Ultra processed foods and their association with cardiometabolic health, nutrition security, health equity, and sustainability: evidence, gaps, and opportunities

Authors: VADIVELOO, MAYA - University Of Rhode Island; GARDENER, CHRISTOPHER - Stanford University; BLEICH, SARA - Harvard University; KHANDPUR, NEHA - Wageningen University And Research Center; LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; OTTEN, JENNIFER - Johns Hopkins University; REBHOLZ, CASEY - University Of Washington; SINGLETON, CHELSEA - Tulane University; VOS, MIRIAM - Emory University; WANG, SELINA - University Of California

Submitted to: Circulation
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/11/2025
Publication Date: N/A
Citation: N/A

Interpretive Summary: Ultra-processed foods and beverages, informally defined as multi-ingredient formulations containing cosmetic additives or foods substances that have undergone industrial processing, have been positively related to adverse health outcomes, particularly cardiometabolic health. A review of the literature indicates that in addition to the latter relationship, ultra-processing has also been associated with reduced food cost and enhanced stability, convenience and palatability. Delayed food spoilage has positive environment impacts. While the mechanisms relating ultra-processed foods to cardiometabolic health are incompletely understood, the weight of the evidence supports food policy and dietary guidance that leads to a decrease in ultra-processed food intake while avoiding unintended consequences. Currently, there is substantial inconsistency in the categorization of ultra-processed food. This inconsistency hampers formulating public health messaging to encourage a shift in dietary patterns towards those that support cardiometabolic health. This statement was written to encourage the nutrition community to continue discussing definitions of ultra-processed foods and using those definitions to formulate clear public health messages.

Technical Abstract: Ultra-processed foods and beverages (UPFs) are a growing public health concern. As defined by Nova, UPFs are multi-ingredient formulations containing cosmetic additives or foods substances of no culinary use (i.e., used only in industrial production) that have undergone industrial processing. Ultra-processing may reduce food cost and enhance stability, convenience, and palatability, yet evidence consistently demonstrates that dietary patterns high in UPFs are associated with adverse health outcomes. While the mechanisms relating UPFs with elevated cardiometabolic and chronic diseases risk are incompletely understood, there is sufficient evidence to support food policy and dietary guidance that addresses the adverse effects of high UPF intake and remains cognizant of the need to avoid unintended consequences. Efforts are needed to identify UPF subgroups most likely to impact cardiometabolic risk while balancing the need for a food supply that is affordable, safe, convenient, and palatable. There is substantial overlap between foods categorized as UPFs and those recommended to limit for cardiometabolic risk reduction, including those that contribute to excess intake of saturated fats, added sugars, and sodium (HFSS). Elucidating mechanisms by which UPFs influence cardiometabolic health, advancing dietary guidance to substantially reduce UPF subgroups with poor nutritional profiles, and clarifying the health effects of UPF subgroups with better nutritional profiles should be prioritized. This Scientific Statement summarizes what is known and identifies research priorities to advance evolving dietary guidance regarding UPFs. Such guidance will contribute to shifting the food landscape to dietary patterns more closely aligned with American Heart Association dietary guidance.