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Ultra-processed foods may be particularly dangerous for individuals with existing heart disease. Yagi Studio/Getty Images
  • Ultra-processed foods (UPF) contain industrially-formulated ingredients and little to no whole food.
  • A recent study found that these foods increased the risk of developing cardiovascular disease.
  • A new study says that these foods are especially dangerous for people who already have cardiovascular disease.

A food must contain minimal amounts of whole food ingredients and five or more — often many more — inexpensive, industrially produced ingredients to qualify as UPF.

Scientists have long cautioned against the overconsumption of UPF, linking them to a range of health conditions. Recent studies have indicated that they can lead to cardiovascular disease (CVD) and all-cause mortality.

A new study finds that consuming UPF increases the risk of a second — and more likely fatal — heart attack or stroke for people who already have CVD.

“We saw,” says first author of the study Dr. Marialaura Bonaccio, “that people with a higher consumption of ultra-processed foods have a two-thirds increased risk of a second heart attack or stroke, this time fatal, compared with participants eating these foods less frequently. The probability of dying from any cause is also 40% higher.”

Worryingly, consumption of UPF is growing, particularly in the United States, where nearly 60% of the average person’s diet is likely to be made up of highly processed foods.

The Department of Epidemiology and Prevention of the I.R.C.C.S. Neuromed in Pozzilli, Italy, conducted the study, which appears in European Heart Journal.

Recognizing ultra-processed foods

Dr. Bonaccio told Medical News Today, “It is important to underline that the definition of ultra-processed food is not linked to the nutritional content, but rather to the process used for its preparation and storage. In other words, even if a food is nutritionally balanced, it might still be considered ultra-processed.”

Cardiology dietician Michelle Routhenstein, MS RD CDE CDN, who was not involved in the study, told MNT:

“I find that many people are hyper-focused on calories, so when they read the food label, if the nutritional facts panel satisfies what they are assessing it for, they can easily dismiss the processing element of the food. I, therefore, like to direct the attention of the consumer to read the actual ingredient list first.”

Routhenstein adds, “When looking at the food label, it may be helpful to understand at a glance the NOVA classification scale.”

The NOVA classification system assigns foods to one of four categories based on the amount of processing they involve:

  • Group 1 — Unprocessed or minimally processed foods. These are either unprocessed foods or foods that have undergone minimal processing, such as cooking or pasteurization.
  • Group 2 — Processed culinary ingredients. These derive from nature or group 1 foods. They include olive oil, salt, maple syrup, and other items which people may use to prepare group 1 foods.
  • Group 3 — Processed foods. These are foods created using items from groups 1 and 2, such as bread and cheese.
  • Group 4 — Ultra-processed food and drink products. Manufacturers have formulated these food products to be tasty, cheap to buy, and easy to prepare. They include few to no products from group 1 and often contain fats, salt, preservatives, stabilizers, food coloring, artificial flavoring, and refined grains.

Open Food Facts summarizes group 4 foods: “soft drinks, sweet or savory packaged snacks, reconstituted meat products, and pre-prepared frozen dishes.”

Dr. Bonaccio shared with MNT some hypotheses regarding the relationship between UPF and the increased risk of CVD-related death:

“Here, we saw that only a small part of the excess of death risk is attributable to the poor nutritional content of these UPF, and this leads [us] to think that other non-nutritional factors of UPF are potentially responsible for their detrimental effects on health.”

“They are frequently packaged in materials that are a source of phthalates and bisphenols that are multifunctional synthetic chemicals used to make plastics flexible and durable.” Dr. Bonaccio added that “UPF are also a major source of food additives and neoformed compounds that have been shown to have adverse effects on human health in experimental and some epidemiological studies.”

“Thus,” Dr. Bonaccio concluded, “it seems that UPFs do not exert specific cardiovascular effects but accelerate the occurrence of secondary events in patients with pre-existing CVD.”

Neuromed’s Dr. Licia Iacoviello says, “it is time to overcome the distinction between healthy and unhealthy food solely on the basis of the nutrient value.”

Dr. Iacoviello notes that knowing, for example, that one is following a Mediterranean diet does not say anything about how the food was prepared. She adds, “Fresh vegetables are not the same as pre-cooked and seasoned vegetables, and the same goes for many other foods. It is a factor to be increasingly considered when advising citizens about proper nutrition.”

When asked if there is some way for a consumer to know if a food is a UPF that they should avoid, Dr. Bonaccio suggested to MNT:

“One simple thing to do for a consumer to make healthier food choices is to look at the number of ingredients a given food contains. If this number exceeds five, that product has a high probability of being a ultra-processed food.”