed foods in Ghana. ANH Acad Blog. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.anh-academy.org/community/blogs/unravelling-the-fresh-misconception-of-ultra-processed-foods-in-ghana\u003c/span\u003e\u003cspan address=\"https://www.anh-academy.org/community/blogs/unravelling-the-fresh-misconception-of-ultra-processed-foods-in-ghana\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Monroe University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ultra-processed foods, Type 2 diabetes incidence, cardiovascular diseases chronic kidney failure and fatty liver diseases or liver related disease conditions Barriers, Impact, Legal framework, Ghana, Nutrition transition, Community-based approach","lastPublishedDoi":"10.21203/rs.3.rs-9634039/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9634039/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe nutrition shift, which increases ultra-processed food intake (UPFs; NOVA Group 4), is linked to the rise in type 2 diabetes (T2D) and non-communicable diseases in Ghana and West Africa. UPFs, with high added sugars, fats, sodium, and synthetic chemicals, replace whole-food meals, causing obesity, insulin resistance, inflammation, and metabolic dysfunction. This scoping review describes the availability and consumption of ultra-processed foods (UPF), their health effects\u0026mdash;specifically type 2 diabetes (T2D), cardiovascular disease (CVD), and renal disease\u0026mdash;and regional impediments and policy responses.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eUsing Arksey and O'Malley's (2005) methodology and PRISMA-ScR recommendations, we searched PubMed, Scopus, Google Scholar, and other databases, grey literature, and Ghanaian repositories from 2016 to 2026. Quantitative, qualitative, and mixed-methods studies on ultra-processed foods (NOVA classification) and outcomes in Ghana and West Africa were eligible. Two reviewers independently assessed, selected, and documented data using standardized forms, using theme synthesis to identify key patterns, mechanisms, obstacles, and flaws. Quality was assessed using MMAT.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003e53 studies met inclusion criteria. In Greater Accra markets, ultra-processed foods (UPFs) make up 85% of shelf space and outnumber unprocessed products 5:1. Increased consumption, especially among urban and migrant populations, is associated with a dose-dependent risk of type 2 diabetes (RR 1.12\u0026ndash;1.31), obesity, cardiovascular disease, and renal issues. The mechanisms are intestinal dysbiosis, endotoxemia, oxidative stress, and signaling pathway impairment. Cost, promotion, cultural misconceptions, food scarcity, and policy execution are obstacles. In longitudinal and intervention research, significant gaps remain. NOVA-based policies, taxation, and multi-sectoral activities must be implemented immediately.\u003c/p\u003e","manuscriptTitle":"Impact of ultra-processed food on type 2 diabetes incidence and related chronic diseases in Ghana and West Africa - A scoping review.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-08 08:11:44","doi":"10.21203/rs.3.rs-9634039/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"81a315ae-85d9-4066-a831-9a2699e1ef61","owner":[],"postedDate":"May 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":67661483,"name":"Food Science \u0026 Technology"},{"id":67661484,"name":"General Cell Biology \u0026 Physiology"},{"id":67661485,"name":"Immunology"},{"id":67661486,"name":"Cellular Metabolism"},{"id":67661487,"name":"Biotechnology and Bioengineering"},{"id":67661488,"name":"Internal Medicine"},{"id":67661489,"name":"Nutrition \u0026 Dietetics"},{"id":67661490,"name":"General Practice"},{"id":67661491,"name":"Epidemiology"},{"id":67661492,"name":"Preventive Medicine"}],"tags":[],"updatedAt":"2026-05-08T08:11:45+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-08 08:11:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9634039","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9634039","identity":"rs-9634039","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}