Growing evidence linking ultra-processed food (UPF) to adverse cardiometabolic outcomes and cardiovascular disease (CVD) has prompted a European Society of Cardiology (ESC) consensus statement calling for routine assessment of UPF consumption in cardiovascular care.
Diet is a cornerstone of CVD prevention and management, yet the impact of food processing has received relatively little attention in routine cardiology practice.
As such, the ESC Council for Cardiology Practice and the European Association of Preventive Cardiology have developed a clinical consensus statement to help clinicians incorporate UPF assessment and counselling into cardiovascular care.
The consensus, published in the European Heart Journal, was informed by a systematic review of longitudinal studies and randomised controlled trials that evaluated associations between UPF intake, cardiometabolic risk factors and cardiovascular outcomes.
UPFs and cardiovascular risk factors
UPFs include industrially manufactured products containing additives, refined ingredients and compounds generated during processing. According to the consensus, these foods have increasingly displaced traditional dietary patterns across Europe and globally.
The evidence review found consistent associations between higher UPF consumption and several established cardiovascular risk factors.
Observational studies and randomised trials linked greater UPF intake to increased risks of overweight and obesity, type 2 diabetes, dyslipidaemia, chronic kidney disease and metabolic dysfunction-associated steatotic liver disease.
Evidence supporting an association with hypertension was considered moderate, while findings relating to metabolic syndrome remained limited and inconclusive.
The authors noted that these relationships were not fully explained by the poor nutritional profile of UPFs and that additives, processing-related contaminants, food matrix alterations and packaging-derived compounds may also contribute to adverse health effects.
The ESC consensus also highlighted substantial variation in UPF consumption across Europe. Previous studies have estimated that UPFs account for more than half of dietary energy intake in some northern European countries, whereas Mediterranean populations report considerably lower levels.
Beyond cardiometabolic risk factors, the review found consistent evidence linking UPF consumption with incident CVD and cardiovascular mortality.
Evidence regarding heart failure and atrial fibrillation was more limited, although available studies suggested potential associations requiring further investigation.
Routine assessment of UPF consumption
Importantly, the authors emphasised that most available evidence was observational and could not establish causality. Residual confounding, reverse causation and limitations of dietary assessment methods remain important considerations.
In addition, randomised controlled trials examining the impact of reducing UPF intake on hard cardiovascular endpoints were found to be lacking, with existing intervention studies largely focused on surrogate outcomes.
Despite these limitations, the ESC consensus statement recommended routine assessment of UPF consumption during lifestyle evaluations, particularly in preventive cardiology clinics and among patients with established cardiovascular or cardiometabolic disease.
Suggested strategies include brief screening tools, clear communication about cardiovascular risks, practical food substitutions and promotion of minimally processed foods.
The consensus statement also calls for greater clinician awareness of food processing as a distinct dietary dimension that complements traditional nutrient-based advice. Future research should focus on clarifying biological mechanisms, improving dietary assessment methods, and, through adequately powered intervention studies, evaluating whether reducing UPF intake can directly improve cardiovascular outcomes, the authors said.
Clear guidance for clinical practice
Co-lead Professor Luigina Guasti, associate professor of internal medicine in the Department of Medicine and Surgery at the University of Insubria in Varese, Italy, said: ‘We hope that this consensus statement from the European Society of Cardiology will help doctors recognise UPFs as a potential risk factor and provide clear guidance to their patients on limiting UPFs to prevent cardiovascular risk factors, disease and death.’
Fellow co-lead Dr Marialaura Bonaccio, senior epidemiologist in the Department of Epidemiology and Prevention at IRCCS Neuromed – Mediterranean Neurological Institute in Pozzilli, Italy, added: ‘We need long-term intervention trials to test whether reducing UPFs improves cardiovascular health.
‘More research is also needed to understand the effects of specific additives, processing compounds and food structures on heart health. Future studies could focus on implementing UPF-focused dietary interventions in clinical practice.’
She continued: ‘The research on UPFs has been accumulating for a decade, and it highlights the risks of high UPF consumption and the benefits of choosing whole or minimally processed foods.
‘This emphasises that disease prevention should not focus solely on nutrients, but also on the degree of food processing. Even foods with good nutritional profiles can be harmful if highly processed. Integrating UPF awareness into routine medical care could improve patients’ health without adding significant cost or time.’
Reference
Guasti L 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. Eur Heart J 2026;May 6:ehag226.