Ultra-Processed Foods and Incident Cardiovascular Disease

Quick Takes

  • Ultra-processed foods have been known to be associated with risk of CVD, cancer, and the obesity epidemic.
  • The fast-food, beverage, and food industries have made progress in reducing the unhealthy ingredients but continue to advertise the unhealthy.
  • Increasing the national and local community investment in health literacy with an emphasis on nutrition could be very cost-effective from the public perspective but have a negative impact on the economy and compete with many other priorities.

Study Questions:

What is the association between ultra-processed foods and cardiovascular disease (CVD) incidence and mortality in the prospective Framingham Offspring Cohort?


The analytical sample included 3,003 adults free from CVD with valid dietary data at baseline. Data on diet, measured by food frequency questionnaire, anthropometric measures, and sociodemographic and lifestyle factors, were collected quadrennially from 1991 to 2008. Data regarding CVD incidence and mortality were available until 2014 and 2017, respectively. Ultra-processed foods were defined as industrial formulations made with no or minimal whole foods and produced with additives such as flavorings and preservatives. The authors used Cox proportional hazards models to determine the multivariable association between ultra-processed food intake (energy-adjusted servings per day) and incident hard CVD, hard coronary heart disease (CHD), overall CVD, and CVD mortality. Multivariable models were adjusted for age, sex, education, alcohol consumption, smoking, and physical activity.


During follow-up (1991 to 2014/2017), the authors identified 251, 163, and 648 cases of incident hard CVD, hard CHD, and overall CVD, respectively. On average, participants consumed 7.5 servings per day of ultra-processed foods at baseline. Each additional daily serving of ultra-processed foods was associated with a 7% (95% confidence interval [CI], 1.03-1.12), 9% (95% CI, 1.04-1.15), 5% (95% CI, 1.02-1.08), and 9% (95% CI, 1.02-1.16) increase in the risk of hard CVD, hard CHD, overall CVD, and CVD mortality, respectively.


The current findings support that higher consumption of ultra-processed foods is associated with increased risk of CVD incidence and mortality. Although additional research in ethnically diverse populations is warranted, these findings suggest CV benefits of limiting ultra-processed foods.


This is an important long-term prospective study that adds to population observational studies that have shown a correlation of ultra-processed foods with atherosclerotic CVD and risk factors, cancer, obesity, and the metabolic syndrome. Ultra-processed foods are favorites of all US generations, particularly when watching sporting events. Examples include frozen meals, soft drinks, hot dogs and cold cuts, fast food, packaged cookies, cakes, and salty snacks. Dr. Eric Brandt (JAMA Cardiol 2017;2:627-34) reported an additional 6.2% decline in hospital admissions for myocardial infarction and stroke among populations living in New York counties with versus without trans-fatty acid restrictions in all eateries and bakeries. The decline in events reached statistical significance 3 years after restrictions were implemented.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Diet

Keywords: Cardiovascular Diseases, Coronary Disease, Diet, Eating, Fast Foods, Life Style, Meals, Metabolic Syndrome, Neoplasms, Obesity, Primary Prevention, Risk Factors, Snacks, Trans Fatty Acids

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