Dr Marialaura Bonaccio, IRCCS, Mediterranean Neurological Neuromed Institute, Pozzilli, Italy
Prof Luigina Guasti, University of Insubria, Varese, Italy
What is the reason for and aim of the publication?
Over the past decade, a growing body of evidence has consistently linked high consumption of ultra-processed foods (UPFs) with obesity, type 2 diabetes, cardiovascular disease, and premature mortality. However, nutritional recommendations have traditionally focused on nutrients and food groups, largely overlooking the degree of food processing.
This consensus document was developed to critically appraise the available evidence on UPFs and cardiovascular health, discuss the potential biological mechanisms involved, and provide practical considerations for clinicians and policymakers. Its main aim is to introduce food processing as an additional dimension of diet quality that deserves attention in cardiovascular prevention and lifestyle management.
What are the most important take-home messages?
- UPFs are consistently associated with a higher risk of cardiometabolic diseases and cardiovascular mortality.
- The adverse health effects of UPFs cannot be explained solely by their poor nutrient composition. Food additives, altered food matrices, processing-induced compounds, packaging contaminants, and effects on satiety, inflammation and the gut microbiome may also contribute.
- Food processing should be considered an additional dimension of diet quality. Alongside asking "What do people eat?", clinicians should increasingly ask "How is this food produced?"
- Clinical cardiologists are advised to include questions on UPF consumption in standard visits and to provide suggestions on how to limit its use.
Central Illustration. In a Cardiology setting, the clinical evaluation of nutritional habits and councelling should include ultra-processed food consumption, associated with worse cardiovascular outcomes. Public health policies need to take ultra-processed foods into account in order to reduce the risk accociated with these products.
What are challenges in practical implementation – and possible solutions?
One major challenge is that ultra-processed foods are deeply embedded in modern food systems because they are affordable, convenient, highly palatable, and heavily marketed. In addition, both healthcare professionals and consumers often find it difficult to identify UPFs and distinguish them from minimally processed foods.
Possible solutions include increasing awareness among clinicians and the public, integrating the concept of food processing into dietary counselling, improving food literacy and labelling, and promoting food environments that facilitate healthier choices based on minimally processed foods.
Which issues still need to be tackled, that are not yet addressed by the paper?
Although epidemiological evidence is remarkably consistent, several questions remain open. More mechanistic and intervention studies are needed to disentangle the specific role of individual processing techniques, food additives, and changes in food structure. In addition, the category of UPFs is highly heterogeneous and future research should better identify which products and components are most harmful and under which circumstances.
What further developments on the topic are emerging?
The field is moving towards a more comprehensive view of diet quality, where nutrients, foods, eating patterns, and food processing are considered together. Emerging research is integrating epidemiology with metabolomics, microbiome science, and food systems research to better understand how industrial food processing influences cardiometabolic health. These advances are likely to inform future dietary guidelines and cardiovascular prevention strategies. For decades we have focused on nutrients. We now understand that the degree of food processing is also an important determinant of diet quality and cardiovascular health.
Ultra-processed foods, lifestyle management, and cardiovascular diseases
Guasti L, Bonaccio M, et al. 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. Eur Heart J. Published online May 6, 2026. https://doi.org/10.1093/eurheartj/ehag226
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