Eating a diet mainly composed of ultra-processed food is associated with a significantly increased risk of cardiovascular disease and mortality, according to a new study published today.

The average American gets half of their daily calories from ultra-processed food, which include many foods that are marketed as healthy, such as protein bars, breakfast cereals and most industrially produced breads.

“As poor diet is a major modifiable risk factor for heart disease, it represents a critical target in prevention efforts,” said Filippa Juul, a faculty fellow at the New York University School of Public Health and lead author of the study. “Our findings add to a growing body of evidence suggesting cardiovascular benefits of limiting ultra-processed foods.”

The term ‘ultra-processed foods’ was first coined by a team of Brazilian nutritionists in a 2016 study that made waves internationally after it linked this type of food with cancer.

According to the International Food Information Council, “any deliberate change in a food that occurs before it is ready for us to eat” makes it ‘processed food’. Ultra-processed foods are defined as “industrial formulations with five or more ingredients.”

What typically sets ultra-processed foods apart from other types of processed foods is the widespread use of flavors, added sugars, fats, and chemical preservatives. The purpose of these ultra-processed foods is convenience since many such products are ready-to-eat, require very little prep to be palatable, and are cheap.

Some examples of ultra-processed foods included in the original 2016 study from Brazil include:

• Soft drinks
• Packaged bread and buns
• Chips
• Candy
• Store-bought ice cream
• Boxed cake mix
• Instant noodles
• Infant formula
• Breakfast cereal
• Energy bars
• Flavored yogurt
• Chicken nuggets
• Fast food burgers
• Hot dogs

Besides cancer, consuming ultra-processed foods is associated with obesity, high blood pressure, metabolic syndrome, Type 2 diabetes, and now cardiovascular disease.

Juul and colleagues analyzed data from the Framingham Offspring Study, which included 3,003 middle-aged adults with an average age of 53.5 years. Diet was assessed by mail using a food questionnaire where participants reported the frequency of consumption of certain foods in the previous year, while the U.S. Department of Agriculture nutrient database was used to calculate nutrient intakes from reported dietary intakes.

During an average of 18 years of follow-up, the researchers observed 648 instances of hard cardiovascular events, meaning sudden and non-sudden coronary death, heart attack, and fatal/non-fatal stroke. They also recorded 713 deaths during the follow-up period, including 108 deaths attributed to cardiovascular disease.

Those who had the highest intake of ultra-processed foods also had the highest incidence rate of cardiovascular disease (CVD). Each daily serving of ultra-processed food was associated with a 7% increase in the risk of hard CVD, a 9% increase in the risk of hard coronary heart disease (CHD, a 5% increase in overall CVD and a 9% increased risk in cardiovascular disease mortality. 

“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. 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,” Juul said in a statement.