Ultra-Processed Foods Linked to Heart Disease Risk, Study Shows

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Key Takeaways:

  • Ultra-processed foods provide 58% of total energy in the average American diet, and tend to be high in sugar, fat and sodium.
  • A new study investigated the association between a high intake of ultra-processed foods and the risk of cardiovascular disease.
  • The researchers found that a higher consumption of ultra-processed foods is associated with an increased risk of cardiovascular disease incidence and mortality. 

Many studies have linked heart disease prevention with lifestyle factors, such as diet. Since food intake is considered a modifiable risk factor, there’s lots of interest in the scientific community to see how eating patterns may affect heart health.

For cardiovascular health, studies support an eating plan that includes mostly whole or minimally processed foods, and a reduced intake of ultra-processed foods.

A recent study published in the Journal of the American College of Cardiology took a closer look at the associations between ultra-processed foods, cardiovascular disease (CVD) incidence, and mortality. They discovered that higher consumption of ultra-processed foods is linked to increased risk of cardiovascular disease and mortality.

Understanding Ultra-Processed Foods

It’s an important area to study since ultra-processed foods provide almost 58 percent of calories in the average American diet.

Ultra-processed foods are convenient, highly palatable products that include added sugar, fat, salt, preservatives, stabilizers, color, flavor enhancers and other additives. They are often made through a series of processes, such as hydrogenation, extrusion and frying, to get to the shelf-ready product. Examples are fast food, candy, soda, baked goods, chicken nuggets and hotdogs.  

In a past systematic review of 20 studies, researchers noted that a high intake of ultra-processed foods was linked to an increased risk of all-cause mortality, CVD, high blood pressure, depression and certain types of cancer.

The current study takes a closer look at the association between ultra-processed foods and CVD incidence and mortality.

The researchers used the data from the prospective Framingham Offspring Cohort. This study pulled dietary information on 3,003 Caucasian adults without CVD. The Framingham data includes a food frequency questionnaire, which asks participants how often they eat a range of different foods. It also collects data on sociodemographic and lifestyle factors.

Food data was divided into categories based on level of processing, and foods were classified as one of these categories:

  1. Whole or minimally processed foods, such as fruits, vegetables, fish, grains and beans
  2. Processed culinary ingredients, such as sugar, oil, salt, herbs and spices
  3. Processed foods, such as canned fish, bread and cheese
  4. Ultra-processed foods, such as candy, soda, fast food, pizza and chicken nuggets
  5. Culinary preparations - mixed dishes that are likely homemade

Upon analysis, the researchers adjusted for age, sex, education, alcohol consumption, smoking, and physical activity, so they could focus specifically on diet and heart health. 

What did the study find?

During the follow-up of 18 years, the researchers noted a total of 648 incident cardiovascular disease events, including 251 cases of hard CVD and 163 cases of hard coronary heart disease. “Hard” refers to serious outcomes such as a heart attack or stroke, rather than something milder like chest pains.

They noted that participants consumed an average of 7.5 servings of ultra-processed foods daily and that each daily serving was associated with:

  • 7% increase in the risk of hard CVD
  • 9% increase in hard CHD
  • 5% increase in overall CVD
  • 9% increased in CVD mortality

“We found that higher intakes of ultra-processed foods were associated with increased risk of incident cardiovascular disease and coronary heart disease, as well as cardiovascular disease mortality,” say two of the study’s researchers, Niyati Parekh, Associate Professor of Nutrition and Public Health, and Filippa Juul, Postdoctoral Fellow, at the School of Global Public Health at New York University.

Niyati Parekh, PhD

Given what we know now, we recommend limiting the intake of ultra-processed foods and eating a diet based on nutritious minimally processed whole foods.

— Niyati Parekh, PhD

“While more research is needed to confirm these findings in other populations, our results add to a growing body of evidence suggesting that it is beneficial for our health to limit ultra-processed foods,” say Parekh and Juul.

This study is observational and shows an interesting association, but cannot prove cause and effect. 

Why are ultra-processed foods problematic?

This study aligns with past research that supports eating patterns that emphasize whole foods over ultra-processed foods for overall health.

“Given what we know now, we recommend limiting the intake of ultra-processed foods and eating a diet based on nutritious minimally processed whole foods,” say Parekh and Juul.

They explain that exact mechanisms underlying why ultra-processed foods may increase the risk of CVD are not fully known, but that there are multiple factors that may contribute to CVD.

“First of all, ultra-processed foods tend to be high in added sugar, sodium and fat, while low in protein, fiber and micronutrients,” say Parekh and Juul. “Processing also induces significant changes to the food matrix, for which ultra-processed foods may affect health outcomes differently than unrefined whole foods with similar nutritional composition.”

They say that ultra-processed foods may also affect satiety (feeling full), glycemic response and the gut microbiota composition and function. Plus, if people fill up on ultra-processed foods, they may consumer fewer cardio-protective foods, such as vegetables, nuts, fish and legumes.

Michelle Routhenstein is a cardiology dietitian and the owner of Entirely Nourished in New York City. She explains that ultra-processed foods can cause the accumulation of negative by-products, such as nitrates, BPA and acrylamide, which increase underlying inflammation and oxidative stress, two of the root causes of heart disease.

“There isn’t a safe guideline of how much ultra-processed foods to eat, but it should be reduced as much as realistically possible,” says Routhenstein, who adds that ultra-processed foods have a negative impact on cardiovascular risk factors such as high blood pressure, high cholesterol, high blood sugar levels, body mass index, and metabolic syndrome.

Better Dietary Patterns

Previous studies have shown that plant-based diets are beneficial for cardiovascular health. A plant-based diet means that the bulk of food choices come from vegetables, fruit, grains, beans, nuts and seeds. But a plant-based diet doesn’t need to be vegan; it can include small amounts animal-based foods, such as poultry, fish and dairy.

The optimal plant-based plan is based on whole foods, but limits ultra-processed foods. That means it is more nourishing to eat a whole apple and whole grain wheat berries rather than eat apple pie made with refined white flour, even though all of those ingredients start out as plants.

The ideal plant-based diet is one that is adapted to the foods that are available in one’s region, and fits within an individual’s culture, traditions and preferences.

Michelle Routhenstein RD CDE CDN

There isn’t a safe guideline of how much ultra-processed foods to eat, but it should be reduced as much as realistically possible.

— Michelle Routhenstein RD CDE CDN

Routhenstein’s focus with her clients is on eating whole plant-based foods that provide the nutrients that the body needs for optimal heart health, which helps reduce cholesterol build up and keep arteries unclogged to prevent a heart attack.

“We discuss decreasing foods that will clog the arteries and add extra pressure on their heart, this includes foods high in saturated fat, trans fat, sodium, and advanced glycation end products,” says Routhenstein. 

What’s next?

One research limitation is that the study participants were primarily Caucasian Americans. Parekh and Juul say they need additional prospective observational studies in diverse populations and settings to confirm the current findings. 

“We also need experimental studies to determine the biological mechanisms by which ultra-processed foods may influence cardiovascular health,” say Parekh and Juul. So, there’s definitely more to come. 

What This Means For You

To prevent heart disease, aim to eat more whole foods while reducing your intake of ultra-processed foods.

8 Sources
Verywell Fit uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Cara Rosenbloom, RD
 Cara Rosenbloom RD is a dietitian, journalist, book author, and the founder of Words to Eat By, a nutrition communications company in Toronto, ON.