Objective To quantify associations of the dietary share of ultra-processed foods (UPF) with the overall diet quality of First Nations peoples. Design A cross-sectional analysis of data from the First Nations Food, Nutrition and Environment Study, designed to contribute to knowledge gaps regarding the diet of First Nations peoples living on-reserve, south of the 60th parallel. A multistage sampling of communities was conducted. All foods from 24 h dietary recalls were categorized into NOVA

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... ries and analyses were performed to evaluate the impact of UPF on diet quality. Setting Western and Central Canada. Subjects First Nations participants aged 19 years or older. Results The sample consisted of 3700 participants. UPF contributed 53·9 % of energy. Compared with the non-UPF fraction of the diet, the UPF fraction had 3·5 times less vitamin A, 2·4 times less K, 2·2 times less protein, 2·3 times more free sugars and 1·8 times more Na. As the contribution of UPF to energy increased so did the overall intakes of energy, carbohydrate, free sugar, saturated fat, Na, Ca and vitamin C, and Na:K; while protein, fibre, K, Fe and vitamin A decreased. Diets of individuals who ate traditional First Nations food (e.g. wild plants and game animals) on the day of the recall were lower in UPF. Conclusions UPF were prevalent in First Nations diets. Efforts to curb UPF consumption and increase intake of traditional First Nations foods and other fresh or minimally processed foods would improve diet quality and health in First Nations peoples.