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Ultra-processed foods and cardiovascular mortality

by A. Manolova | 6 October 2021

nutrition, Ultra-processed, foods, cardiovascular, mortality, health, prevention, food

Cardiovascular disease is the most common cause of death in the United States and worldwide. These diseases are a group of disorders that affect the heart and vascular system, and include coronary artery disease (affecting the vessels that feed the heart), cerebrovascular disease (affecting the vessels that feed the brain), rheumatic disease, venous thrombosis and many others. In 2016, the number of deaths due to these diseases was 840,000 in the United States and 17.9 million worldwide, representing 31% of total global mortality. They are linked to genetics, aging and our behaviors: smoking, alcohol consumption, level of physical activity & dietary habits. Poor dietary habits are one of the major risk factors for cardiovascular disease. But fortunately, it is also an ideal target in their prevention because it is modifiable.

Today, in the United States alone, approximately 58% of daily calories are provided by ultra-processed foods such as sweet bars, cereals, cookies, cakes, chips, sweetened drinks, etc. They represent industrial formulations designed partially or totally from substances derived from additives and food. They are usually ready to eat, very cheap, very appetizing, very high in calories and they benefit from a strong marketing/packaging strategy. Their nutritional quality is very poor, and many studies now show that consumption of these products is associated with obesity, hypertension, dyslipidemia, cancer and hormonal disorders. Ultra-processed foods have often been associated with cardiovascular disease, but is there a preventive link with mortality from these diseases?

The Study

To study this link, Chinese researchers carried out a prospective analysis using data from the American Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial which began in the late 1990s and ended in 2015. The researchers analysed the data of 91,891 American adults (54-74 years old), and more specifically the link between the consumption of ultra-processed foods and mortality linked to cardiovascular disease.

All participants in the study completed a detailed 137-item questionnaire about their daily food intake. At the beginning of the study, none of the participants had suffered or were suffering from cardiovascular problems or cancer. In addition to this data, participants indicated their gender, ethnicity, height, body mass, education level, history of diabetes or hypertension and whether or not they were smokers.

Using this data, the researchers were able to classify the foods consumed into 1 of 4 NOVA categories (1) Unprocessed or minimally processed foods, 2) Culinarily processed ingredients, 3) Processed foods and 4) Ultra-processed foods). The consumption of ultra-processed foods was expressed as a portion per day. Finally, the researchers recorded the number of deaths during the study period. Participants were divided into quintiles, with the first quintile being the reference quintile with the lowest consumption of ultra-processed foods.

Results & Analyzes

The average consumption of portions of ultra-processed foods was 2.7 ± 3.8 per day. This corresponded to a daily energy contribution of about 35.5 ± 16.6 %. Compared to the 1st quintile (less than 0.5 ± 0.1 servings per day), people in the 5th quintile (more than 4.0 ± 8.2 servings per day)were more likely to be male, younger, smokers or ex-smokers, overweight or obese, with diabetes or hypertension, lower levels of alcohol consumption, physical activity and education but higher calorie consumption. They also consumed more red meat and dairy products, sugars and saturated fats but less fruit and vegetables.

During 13.5 ± 3.3 years, 5490 cardiovascular deaths were reported, of which 72.6% were due to heart disease and 20.5% to cerebrovascular disease. The main results of this study show that people consuming the most portions of ultra-processed foods were at the highest risk of cardiovascular mortality (1.5 times higher than participants who consumed the least ultra-processed foods). No association was observed for cerebrovascular disease. In further analyses, the researchers found that the risk of mortality was higher in women than in men.

A threshold of 2.3 servings per day was observed below which there was no association between the consumption of ultra-processed foods and the risk of cardiovascular mortality. However, this threshold was lower for women than for men (1.8 for women versus 4.1 for men).

There are several possible reasons for the adverse effects of ultra-processed foods. Firstly, their consumption reduces the consumption of unprocessed products such as fruit and vegetables. Secondly, the nutritional composition of these products is generally poor, with high levels of added sugars, trans fatty acids and very little fiber. In addition, chemical transfers between the packaging and the products can occur. Studies have shown that the consumption of ultra-processed foods can increase exposure to phthalates, which are themselves risk factors for cardiovascular disease. Food additives such as phosphate can also cause cardiovascular problems. Finally, ultra-processed foods can be contaminated by industrial processes with various substances that are toxic to humans and their health.

Regarding the difference between women and men, the researchers propose two hypotheses. The first is hormonal. The women who participated in this study were menopausal. So, there was no difference in estrogen levels. On the other hand, women have lower levels of testosterone than men. And some studies show that testosterone may play a positive role in maintaining cardiovascular health. The second explanation is that prevention and screening are generally less extensive than for men, at least for cardiovascular disease.

Practical Applications

High consumption of ultra-processed foods is associated with an increased risk of cardiovascular mortality. And these adverse health effects are even more dangerous for women than for men. According to this study, the consumption of this type of product should therefore be limited to less than 2 portions per day. However, as we explained in a previous article, due to their composition, ultra-processed products delay the satiety effect. Unfortunately, it is therefore very easy to consume many portions a day without even realizing it.

Reducing the consumption of ultra-processed foods is first and foremost a matter of personal choice, which must be guided by an understanding of the impact that their consumption can have on our long-term health.


  1. Zhong G-C, Gu H-T, Peng Y, Wang K, Wu Y-Q-L, Hu T-Y, Jing F-C and Hao F-B. Association of ultra-processed food consumption with cardiovascular mortality in the US population : long-term results from a large prospective multicenter study. Int J Behav Nutr Phys Act, 2021.

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