Ultra-processed foods account for 58% of total energy in the average U.S. diet, but diet is a modifiable risk factor in the prevention of cardiovascular disease. A study published March 22 in the Journal of the American College of Cardiology found that higher consumption of ultra-processed foods may be associated with an increased risk of cardiovascular disease incidence and mortality, with each additional daily serving found to further increase risk.

Filippa Juul, MS, PhD, et al., used data from the Framingham Offspring Study to examine the role ultra-processed foods play in cardiovascular disease. The study included 3,003 middle-aged adults (on average 53.5 years). Over half of participants were female, 33.1% had undergone 16 years or more of education and two-thirds were either former or current smokers. Study participants were primarily Caucasian. Overall, 5.8% had diabetes and 19% had high blood pressure; prevalence was higher among participants who were high consumers of ultra-processed foods compared to low consumers.

Diet was assessed by mail using a food questionnaire where participants reported the frequency of consumption of certain foods in the previous year, with options ranging from <1 serving/months to ≥6 servings/day. Using a modified version of the NOVA framework, researchers classified food questionnaire food items into five categories: unprocessed or minimally processed foods; processed culinary ingredients; processed foods; ultra-processed foods; and culinary preparations.

Results showed that during an average of 18 years of follow-up, a total of 648 cardiovascular events occurred, including 251 cases of hard cardiovascular disease and 163 cases of hard coronary heart disease (CHD). There were 713 deaths during the follow-up period, including 108 cardiovascular disease deaths. Participants with the highest intakes of ultra-processed foods – including industrial formulations made with no or minimal whole foods and produced with additives such as flavorings or preservatives – had higher incident rates compared to those consuming the least amount of ultra-processed foods.

Each daily serving of ultra-processed food was associated with a 7% increase in the risk of hard cardiovascular disease, a 9% increase in the risk of hard CHD, a 5% increase in overall cardiovascular disease and a 9% increased risk in cardiovascular disease mortality. Researchers also found that intake of bread was associated with an increased risk of hard cardiovascular disease, hard CHD and overall mortality, while ultra-processed meat intake was associated with an increased risk of hard cardiovascular disease and overall cardiovascular disease. Salty snack foods were associated with increased risk of hard cardiovascular disease and CHD, while consumption of low-calorie soft drinks were associated with increased risk of overall cardiovascular disease.

"Population-wide strategies such as taxation on sugar-sweetened beverages and other ultra-processed foods and recommendations regarding processing levels in national dietary guidelines are needed to reduce the intake of ultra-processed foods," said Juul. "Of course, we must also implement policies that increase the availability, accessibility and affordability of nutritious, minimally processed foods, especially in disadvantaged populations. At the clinical level, there is a need for increased commitment to individualized nutrition counseling for adopting sustainable heart-healthy diets."

In an accompanying editorial, Robert J. Ostfeld, MD, MSc, FACC, and Kathleen E. Allen, MS, RD, write, "Recognizing that multiple factors feed into individual food choice, where do we go from here? Ultimately, the goal should be to make the unhealthy choice the hard choice and the healthy choice the easy choice."

Clinical Topics: Prevention, Diet, Hypertension

Keywords: Diet, Vulnerable Populations, Diabetes Mellitus, Hypertension

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