Urges for cardiologists to screen patients for UPF intake

European cardiologists are urging doctors to treat ultra-processed food consumption as an emerging cardiovascular risk factor, citing growing evidence linking UPFs to obesity, diabetes, kidney disease, and poorer heart health outcomes.

Study: Ultra-processed foods, lifestyle management, and cardiovascular diseases: A clinical consensus statement of the European Society of Cardiology Council for Cardiology Practice and the European Association of Preventive Cardiology of the European Society of Cardiology. Image credit: Rimma Bondarenko/Shutterstock.com

A recent European Heart Journal clinical consensus statement presented a clinical consensus developed by the European Society of Cardiology (ESC) to raise awareness of cardiovascular risks associated with UPFs and provide practical guidance for addressing UPF consumption in routine cardiology care. The statement emphasizes that much of the current evidence linking UPFs to cardiovascular disease is observational and that associations with clinical cardiovascular outcomes should be interpreted cautiously.

Shifting dietary patterns and their implications for cardiovascular health

Food quality and quantity are key determinants of cardiovascular (CV) disease. Low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B-containing lipoproteins drive immune-mediated inflammation and atherosclerosis. Traditional dietary guidelines focus on reducing animal-derived lipids and promoting fruits, vegetables, and unsaturated fats.

UPFs are food formulations produced via extensive industrial processing, primarily from low-cost sources and additives. This results in poor nutritional value and the presence of cosmetic additives and neo-formed compounds with potential adverse health effects.

The shift from traditional diets to higher UPF intake increases health risks for the general population, particularly cardiovascular disease. Despite growing epidemiological evidence linking UPF consumption to poor CV health, this issue remains underrecognized in public health and cardiology.

National dietary guidelines prioritize nutrient- and food-based recommendations, often overlooking food processing. Consequently, UPFs are largely neglected in clinical practice, despite the central role of diet in CV prevention and management.

Reframing CV risk: The consensus on ultra-processed foods

In response to limitations in current clinical guidelines, leading European cardiology and preventive health associations have released a consensus statement identifying food processing and UPFs as important, emerging risk factors for CV disease. The document notes that UPFs are best understood as contributing to intermediate cardiometabolic risk factors, such as obesity, hypertension, dyslipidemia, and insulin resistance, which may in turn increase cardiovascular risk, rather than as proven direct causes of cardiovascular disease. The key aspects of the statement are discussed below:

UPF classification systems, food quality, and public health concerns

A key focus of the consensus is the definition and classification of UPFs, particularly through systems like Nova, which sorts foods by the degree and purpose of industrial processing rather than just nutrient content. This distinction is important because high UPF consumption is linked to increased chronic disease risk, even after accounting for nutrient profiles, indicating that additives and processing-related factors also contribute to health impacts. While UPFs tend to be higher in unhealthy fats, sugars, and salt, and lower in beneficial nutrients, their effects extend beyond nutrition alone.

The consensus highlights that assessing food quality requires considering both nutrient composition and processing level, since some minimally processed foods may still be unhealthy, and some UPFs may appear healthy based on nutrient scores alone.

The statement also emphasizes that food processing and nutrient profile should be viewed as complementary dimensions of food quality, rather than treating all minimally processed foods as healthy or all UPFs as nutritionally poor. UPF intake has increased globally, especially among younger, urban populations in countries such as the Netherlands, Germany, and the UK, with consumption patterns often reflecting broader structural and socioeconomic influences, including marketing, cost, and food availability.

Mechanistic pathways linking UPFs to CV risk

UPFs may negatively affect CV health through both nutritional and processing-related mechanisms. Diets high in UPFs typically increase intake of added sugars, trans fats, and saturated fats, which contribute to atherosclerosis, endothelial dysfunction, and type 2 diabetes, while reducing intake of cardioprotective nutrients found in minimally processed foods.

In addition to poor nutrient profiles, UPFs may adversely affect health through non-nutrient pathways. Industrial processing generates harmful compounds such as advanced glycation end products, acrylamide, and trans fatty acids, and allows packaging contaminants like bisphenols, phthalates, mineral oils, and microplastics to enter foods. These substances have been proposed as possible contributors to increased cardiometabolic and cardiovascular risk.

UPFs also contain cosmetic additives, including sweeteners, emulsifiers, thickeners, and colorants, which can alter gut microbiota, affect inflammatory pathways, and cause markers of DNA damage, as shown in experimental and limited human studies. Structural changes in UPFs may influence satiety, eating behavior, glycemic responses, and nutrient bioavailability, leading to overeating, while aggressive marketing and packaging further drive excess consumption.

Health risks associated with ultra-processed food consumption

Below are the main cardiometabolic and chronic diseases associated with UPF intake, along with the core mechanisms thought to underlie these associations:

• Obesity: UPFs are strongly linked to a greater risk of overweight and obesity, mainly due to high energy density, low satiety, and disrupted gut–brain signaling.
• T2D: Higher UPF intake increases the risk of T2D and prediabetes, driven by added sugars, low fiber, and additives that affect glucose metabolism.
• Hypertension: UPFs are associated with elevated blood pressure, likely due to excess sodium, sugar, and unhealthy fats, as well as their effects on inflammation and the gut microbiota. However, the paper describes the evidence as moderate and based on a limited number of studies.
• Dyslipidemia: UPFs contribute to abnormal lipid profiles, including high triglycerides and LDL-C, and low HDL-C, largely through trans and saturated fats. The consensus notes that current evidence is based on only a small number of prospective studies.
• Metabolic syndrome: Evidence linking UPFs to metabolic syndrome remains limited and inconclusive, potentially through poor nutrition, additives, and altered glucose and satiety regulation.
• Non-alcoholic fatty liver disease (NAFLD): UPFs are consistently associated with non-alcoholic fatty liver disease, as high fructose, saturated fats, and additives promote liver fat and metabolic dysfunction.
• Chronic kidney disease: Higher UPF intake was consistently associated with increased CKD risk in prospective cohort studies, likely through inflammation, oxidative stress, changes in lipid metabolism, and gut barrier impairment.

Strategies and policies to reduce UPF intake

Policy measures such as education, labeling, and regulation can help shape healthier food environments, but clinicians should focus on practical UPF counseling during routine care. Cardiologists should assess patients’ UPF intake and offer targeted, clear advice, especially for those at risk of CV or metabolic disease.

Effective counseling involves brief screening, communicating risks, suggesting simple substitutions, such as water for sugary drinks, and tailoring recommendations to individual needs. Encouraging habits such as reading nutrition labels, cooking at home, meal planning, and using behavioral strategies can support lasting change. Counseling should remain brief and, when needed, be supplemented with referrals to dietitians.

Future directions

Future research should focus on large, long-term studies across diverse populations to clarify the causal links between UPF consumption and CV health. These studies are crucial for shaping public health recommendations and clinical guidelines. In parallel, more mechanistic research is needed to explore how UPFs affect CV disease, including effects on food choice, composition, and physiological processes such as digestion and the gut microbiome.

It is also important to investigate the social and environmental factors that drive UPF consumption, such as cost, marketing, labeling, packaging, and access to cooking facilities. These influences often encourage higher UPF intake, particularly in disadvantaged communities. Addressing these broader determinants will be essential for developing effective dietary interventions and supporting health equity.

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