Ultra-processed Foods and Cardiovascular Diseases: Potential Mechanisms of Action

Abstract

Ultra-processed foods are industrially manufactured ready-to-eat or ready-to-heat formulations containing food additives and little or no whole foods, in contrast to processed foods, which are whole foods preserved by traditional techniques such as canning or pickling. Recent epidemiological studies suggest that higher consumption of ultra-processed food is associated with increased risk of cardiovascular disease (CVD). However, epidemiological evidence needs to be corroborated with criteria of biological plausibility. This review summarizes the current evidence on the putative biological mechanisms underlying the associations between ultra-processed foods and CVD. Research ranging from laboratory-based to prospective epidemiological studies and experimental evidence suggest that ultra-processed foods may affect cardiometabolic health through a myriad of mechanisms, beyond the traditionally recognized individual nutrients. Processing induces significant changes to the food matrix, for which ultra-processed foods may affect health outcomes differently than unrefined whole foods with similar nutritional composition. Notably, the highly degraded physical structure of ultra-processed foods may affect cardiometabolic health by influencing absorption kinetics, satiety, glycemic response, and the gut microbiota composition and function. Food additives and neo-formed contaminants produced during processing may also play a role in CVD risk. Key biological pathways include altered serum lipid concentrations, modified gut microbiota and host–microbiota interactions, obesity, inflammation, oxidative stress, dysglycemia, insulin resistance, and hypertension. Further research is warranted to clarify the proportional harm associated with the nutritional composition, food additives, physical structure, and other attributes of ultra-processed foods. Understanding how ultra-processing changes whole foods and through which pathways these foods affect health is a prerequisite for eliminating harmful processing techniques and ingredients.

Ultra-processed food intake is associated with grip strength decline in middle-aged and older adults: a prospective analysis of the TCLSIH study

“…This suggests that baseline grip strength was an important confounding variable for such association. Moreover, studies suggested that UPF intake may replace the intake of minimally processed foods such as fruits and vegetables [32]. However, adjustments for diet factors including fruits and vegetables did not alter such association.…”

“Even We Are Confused”: A Thematic Analysis of Professionals' Perceptions of Processed Foods and Challenges for Communication

“…Processing such as grinding and chopping can increase the metabolizable energy, i.e., the amount of calories absorbed from food, as shown with almonds ( 34 ). The highly degraded physical structure of ultra-processed foods, or other aspects such as additives, have been suggested as possibly relevant for the associations of ultra-processed foods with other health outcomes such as cardiovascular disease ( 35 ).…”

Ultra-processed food and incident type 2 diabetes: studying the underlying consumption patterns to unravel the health effects of this heterogeneous food category in the prospective Lifelines cohort

“…On the other hand, the UPF products identified in these two savory snack patterns are generally high in salt and fat and are often energy dense. It is conceivable that they may increase diabetes risk through metabolic disturbances, such as elevated blood pressure and lipid abnormality [ 40 , 41 ]. Therefore, a cautious interpretation of the health effects of UPF is warranted.…”