Association Between Food-Delivery Application Use and Consumption of Ultra-Processed Foods Among University Students: A Systematic Evidence Synthesis

Abstract

Background: Online food-delivery applications (OFDAs) have altered the food environment by allowing immediate access to large numbers of restaurant and takeaway options. University students may be particularly susceptible because food choice during this life stage is influenced by time constraints, convenience, affordability and increasing independence. Many foods prominently available through OFDAs are energy-dense and nutritionally poor; however, “unhealthy” or “discretionary” food classifications should not automatically be considered equivalent to NOVA-defined ultra-processed foods (UPFs).
Objective: To synthesize high-quality evidence available through 2021 concerning OFDA use, the nutritional characteristics of online food environments, food choices among university students, and the plausibility that frequent OFDA use contributes to greater UPF exposure.
Methods: A structured systematic evidence synthesis was conducted using peer-reviewed literature published no later than 31 December 2021. References were restricted to Q1 journals in nutrition, public health, food behavior and related disciplines. Direct university-student OFDA studies were prioritized and triangulated with platform-menu analyses, population OFDA studies and established UPF literature. Because eligible studies did not consistently classify ordered foods according to NOVA, a pooled effect estimate for OFDA use and UPF intake was not calculated.
Results: Direct student evidence showed that 77.6% of 290 Malaysian public-university students reported ordering more unhealthy than healthy foods through OFDAs. Price and convenience were the strongest reported choice motives, while 76.9% perceived healthy-food availability negatively. Platform studies showed similarly unhealthy digital environments: 85.9% of popular menu items from major Australian/New Zealand delivery outlets and 80.5% of 13,841 menu items from independent Australian takeaway outlets were classified as discretionary. Population studies demonstrated that OFDA use was concentrated among younger adults and increased with greater online food-outlet accessibility. Independent UPF evidence established that higher UPF intake is associated with poorer dietary quality and that experimentally provided ultra-processed diets can increase ad libitum energy intake.
Conclusion: Evidence available through 2021 supports a plausible relationship between frequent OFDA use and dietary patterns conducive to greater UPF consumption among university students, but direct NOVA-based evidence remained insufficient to establish a quantitative causal association. Future studies should combine objectively recorded OFDA orders with NOVA classification and prospective dietary assessment.