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A clinical consensus statement published in the European Heart Journal looks at UPFs and cardiovascular diseases.
Dr Oonagh Markey, Senior Lecturer in Nutritional Sciences, Loughborough University, said:
“This paper offers a synthesis of primarily observational evidence linking higher total ultra‑processed food intake with cardiovascular risk. While the overall message is broadly consistent with the data, careful interpretation is needed. Ultra‑processed foods are a broad and heterogeneous category, so they cannot be treated as a single exposure. The authors briefly acknowledge this and, in the clinical consensus statements, take a pragmatic approach by focusing on clearly high‑risk UPF groups such as sugary drinks and processed meats, which aligns with existing HFSS‑based advice. However, the epidemiological evidence base would be strengthened by looking at different sub‑categories of ultra-processed foods more specifically. Moreover, the relationship between UPF intake and cardiovascular risk cannot yet be assumed to be causal, given the lack of long‑term randomised trials and mechanistic evidence, including the difficulty of disentangling the effects of food processing from the established effects of nutrients.”
Prof Jules Griffin, Director of The Rowett Institute, University of Aberdeen, said:
“This consensus statement by the European Society of Cardiology authored by a team of cardiologists and scientists across Europe provides a comprehensive review of the scientific literature for studies that examine the link between ultra-processed food consumption with cardiovascular disease and related disorders. The authors have produced a wide-ranging review of the literature concluding that ultra-processed food is associated with increased body weight, type 2 diabetes, dyslipidaemia and fatty liver disease, while there is evidence, albeit weaker, for associations with hypertension and the metabolic syndrome.
“This is a high-quality review of the literature and summarises well the current state of the field for heart disease, also highlighting areas where the evidence is still inconclusive, largely because of the size of the studies conducted to date. This consensus statement contains very useful guidance for cardiologists to incorporate nutrition advice about ultra-processed food into clinical practice – something which is currently lacking. The authors highlight that the current weight of evidence is dominated by observational studies and thus, these associations should be interpreted with caution, although the research on weight gain is backed up by good quality randomised controlled trials, the gold standard for testing causation.
“One important limitation of the work is that although the authors highlight that some studies have shown that the ill health effects associated with ultra-processed food cannot be explained by its high salt, high saturated fat, high sugar and low fibre and vitamin content alone, the majority of the mechanisms proposed for how UPF acts are explained by individual nutrition components – highlighting more research is needed.”
Dr Andrew Ludman, VP for Clinical Standards of the British Cardiovascular Society, said:
“Cardiovascular disease is one of the main causes of premature illness and death in the UK and early preventative action is crucial. The paper, which is a clinical consensus statement, provides a valuable systematic review of the research literature regarding the potential link between ultra processed foods (UPFs) and cardiovascular disease. The consensus statement has used a robust methodology to appraise the available evidence but the authors themselves acknowledge that unfortunately most trials are observational in nature and it is hard to prove direct causation between UPFs and specific cardiovascular risk factors. However, the authors do describe a consistent and significant association and report biological plausibility for the observed effect. The authors do well to explain this challenge and point out the strengths and weaknesses of their conclusions but also the subsequent implementation advice – they acknowledge that unfortunately most trials are observational in nature, and it is hard to prove direct causation between UPFs and specific cardiovascular risk factors.
“However, important knowledge gaps remain, both around the mechanism for any harm from UPFs, and in understanding the complex relationship of UPFs with other elements of lifestyle and how these contribute to cardiovascular risk factors. Nevertheless, it is a detailed review of the published evidence, and will be an important resource for busy, practicing cardiologists, as it adds clear practical advice about how to start to address the topic of UPFs with our individual patients – the statement could be a really useful starting point for general cardiologists to educate themselves if unfamiliar with the topic but also to then take this into their clinical practice. As cardiologists, we need to continue to help our patients make healthy choices and this statement will give valuable clinical information needed.”
Dr Vahitha Abdul Salam, Senior Lecturer (Associate Professor) & Group Leader in Vascular Pharmacology, Queen Mary University of London, said:
“This is a welcome and well-conducted study that adds important weight to the growing evidence linking ultra-processed foods (UPFs) to heart disease risk. What makes it stand out is its consistency; the findings hold across different populations worldwide, which gives us greater confidence that what we’re seeing is a real effect rather than a statistical artefact. It also breaks new ground by quantifying risk in a way that is meaningful to clinicians and policymakers: for every 10% increase in UPF consumption, cardiovascular risk rises measurably. The NOVA food classification system used in the research is a practical, accessible tool that can genuinely inform both medical practice and public health guidance.
“As with all studies of this kind, it is important to be clear-eyed about what the evidence can and cannot tell us. A definitive causal link has not yet been proven, and factors such as socioeconomic background, smoking, and physical activity may still play a role that is difficult to fully account for. It is also worth noting that “ultra-processed food” covers a very wide range of products, and the risk may not apply equally to all of them.
“Nevertheless, the overall picture is consistent and compelling. This research reinforces the case for making UPF awareness a mainstream part of cardiovascular prevention — and gives public health authorities a sound evidence-base to act on.”
Dr Alexander Jones, BHF Clinical Research Fellow in Paediatric Cardiovascular Medicine, University of Oxford, said:
“This is a timely and useful consensus statement from the European Society of Cardiology. It brings together a growing body of research showing that people who eat more ultra-processed foods (UPFs) tend to have a higher risk of heart disease. Many of the reviewed studies do try to take account of other factors—such as smoking, physical activity and overall diet—and, despite this, the findings are broadly consistent. The authors also explain that much of this risk may sit within a chain of effects, where these foods contribute to weight gain, diabetes and high blood pressure, which in turn are well-known to increase cardiovascular risk, but this may not be the whole story. At least some studies also adjust for total calorie intake and key nutrients like fat, sugar or fibre, and still find links between UPFs and heart disease.
“There are still important uncertainties. Ultra-processed foods are difficult to define consistently, and diet is hard to measure accurately. People who eat more of these foods may also differ in other ways – for example in income, lifestyle or health behaviours – that are not fully captured in all studies. It is also possible that people who are already at higher risk of heart disease for other reasons change their diet, rather than diet being the cause of their ill health.
“Even so, there is growing evidence that processing itself may matter, beyond fat, sugar or fibre content. This now needs testing in well-designed trials, alongside research to understand what aspects of processing might be driving these effects.”
Prof Gunter Kuhnle, Professor of Nutrition and Food Science, University of Reading, said:
“This guidance is concerning, because it is not only based on weak evidence but casts doubt at the expertise and the reliability of the EU regulatory system without any evidence.
“While there have been ongoing discussions about the potential adverse health effects of so-called ultra-processed foods, there is still very little evidence beyond observational studies that support these claims. A key limitation of these observational studies is it is very difficult to estimate ultra-processed food intake accurately: this is not just due to the usual difficulties of measuring diet, but also because the data collected often does not allow a clear categorisation according to NOVA. For example, all bread consumed in the UK is usually categorised as ultra-processed – irrespective of the actual category.
“Randomised clinical trials with ultra-processed foods have not shown any severe adverse effects, especially on cardio-vascular risk markers. Indeed, a study comparing ultra-processed and minimally processed diets that follow current dietary recommendations did not find any difference (https://www.nature.com/articles/s41591-025-03842-0). The authors also clearly state that “[t]o date, RCTs assessing the impact of UPF reduction on hard CV clinical endpoints are lacking, with existing interventional evidence limited to short-term studies focusing on intermediate or surrogate outcomes.”Considering the limitations of observational data, this raises question whether such a guidance might be premature.
“There are very good data on dietary primary and secondary prevention of cardio-vascular diseases, which include for example increased intake of fibre, plant-based foods or the reduction of sodium and sugar intake. This is also partly included in the guidance with recommendations to reduce intake of sugary drinks. However, there is currently no evidence that that such dietary changes are only beneficial when they are from minimally processed foods.
“There is no evidence that consuming home-cooked food – the first behaviour change recommended in the statement – reduces the risk of cardio-vascular disease. The recommendation is also problematic as not everyone will have the skills, time and facilities to home-cook, and home cooked meals are not necessarily more healthy than processed or indeed ultra-processed foods. For example, home-made and even artisan bread often contain considerably more sodium than ultra-processed bread. There are further unrealistic and potentially harmful simplifications, e.g. the claim that foods with more than five ingredients are likely UPF. What is notably absent – apart from one brief mentioning – is the role dietitian have in providing dietary advice.
“The consensus statements claims that additives are potentially harmful without providing any evidence for these claims. Additives are very strictly regulated in the UK and the EU, and those additives that are permitted to be used in foods have been carefully assessed. The claim in the consensus statement implies that these assessments cannot be trusted – and in turn, that the regulators are potentially unreliable. While decisions by regulators can – and should – of course be questioned, this should be done with clear evidence.”
‘Ultra-processed foods, lifestyle management, and cardiovascular diseases: A clinical consensus statement of the European Society of Cardiology Council for Cardiology Practice and the European Association of Preventive Cardiology of the European Society of Cardiology’ by Luigina Guasti et al. was published in the European Heart Journal at 00:05 UK time on Thursday 7 May 2026.
DOI: 10.1093/eurheartj/ehag226
Declared interests
Dr Oonagh Markey: “OM receives research funding from the Arla Foods Ingredients Group P/S for work unrelated to this consensus statement. She also serves in an advisory capacity on the School Milk and Nursery Alliance.”
Prof Jules Griffin: “I am a consultant for Sitryx, a company specialising in designing drugs to target immunometabolism.
I have received funding from the European Union to investigate endocrine disrupting chemicals and hold a grant from UK Research and Innovation examining the health benefits of a fish diet.
I am a recipient of a travel award from Shimadzu Corporation to present results on their mass spectrometers.
I hold shares in GlaxoSmithKline and Haleon plc.”
Dr Andrew Ludman: “I am a practicing UK cardiologist (NHS and privately, Exeter Heart Ltd) and Trustee of the British Cardiovascular Society (as it is a registered charity). I do not have any additional relevant declarations.”
Dr Vahitha Abdul Salam: “I declare I have no conflict of interest.”
Dr Alexander Jones: “None to declare.”
Prof Gunter Kuhnle: “I am a former member of the EFSA ANS Panel, the UK Committee on Toxicity of Chemicals in Food, Consumer Products, and the Environment; a current member of the Advisory Committee on Novel Foods and Processes; the Director of the Chemical Analysis Facility at the University of Reading, which provides analytical services to academic and commercial clients; have received research funding (2010–20) from Mars for work on flavanols; and have received consultancy payments from RSM UK and EQT, paid to the University of Reading.”