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The association between consumption of ultra-processed foods and sperm quality parameters: a cross-sectional study

BMC Research Notes volume 18, Article number: 48 (2025) Cite this article

Abstract

Background

While recent studies suggest a correlation between unhealthy dietary patterns, oxidative stress, inflammation, and male infertility, the potential association between ultra-processed foods (UPFs) and male infertility remains underexplored. Therefore, the aim of the present study was to investigate the association between UPF intake and male infertility by evaluating sperm quality parameters.

Methods

The participants (n = 260) of the current cross-sectional study were recruited from an infertility center in Isfahan Province, Iran. Four semen parameters—such as total sperm motility, sperm concentration, sperm volume, and normal sperm morphology—were evaluated. Also, the participants’ food intake was assessed using a validated 168-item food frequency questionnaire. Moreover, the NOVA system was employed to calculate the UPF index. The association between UPFs and sperm parameters was analyzed using logistic regression.

Results

In the crude model, no significant associations were observed between the second and last tertiles of UPFs with abnormalities in sperm concentration, total motility, and morphology (p > 0.05 for all). However, after adjusting for age, marriage duration, body mass index, physical activity, depression, anxiety, stress, energy intake, cigarette history, and mineral and vitamin supplements, a significantly higher association was identified between the second tertile of UPFs and abnormalities in sperm concentration (odds ratio (OR) = 3.962, 95% confidence interval (CI): 1.345–11.670, p = 0.013).

Conclusions

In conclusion, although the analysis did not find significant associations between UPF consumption and impaired sperm motility and morphology, it revealed significant trends linking higher UPF intake with lower sperm concentration. If future studies confirm these results, they could aid in designing interventional and preventive programs aimed at addressing infertility in men of reproductive age in the field of public health.

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Introduction

Infertility is defined as the inability of a couple to conceive after one year of regular unprotected sexual intercourse [1]. Globally, it is estimated that at least 180 million people struggle with infertility [2]. In addition, nearly 11% of the Iranian population experiences infertility at some point in their lives [3]. Accurately estimating the prevalence of male infertility is challenging, as many couples seek treatment at private outpatient clinics [4]. Testicular abnormalities, including semen defects, are responsible for 65–80% of all cases of male infertility [2]. Semen quality assessment, including sperm count, motility, and morphology, remains the most comprehensive and practical method for assessing male fertility [5]. Given the observed decline in semen quality across various countries, male infertility has emerged as a global health concern [5].

Oxidative stress refers to an imbalance between pro-oxidant status and the antioxidant defense system, resulting from excessive production of reactive oxygen species (ROS) [6]. Elevated ROS levels cause structural damage to sperm proteins, deoxyribonucleic acid (DNA), and fatty acids [7]. Evidence suggests that ROS-induced sperm damage contributes to 30–80% of male infertility cases [8]. Oxidative stress can significantly impact male fertility, leading to lower sperm count, reduced viability, impaired motility, and DNA damage [9, 10].

Ultra-processed foods (UPFs) are defined as ready-to-eat products, including carbonated drinks, high-sugar beverages, sweet snacks, and instant meals, which are often substituted for healthier dietary options [11]. While food processing extends the shelf life of products by inhibiting microbial activity, it can also lead to the formation of undesirable toxic byproducts and substantial nutrient loss [12].

Previous research has consistently demonstrated that UPF consumption is associated with increased oxidative stress, alterations in gut microbiota, and inflammation [13,14,15,16,17]. These effects are largely attributed to the high caloric content, saturated and trans fats, and high glycemic index of UPFs, coupled with their low dietary fiber content [13,14,15,16,17].

While recent studies suggest a correlation between unhealthy dietary patterns, oxidative stress, inflammation, and male infertility, the association between UPFs and male infertility remains underexplored. Limited evidence supports an inverse association between UPF consumption and sperm quality parameters, such as sperm count and motility [18, 19]. Therefore, the aim of the present study was to investigate the association between UPF intake and male infertility based on sperm quality parameters. Understanding this relationship may offer valuable recommendations for couples with reproductive challenges.

Methods

Study design

The participants in the current cross-sectional study were recruited from an infertility center in Isfahan Province, Iran. The study was conducted from July to August 2018. Participants’ ages ranged from 18 to 55 years, with a history of infertility in the last five years. Individuals with a medical history of genital disease, urinary infection, cancer, cardiovascular disease, renal disease, diabetes, cytotoxic drug use, and anticoagulant use were excluded from the present study [20, 21]. Additionally, individuals with incomplete information or a daily calorie intake of less than 800 or more than 4200 kcal/day were excluded from this study. The sample size was calculated based on the study by Chiu et al. [22], using sperm concentration with z = 1.96, d = 0.3, and s = 2.5. Finally, the data of 260 participants were included in the analysis. All participants provided an informed consent form. This study was ethically approved by the Isfahan University of Medical Sciences (IR.MUI.RESEARCH.REC.1397.232). Some details of this study have been previously published [23,24,25].

Sperm parameters

Semen samples were collected in sterile containers, and for analysis, samples were maintained in liquid form at 37 °C. The laboratory manual of the World Health Organization (WHO) was followed for the sample evaluation [26]. In addition, four semen parameters—total sperm motility, sperm concentration, sperm volume, and normal sperm morphology—were assessed [27].

Assessment of depression, anxiety, and stress

To assess depression, anxiety, and stress scales (DASS), a 21-item questionnaire (DASS-21) was used for all participants. The reliability of the questionnaire was confirmed by calculating the Cronbach’s alpha coefficient, which was 0.84. Comparable internal consistency coefficients have been reported in earlier studies [28]. Each item is rated on a four-point scale, ranging from 0 (not applicable to me at all) to 3 (applies to me very much or most of the time). Each of the three subscales consists of 7 questions, and the scores for depression, anxiety, and stress were calculated based on the responses to these questions.

Assessment of food intakes

Participants’ food intake was assessed using a validated 168-item food frequency questionnaire (FFQ) [29]. The average consumption over the last year was recorded based on frequency of use (daily, weekly, or monthly). Daily intake for each item was then calculated. The Nutritionist IV software for Windows (modified for Iranian foods) was used to assess micronutrient intakes.

UPFs

The NOVA system was used to calculate the UPF index. UPFs were categorized into dairy beverages, sweets, bread, non-dairy beverages, oil and sauce, processed meat and fast food, cakes and cookies, and others. Additionally, the items included processed meats, biscuits, cakes, candies, sweets, ice cream, salty snacks, sweetened beverages, buns, industrial fruit drinks, packaged bread, sauces, margarine, soft drinks, dressings, fries, and others. The energy received from the intake of each UPF item was calculated. Next, the proportion of each food item relative to total UPF intake was estimated (daily calorie intake of each UPF item divided by total energy intake, multiplied by 100) [30, 31].

Assessment of other variables

A checklist was used to collect additional demographic information, medical history, cigarette and alcohol use, and supplement intake. Weight was measured with an accuracy of 0.1 kg, and height and waist circumference (WC) were measured with an accuracy of 0.5 cm. Subsequently, body mass index (BMI) was calculated in kilograms per square meter. Physical activity level was assessed using the short form of the International Physical Activity Questionnaire (IPAQ) [32].

Statistical analysis

The Kolmogorov-Smirnov test was used to assess the normality of the data. To determine the relationship between continuous variables, the analysis of variance (ANOVA) test and the Kruskal-Wallis test were used. Additionally, the chi-square test was employed to assess the association between categorical variables. The correlation between UPFs and sperm parameters was assessed by the Pearson test. The association between UPFs and sperm parameters was evaluated using logistic regression. In the adjusted model, age (years), marriage duration (years), BMI (kg/m2), physical activity (MET.h/day), anxiety, depression, stress, energy intake (kcal/day), mineral and vitamin supplements (no/yes), and cigarette history (no/yes) were controlled. The statistical analyses were conducted using SPSS software (version 20.0, SPSS Inc, Chicago, IL, USA). A p-value < 0.05 was considered statistically significant.

Results

Baseline characteristics of the study population based on tertiles of UPFs are presented in Table 1. The mean age (p < 0.001), BMI (p = 0.027), and WC (p = 0.041) were significantly different across tertiles of UPFs. Additionally, the percentage of individuals with a cigarette history (p = 0.015) and the percentage of those taking vitamin and mineral supplements (p = 0.001) were significantly different between UPF tertiles. The intake of energy (p = 0.007), protein (p = 0.013), fat (p < 0.001), saturated fatty acids (SFAs) (p < 0.001), and UPFs (p < 0.001) was significantly higher in the highest tertile of UPFs, whereas the intake of processed foods was significantly lower in the highest tertile (p < 0.001).

Table 1 Baseline features of the study population based on tertiles of UPFs
Full size table

The correlation between UPFs and sperm parameters is shown in Figs. 1, 2 and 3. According to Fig. 1, a significant negative correlation was found between UPFs and sperm concentration (correlation coefficient: -0.133, p = 0.035, R2 linear: 0.018). However, as shown in Figs. 2 and 3, the correlations between UPFs and total motility and morphology were not significant (p ˃ 0.05).

Fig. 1
figure 1

Correlation between UPFs and sperm concentration

Full size image
Fig. 2
figure 2

Correlation between UPFs and total sperm motility

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Fig. 3
figure 3

Correlation between UPFs and sperm morphology

Full size image

The association between UPFs and sperm parameters is represented in Table 2. In the crude model, no significant associations were found between the second and highest tertiles of UPFs and abnormalities in sperm concentration, total motility, and morphology (p > 0.05 for all). However, after adjusting for age, marriage duration, BMI, physical activity, depression, anxiety, stress, energy intake, cigarette history, and mineral and vitamin supplements, a significantly stronger association was observed in the second tertile of UPFs with abnormalities in sperm concentration (odds ratio (OR) = 3.962, 95% confidence interval (CI): 1.345–11.670, p = 0.013).

Table 2 Association between UPFs and sperm parameters
Full size table

Discussion

To the best of our knowledge, this study is one of the few studies that assessed the association between UPF consumption and certain sperm parameters. The results of the current study, in the adjusted model, indicated that the second tertile of UPF consumption is associated with a higher risk of having low-concentration semen compared to the first tertile. However, no significant association was observed between the highest tertile of UPF consumption and the odds of low-concentration semen. Additionally, no significant association was found between UPF consumption and the risk of motility and morphological abnormalities.

Although previous studies support the notion that Western dietary patterns play a key role in male infertility [33,34,35], there is insufficient evidence linking UPF intake to male infertility so far. Previous studies align with the results of the current study, but from a different perspective. For instance, a cross-sectional study of 200 healthy men showed that a higher intake of UPFs is associated with lower sperm count, concentration, and motility [36]. Similarly, a case-control study involving 597 asthenozoospermia cases and 612 normozoospermic controls found that the highest tertile of UPF intake was directly correlated with asthenozoospermia, or reduced sperm motility [19]. However, other sperm quality parameters were not assessed in the previous study. Similarly, in another study involving 115 cases of male infertility, an indirect association was observed between sperm motility and the Artuklu Sperm Quality Index (ASQI), a novel index indicating adherence to an unhealthy dietary pattern [37]. Thus, generally, UPFs were reported to negatively impact overall semen quality across different parameters. In line with previous findings, a meta-analysis of observational studies concluded that adherence to a Western dietary pattern, emphasizing higher consumption of high-fat dairy products, processed meats, and lower intake of vegetables, whole grains, and fruit, is adversely correlated with sperm concentration. However, no significant association was observed between the Western dietary pattern and abnormal sperm motility and morphology [38]. Further studies are recommended to clarify the impact of UPFs on sperm parameters.

Some explanations could account for the non-significant association between UPF intake and motility or morphological deficits. UPFs encompass a wide variety of products with different nutritional profiles and additives [39]. The heterogeneity within UPF groups across different societies may influence their potential effects on sperm parameters [18, 39]. Furthermore, the biological mechanisms linking UPF consumption to sperm quality are complex and not fully understood [18, 39]. Factors such as oxidative stress, hormonal dysfunctions, and inflammation induced by UPF components may not equally affect all individuals, leading to variability in study outcomes [18, 39].

Recently, lifestyle changes and advancements in food processing technologies have led to increased demand for more affordable and readily available food products, such as highly processed foods [40]. Higher consumption of UPFs is associated with adverse health consequences, including an increased risk of metabolic and cardiovascular diseases, type 2 diabetes mellitus, cancers, mental disorders, and mortality [41]. The association between UPF intake and infertility is not well studied; however, several underlying mechanisms can be proposed. For instance, UPFs contain high amounts of sugar, salt, and fat, especially trans-fatty acids (TFAs) and SFAs, which can lead to weight gain and obesity due to the consumption of calorie-dense products [40, 42, 43].

Obesity may affect reproductive health through mechanisms such as insulin resistance, hyperleptinemia, elevated estrogen levels, psychological sexual dysfunction, and oxidative and inflammatory pathways. Consequently, impaired spermatogenesis and lower sperm quality parameters are increasingly prevalent in the obese population [44, 45]. The significantly higher levels of WC, BMI, energy, fat, and SFAs in the highest tertile of UPF intake compared to the lowest tertile in the present study may strengthen the proposed link between UPFs, obesity, and infertility. Consistently, previous studies have shown that higher intake of SFAs is negatively associated with lower sperm count or concentration [46, 47]. Thus, considering the direct association between SFAs and UPF intakes, as well as the significant trend of higher UPF intake and lower sperm concentration revealed in the present study, it seems that the effect of UPF consumption on male infertility might be explained through the plausible role of SFAs. Moreover, unhealthy dietary patterns, including higher intake of sugars, fats, and highly processed foods, are associated with increased ROS production in the sperm, reduced antioxidant capacity, and further male fertility issues. Therefore, oxidative stress exerts detrimental effects on sperm quality and quantity in various aspects [9]. Additionally, apart from the higher amounts of sugars, fats, calories, and SFAs, UPFs lack essential nutrients such as fiber, protein, vitamins A, C, D, E, B3, and B12, as well as minerals like zinc, phosphorus, magnesium, and potassium [48, 49]. The role of nutrients in sperm quality and quantity has been extensively studied. For example, zinc, selenium, and other antioxidant minerals and vitamins have been associated with improved fertility by suppressing inflammatory and oxidative pathways. Antioxidant micronutrients, in particular, can enhance sperm count, progressive motility, viability, and DNA fragmentation, and help maintain normal morphology [9]. Furthermore, the presence of zinc, copper, magnesium, and vitamins E and C in semen, along with the effect of fat-soluble vitamins on sperm quality [50, 51], suggests that reducing UPF intake could improve fertility in men. In addition to their poor nutrient density, UPFs contain cosmetic additives, packaging contaminants, hydrogenated oils, modified starches, and hydrolyzed proteins, all of which can negatively affect various aspects of human health, including reproductive health status [11, 18, 52, 53].

Limitations and strengths

The present study has several limitations. First, dietary intake assessment often relies on self-reported data, which can lead to recall bias. In this study, dietary intake was evaluated using a validated food frequency questionnaire, which, to some extent, depends on participants’ memory. Second, cross-sectional studies cannot fully establish causative associations between UPFs and infertility. In this regard, clinical trials may provide more definitive insights. Third, due to the nature of cross-sectional studies, the findings should not be generalized to other populations, as genetic variations, dietary habits, food industries, and environmental exposures can significantly impact reproductive health. Although UPF intake was assessed using a standardized measure (NOVA IV), the subgroups of UPFs, as well as occupational hazards and environmental factors, may also influence sperm parameters. Lastly, while oxidative stress may serve as a link between male infertility and UPFs, evaluating oxidative stress markers was not feasible in this study. It is worth noting that the current study is one of the few studies to evaluate the association between UPF consumption and male infertility, as measured by sperm parameters. Additionally, a validated 168-item FFQ was used to assess food intake, and UPF consumption was calculated based on the widely recognized grading system, NOVA IV. Moreover, the analyses were conducted while considering relevant confounders to eliminate potential effects. Additionally, evaluating dietary patterns or indices is more appropriate than measuring single nutrients when exploring the association between UPFs and male fertility.

Conclusions

In conclusion, although the analysis did not find significant associations between UPF consumption and impaired sperm motility and morphology, it revealed significant trends linking higher UPF intake with lower sperm concentration. The role of saturated fats and animal products in UPFs may partly explain this observed trend. Thus, to maintain male reproductive health, it is recommended that populations reduce their consumption of UPFs, particularly low-fat animal products with lower levels of SFAs. Future cohort studies and clinical trials should focus on identifying specific components of UPFs, especially dietary fatty acid profiles, while also considering environmental factors that impact sperm quality. Additionally, measuring oxidative stress biomarkers could help develop targeted dietary recommendations and improve fertility outcomes. If future studies confirm these results, they could aid in designing interventional and preventive programs aimed at addressing infertility in men of reproductive age in the field of public health.

Data availability

The datasets of the study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors express their gratitude to the participants for their kind cooperation.

Funding

No funding.

Author information

Authors and Affiliations

  1. Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Mitra Soltani

  2. Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

    Mohammad Reza Ahmadi

  3. Department of Nutrition and Biochemistry, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran

    Zainab Shateri

  4. Iranian Social Security Organization, Isfahan Province Health Administration, Isfahan, Iran

    Zahra Maghsoudi

  5. Student Research Committee, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

    Milad Rajabzadeh-Dehkordi, Moein Askarpour & Amir Hossein Asadi

  6. Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

    Mehran Nouri

  7. Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

    Mehran Nouri

Authors
  1. Mitra Soltani
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  2. Mohammad Reza Ahmadi
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  3. Zainab Shateri
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  4. Zahra Maghsoudi
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  5. Milad Rajabzadeh-Dehkordi
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  6. Moein Askarpour
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  7. Amir Hossein Asadi
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  8. Mehran Nouri
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Contributions

M.S., M.R.A., Z.S., Z.M., M.R. and A.H.A; Contributed to writing the first draft. M.N. and M.A.; Contributed to all data and statistical analysis and interpretation of data. M.N., Z.S. and M.A.; Contributed to the research concept, supervised the work, and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mehran Nouri.

Ethics declarations

Ethics approval and consent to participate

This study was conducted in accordance with the ethical standards of the Declaration of Helsinki and was approved by Isfahan University of Medical Sciences (IR.MUI.RESEARCH.REC.1397.232). All participants read and signed the informed consent form.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Soltani, M., Ahmadi, M.R., Shateri, Z. et al. The association between consumption of ultra-processed foods and sperm quality parameters: a cross-sectional study. BMC Res Notes 18, 48 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13104-025-07107-4

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13104-025-07107-4

Keywords

BMC Research Notes

ISSN: 1756-0500

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