A study published in The Journal of Nutrition confirms an association between higher consumption of ultra-processed foods and higher risk of coronary artery disease among middle-aged US adults.

Cardiovascular disease, a leading cause of death worldwide, is partly attributed to modifiable lifestyle risk factors such as diet. A growing concern among healthcare professionals is the increased consumption of ultra-processed foods, defined as food and drink products formulated through industrial processes. Ultra-processed foods often contain high amounts of refined carbohydrates, saturated fat, salt, and sugar, and are low in fiber and micronutrients (vitamins and minerals). According to a nationwide study, ultra-processed food consumption contributes to as high as 60% of total energy intake in the United States. Although studies have shown associations between cardiovascular disease and consumption of ultra-processed foods, there is limited prospective research. Considering this knowledge gap, Shutong Du, Hyunju Kim, and Casey Rebholz from Johns Hopkins University conducted a study using data from the Atherosclerosis Risk in Communities study, a community-based prospective cohort study of cardiovascular disease and its risk factors in middle-aged adults.

A total of 13,548 adults, 45 to 65 years of age, were included in the present study.  Dietary intake data were collected through a 66-item food frequency questionnaire.  The level of intake (servings per day) of ultra-processed foods was calculated for each participant. A variety of techniques were used to ascertain coronary artery disease events during follow-up. Participants also reported sociodemographic information (age, race, sex, and education level), health behaviors (smoking status, drinking status, physical activity) and medical history (diagnosed disease).

There were 2006 incident coronary artery disease cases documented over a median follow-up of 27 years. Coronary artery disease incidence rates were significantly higher among those with higher ultra-processed food intakes compared those with the lowest intakes.  Participants with the highest intakes of ultra-processed foods had a 19% higher risk of coronary artery disease compared with the lowest. Participants with the highest intakes of ultra-processed foods also had higher intakes of total fat, saturated fat, and sugar, and lower intakes of fiber, protein, and micronutrients.

In this study of middle-aged US adults, higher ultra-processed food consumption was associated with a higher risk of coronary artery disease.  Expanding on previous studies, these findings provide further justification for healthcare providers to advise their patients to limit consumption of ultra-processed food. The investigators encourage further research to confirm these results in longitudinal studies using uniformly agreed upon definitions and classification systems of ultra-processed foods.


Shutong Du, Hyunju Kim, Casey M Rebholz, Higher Ultra-Processed Food Consumption Is Associated with Increased Risk of Incident Coronary Artery Disease in the Atherosclerosis Risk in Communities Study, The Journal of Nutrition, Volume 151, Issue 12, December 2021, Pages 3746–3754, https://doi.org/10.1093/jn/nxab285.

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