European cardiologists are urging doctors to treat the consumption of ultra-processed foods as a new cardiovascular risk factor, citing growing evidence linking UPF to obesity, diabetes, kidney disease and poor heart health.
Research: Ultra-processed foods, lifestyle management, and cardiovascular disease: Clinical consensus statement of the European Society of Cardiology’s Cardiology Practice Council and the European Society of Cardiology’s European Society of Preventive Cardiology. Image credit: Rimma Bondarenko/Shutterstock.com
recent european heart journal The Clinical Consensus Statement presented a clinical consensus developed by the European Society of Cardiology (ESC) to raise awareness of the cardiovascular risks associated with UPF and provide practical guidance for addressing UPF intake in routine cardiac care. This statement emphasizes that much of the current evidence linking UPF and cardiovascular disease is observational and that associations with clinical cardiovascular outcomes should be interpreted with caution.
Changes in dietary patterns and their impact on cardiovascular health
Diet quality and quantity are important determinants of cardiovascular (CV) disease. Low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B-containing lipoproteins cause immune-mediated inflammation and atherosclerosis. Traditional dietary guidelines focus on reducing fats from animal sources and increasing intake of fruits, vegetables, and unsaturated fats.
UPF is a food formulation produced primarily from low-cost sources and additives through extensive industrial processing. The result is a decrease in nutritional value and the presence of cosmetic additives and neoformed compounds that can have a negative impact on health.
The transition from traditional diets to higher UPF intake increases health risks in the general population, especially cardiovascular diseases. Despite growing epidemiological evidence linking UPF intake to poor CV health, this issue remains under-recognized in public health and cardiology.
National dietary guidelines prioritize nutrient and food-based recommendations, often overlooking food processing. As a result, UPF is largely ignored in clinical practice, despite the central role of diet in the prevention and management of cardiovascular disease.
Reframing CV risk: consensus on ultra-processed foods
In response to the limitations of current clinical guidelines, Europe’s leading cardiology and preventive health associations have published a consensus statement identifying food processing and UPF as important new risk factors for cardiovascular disease. The document points out that, rather than being proven as a direct cause of cardiovascular disease, UPF is best understood as contributing to intermediate cardiometabolic risk factors such as obesity, hypertension, dyslipidemia, and insulin resistance, which may in turn increase cardiovascular risk. Important aspects of this statement are discussed below.
UPF classification system, food quality, and public health concerns
A key focus of the consensus is the definition and classification of UPF, particularly through systems like Nova that classify foods not only by nutrient content but also by degree and purpose of industrial processing. This distinction is important. This is because, even after accounting for nutrient profile, high UPF intake is associated with increased risk of chronic disease, indicating that additives and processing-related factors also contribute to health effects. UPF tends to be high in unhealthy fats, sugars, and salts and low in beneficial nutrients, but its effects extend beyond just nutrition.
This consensus emphasizes that both nutrient composition and processing level need to be considered when assessing food quality. This is because some minimally processed foods can still be unhealthy, and some UPFs can appear healthy based on nutrient scores alone.
The statement also emphasizes that food processing and nutritional profile should be viewed as complementary aspects of food quality, rather than treating all minimally processed foods as healthy or all UPF as nutritionally bad. UPF intake is increasing globally, particularly among young people in urban areas such as the Netherlands, Germany and the UK, and consumption patterns often reflect broader structural and socio-economic influences such as marketing, cost and food availability.
Mechanistic pathways linking UPF and CV risk
UPF CV health can be adversely affected through both nutritional and processing-related mechanisms. Diets high in UPF typically increase intake of added sugars, trans fats, and saturated fats, which contribute to atherosclerosis, endothelial dysfunction, and type 2 diabetes, while decreasing intake of cardioprotective nutrients found in minimally processed foods.
In addition to a poor nutrient profile, UPF can negatively impact health through non-nutrient pathways. Industrial processing produces harmful compounds such as advanced glycation end products, acrylamide, and trans fatty acids, and can introduce packaging contaminants such as bisphenols, phthalates, mineral oils, and microplastics into foods. these substances It has been proposed that it may contribute to increased cardiometabolic and cardiovascular risk.
UPF also contains cosmetic additives such as sweeteners, emulsifiers, thickeners, and colorants, which experimental and limited human studies have shown can alter the gut microbiome, affect inflammatory pathways, and cause markers of DNA damage. Structural changes in the UPF can affect satiety, feeding behavior, glycemic response, and nutrient bioavailability, leading to overeating, while aggressive marketing and packaging further promote overconsumption.
Health risks associated with consuming ultra-processed foods
Below are the main cardiometabolic and chronic diseases associated with UPF intake and the central mechanisms thought to underlie these associations.
- Obesity: UPF is strongly associated with increased risk of overweight and obesity, primarily due to high energy density, decreased satiety, and disrupted gut and brain signaling.
- T2D: Increased intake of UPF increases the risk of T2D and prediabetes caused by added sugars, low fiber, and additives that affect glucose metabolism.
- High blood pressure: UPF is associated with increased blood pressure, which is likely caused by excess sodium, sugar, and unhealthy fats, as well as inflammation and effects on your gut flora. However, the paper describes the evidence as moderate and based on a limited number of studies.
- Dyslipidemia: UPF contributes to an abnormal lipid profile, including high triglycerides and LDL-C, and low HDL-C, primarily through trans and saturated fats. The consensus points out that current evidence is based on only a small number of prospective studies.
- Metabolic syndrome: Evidence linking UPF and metabolic syndrome remains limited and inconclusive, and may be due to nutritional deficiencies, additives, and changes in blood sugar and satiety regulation.
- Nonalcoholic fatty liver disease (NAFLD): UPF is consistently associated with nonalcoholic fatty liver disease because high fructose, saturated fat, and additives promote liver fat and metabolic dysfunction.
- Chronic kidney disease: In prospective cohort studies, increased UPF intake is consistently associated with increased CKD risk, likely due to inflammation, oxidative stress, altered lipid metabolism, and impaired intestinal barrier function.
Strategies and policies to reduce UPF intake
Policy measures such as education, labeling, and regulation can help create a healthier food environment, but clinicians should focus on practical UPF counseling during daily practice. Cardiologists should assess their patients’ UPF intake and provide clear, targeted advice, especially for patients at risk for cardiovascular and metabolic disease.
Effective counseling includes simple screening, communicating risks, suggesting simple alternatives, such as water instead of sugary drinks, and making recommendations tailored to individual needs. Encouraging habits like reading nutrition labels, cooking at home, planning meals, and using behavioral strategies can support lasting change. Counseling should be brief and supplemented with a referral to a dietitian if necessary.
Future direction
Future research should focus on large-scale, long-term studies in diverse populations to clarify the causal relationship between UPF intake and CV health outcomes. These studies are critical for shaping public health recommendations and clinical guidelines. In parallel, more mechanistic studies are needed to investigate how UPF influences CV disease, including food selection, composition, and effects on physiological processes such as digestion and the gut microbiome.
It is also important to examine the social and environmental factors that drive UPF consumption, including cost, marketing, labeling, packaging, and access to cooking facilities. These effects often drive increased UPF intake, especially in disadvantaged communities. Addressing these broad determinants is essential to developing effective dietary interventions and supporting health equity.
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