Summary:
Diet quality plays an important role in cardiovascular health, and diets rich in whole foods such as fruits, vegetables, whole grains, and legumes are associated with lower risk of cardiovascular disease, while diets high in processed meats, refined grains, added sugars, and saturated fats are linked to poorer cardiometabolic outcomes. Despite this, a large proportion of energy intake in the United States comes from ultra-processed foods (UPFs). These foods may influence health through several pathways, including increased energy intake, changes to the gut microbiome, disrupted appetite regulation, and metabolic effects that contribute to conditions such as obesity, insulin resistance, and high blood pressure. This study is a prospective cohort study that examined the relationship between UPF consumption and risk of atherosclerotic cardiovascular disease (ASCVD) in a large sample of over 6,800 US adults aged 45-84 years without existing cardiovascular disease. Participants were followed over time to identify cardiovascular events such as heart attack, stroke, and cardiovascular-related death. The findings showed that higher UPF intake was associated with an increased risk of developing ASCVD. Each additional daily serving of UPF was linked to an increase in risk, while those with the highest intake had substantially greater risk. The association was stronger among Black participants compared to non-Black participants, indicating potential differences across population groups. Overall, the results suggest that greater consumption of ultra-processed foods is associated with higher risk of cardiovascular disease. The strength of this relationship may vary across different demographic groups, highlighting the need to consider social and environmental factors when examining diet and health.
Abstract:
Background: Ultraprocessed foods (UPFs) have been linked to adverse cardiometabolic outcomes and increased atherosclerotic cardiovascular disease (CVD) (ASCVD) risk. However, prior research has largely focused on homogenous populations, lacking racial and ethnic diversity. Objectives: The objectives are to examine the longitudinal relationship between UPF consumption and ASCVD risk and to investigate whether these associations differ by race/ethnicity, sex, or socioeconomic status. Methods: The MESA (Multiethnic Study of Atherosclerosis) is a prospective cohort study of 6,814 U.S. adults aged 45 to 84 years, without clinically apparent CVD. UPF consumption was classified according to the Nova classification system. Multivariable cox proportional hazards models were used to evaluate the association between UPF intake and incident CVD events. Incident CVD events included nonfatal myocardial infarction, resuscitated cardiac arrest, death resulting from coronary heart disease, stroke (not transient ischemic attack), and death resulting from stroke. Results: Each additional daily serving of UPF was associated with a 5.1% increased risk of ASCVD events (HR: 1.051; 95% CI: 1.011-1.093). Participants in the highest quintile of UPF consumption had a 66.8% higher risk compared to those in the lowest (HR: 1.668; 95% CI: 1.196-2.325). A significant multiplicative interaction was observed between UPF intake and Black race (P = 0.010), with stratified analyses demonstrating a higher ASCVD risk in Black Americans (HR: 1.061; 95% CI: 1.016-1.108), compared to non-Black Americans (HR: 1.032; 95% CI: 1.001-1.065). Conclusions: In a large, multiethnic cohort, higher UPF consumption was significantly associated with an increased risk for ASCVD events, with a more pronounced association among Black Americans.
Article Publication Date: 17/03/2026
DOI: 10.1016/j.jacadv.2025.102516
