In more than 6 500 American adults who showed no signs of cardiovascular disease at baseline, researchers found that higher ultra-processed food (UPF) intake was identified with a greater long-term risk of ASCVD, and with a stronger association in black participants, reports News Medical.
The study, published in the journal JACC Advances, highlights the growing cardiovascular hazards associated with higher daily consumption of these foods across diverse populations, said the researchers.
Analysing data from more than 6 000 multi-ethnic US adults without pre-existing cardiovascular disease (CVD), the researchers identified a clear, approximately linear association between higher UPF intake and increased incident atherosclerotic cardiovascular disease (ASCVD) risk.
It was particularly pronounced among black participants, said the team – led by Wake Forest University School of Medicine in North Carolina – who discuss potential socio-environmental and structural contributors.
Their findings add to growing evidence linking UPFs to poor cardiometabolic outcomes and emphasise the need for targeted dietary strategies and public health interventions.
Dietary patterns and risks
Healthy dietary patterns, like the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets, are well established for improving cardiometabolic health and lowering CVD risk. These diets focus on fruits, vegetables, whole grains, legumes, nuts, and low-fat dairy.
In contrast, diets high in red and processed meats, refined grains, added sugars, and saturated fats are associated with adverse outcomes, including ASCVD. UPFs, characterised by industrial formulations with additives and minimal whole foods, have emerged as key contributors.
However, much of the existing evidence comes from racially homogeneous populations, limiting generalisability.
In this longitudinal study, researchers evaluated associations between UPF intake and incident ASCVD risk, including variation by race/ethnicity, sex, and socio-economic status.
The study included participants from the Multi-ethnic Study of Atherosclerosis (MESA), comprising adults aged 45-84 without baseline CVD. Data were collected between 2000 and 2002, with follow-up to 2012.
Researchers collected demographic, socio-economic, clinical, and lifestyle data using standardised questionnaires. Clinical measures included blood pressure, lipid profiles, anthropometry, and waist circumference.
Dietary intake was assessed using food-frequency questionnaires (FFQs), and foods were classified using the NOVA system. The Alternative Healthy Eating Index (AHEI) was used to evaluate overall diet quality.
Multivariate Cox regression models estimated hazard ratios for incident CVD events, including myocardial infarction, cardiac arrest, stroke, and cardiovascular mortality.
Restricted cubic spline models evaluated dose-response relationships, and survival analyses were conducted across UPF intake quintiles. Additional analyses explored subgroup differences and socio-environmental influences. As an observational study, results indicate association rather than causation.
Dose response relationship between UPF and ASCVD
The analysis included 6 531 participants (3 093 men and 3 438 women) across diverse racial and ethnic groups. Participants consumed an average of 4.38 servings of UPFs per day. Over 83 870 person-years of follow-up, 710 incident CVD events were recorded.
Higher UPF intake was associated with increased ASCVD risk. Each additional daily serving corresponded to an approximate 5% increase in risk (HR, 1.05), with risk rising more steeply at higher intake levels.
Survival analyses showed that individuals in the lowest UPF intake quintile had the highest CVD-free survival, while those in the highest quintile had the lowest. The highest quintile had a 67% greater risk of ASCVD than the lowest quintile (HR, 1.67).
These findings demonstrate a consistent dose-response relationship over two decades, although dietary intake was assessed only at baseline.
Stratified analyses showed stronger associations among black participants (HR, 1.06) than among non-black participants (HR, 1.03). Sugary UPFs showed the most consistent association with increased risk, while processed meats showed borderline associations, and mixed dishes were not significant. No significant interactions were observed by sex or income.
Although biological mechanisms were not directly tested, the authors suggest potential pathways including excess energy intake, metabolic dysfunction, hypertension, and inflammation.
Public health implications and study limitations
The findings identify UPF intake as a significant, modifiable risk factor for cardiovascular disease, with disproportionate effects in black populations. Clinical and public health strategies should address UPF consumption alongside broader structural factors such as food access, marketing, and socio-economic inequalities.
Limitations include reliance on self-reported dietary data and potential misclassification within FFQs. Future research should refine UPF definitions, investigate biological mechanisms, and evaluate targeted interventions. Dietary intake was measured at baseline, although follow-up analyses suggested relative stability over time.
Study details
Association Between UPF and Cardiovascular Disease Risk: MESA (Multiethnic Study of Atherosclerosis)
Haidar A, Rikhi R, Watson K, et al.
Published in JACC Advances on 17 March 2026
Abstract
Background
Ultraprocessed foods (UPFs) have been linked to adverse cardiometabolic outcomes and increased atherosclerotic cardiovascular disease (CVD) (ASCVD) risk. However, prior research has largely focused on homogenous populations, lacking racial and ethnic diversity.
Objectives
The objectives are to examine the longitudinal relationship between UPF consumption and ASCVD risk and to investigate whether these associations differ by race/ethnicity, sex, or socioeconomic status.
Methods
The MESA (Multiethnic Study of Atherosclerosis) is a prospective cohort study of 6 814 US adults aged 45 to 84, without clinically apparent CVD. UPF consumption was classified according to the Nova classification system. Multivariable cox proportional hazards models were used to evaluate the association between UPF intake and incident CVD events. Incident CVD events included non-fatal myocardial infarction, resuscitated cardiac arrest, death resulting from coronary heart disease, stroke (not transient ischaemic attack), and death resulting from stroke.
Results
Each additional daily serving of UPF was associated with a 5.1% increased risk of ASCVD events (HR: 1.051; 95% CI: 1.011-1.093). Participants in the highest quintile of UPF consumption had a 66.8% higher risk compared to those in the lowest (HR: 1.668; 95% CI: 1.196-2.325). A significant multiplicative interaction was observed between UPF intake and black race (P = 0.010), with stratified analyses demonstrating a higher ASCVD risk in black Americans (HR: 1.061; 95% CI: 1.016-1.108), compared to non-black Americans (HR: 1.032; 95% CI: 1.001-1.065).
Conclusions
In a large, multiethnic cohort, higher UPF consumption was significantly associated with an increased risk for ASCVD events, with a more pronounced association among black Americans.
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