Ultraprocessed Food Intake Tied To Higher Cardiovascular and All-Cause Mortality


ultra processed food

Ultra-processed food Intake Tied To Higher Cardiovascular and All-Cause Mortality

“Ultraprocessed food (UPF) “intake was associated with higher cardiovascular and all-cause mortality rates for people with type 2 diabetes” (T2D), “regardless of the nutritional quality of the rest of their diet,” investigators concluded in findings were published online ahead of print in the American Journal of Clinical Nutrition. To reach this conclusion, researchers “conducted a prospective observational cohort study to evaluate the connections between UPF consumption and mortality among 1,065 participants with type 2 diabetes who completed a 188-item food frequency questionnaire.”


Background food

Nutritional strategies for prevention and management of type 2 diabetes traditionally emphasize dietary patterns reflecting nutrient goals, but the health implications of ultraprocessed food (UPF) for patients with type 2 diabetes remain unknown.


This study aimed to evaluate the association of UPF intake with all-cause and cardiovascular disease (CVD) mortality among participants with type 2 diabetes from the Moli-sani Study in Italy (enrollment 2005–2010).


This was a prospective observational cohort study on 1065 individuals with type 2 diabetes at baseline, followed up for 11.6 y (median). Food intake was assessed by a 188-item food-frequency questionnaire. UPF was defined following the Nova classification and calculated as the ratio (weight ratio; %) between UPF (g/d) and total food eaten (g/d). Overall diet quality was assessed through the Mediterranean Diet Score (MDS). Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality.

Results food ultraprocessed

The average UPF consumption was 7.4% (±5.0%). In multivariable-adjusted Cox analyses, greater UPF intake (Q4, ≥10.5% and ≥9% of total food eaten for females and males, respectively), as opposed to the lowest (Q1, UPF <4.7% and <3.7% for females and males, respectively), was associated with higher hazards of both all-cause (HR: 1.70; 95% CI: 1.25, 2.33) and CVD mortality (HR: 2.64; 95% CI: 1.59, 4.40); inclusion of the MDS into the model did not substantially alter the magnitude of these associations (HR: 1.64; 95% CI: 1.19, 2.25 and HR: 2.55; 95% CI: 1.53, 4.24 for all-cause and CVD mortality, respectively). A linear dose-response relationship of UPF intake with both all-cause and CVD mortality was also observed.


In participants with type 2 diabetes at study entry, higher UPF consumption was associated with reduced survival and higher CVD mortality rate, independent of diet quality. Besides prioritizing the adoption of a diet based on nutritional requirements, dietary guidelines for the management of type 2 diabetes should also recommend limiting UPF.

Ultra-processed foods, also referred to as ultra-processed food products (UPP), is a category of the NOVA food classification that has been proposed to categorise foods according to the degree of food processing.  Epidemiological data suggests that ultra-processed food intake can increase the risk of certain diseases, including obesitytype 2 diabetes and cancer. Some countries have introduced dietary recommendations and other measures to reduce ultra-processed food intake. Some studies consider ultra-processed foods to have higher environmental impacts than fresh foods.

The concept of ultra-processed foods is not universally accepted and is currently discussed among nutrition and public health scientists. Key criticisms are the ambiguity of the definition and the inclusion of foods in the category that are considered healthy under the nutrient profile system.

NOVA food classification

The NOVA (a name, not an acronym) food classification system that was initially developed by the Brazilian nutrition researcher Carlos Monteiro, with his team at the Center for Epidemiological Research in Nutrition and Health (NUPENS) at the University of São Paulo, Brazil. It is based on the assumption that food processing is more relevant for health than individual foods or nutrients. NOVA categorises foods into four categories:

  1. Unprocessed or minimally processed foods
  2. Processed culinary ingredients
  3. Processed foods
  4. Ultra processed food and drink products

Processing as such is essential, and virtually all food is processed in some way. The term ultra-processing refers to the processing of industrial ingredients derived from foods, for example by extruding, moulding, re-shaping, hydrogenation, and hydrolysis. Ultra-processed foods generally also include additives such as preservativessweeteners, sensory enhancers, colourants, flavours, and processing aids, but little or no whole food. Infant formula and medical food are also considered ultra-processed. However, food additives are not necessarily a marker of ultra-processed foods as the use of preservatives, for example antioxidant or nitrite, are permitted for category 3.

The definition is currently not used by the European Food Safety Authority or the Food and Drug Administration for regulatory purposes.


Ultra-processed foods are an important part of the portfolio of the food industry because they rely on low cost ingredients and often enjoy higher profit margins. They often have an extended shelf life, an important consideration for lower income consumers without reliable access to refrigeration. Among other reasons for the popularity of ultra-processed foods are the inexpensive cost of their main ingredients and aggressive marketing, especially toward youth consumers and particularly in middle income countries.undefined

Epidemiological data suggests that ultra-processed food intake can increase the risk of certain diseases, including obesitytype 2 diabetes and cancer and an approximately 20% higher risk of earlier death. A 2023 review found that high consumption of ultra-processed food is associated with increased risk of colorectal cancer.

Four Latin American countries—Brazil, Uruguay, Peru, and Ecuador—have so far published national official dietary guidelines that recommend avoiding ultra-processed foods. Chile has introduced a tax on ultra-processed foods.undefined



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