Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study
Open accessAbstract
Background Ultra-processed foods provide 58% of total energy in the U.S. diet, yet their association with cardiovascular disease (CVD) remains understudied.Objectives The authors investigated the associations between ultra-processed foods and CVD incidence and mortality in the prospective Framingham Offspring Cohort.Methods The analytical sample included 3,003 adults free from CVD with valid dietary data at baseline. Data on diet, measured by food frequency questionnaire, anthropometric measures, and sociodemographic and lifestyle factors were collected quadrennially from 1991 to 2008. Data regarding CVD incidence and mortality were available until 2014 and 2017, respectively. Ultra-processed foods were defined according to the NOVA framework. The authors used Cox proportional hazards models to determine the multivariable association between ultra-processed food intake (energy-adjusted servings per day) and incident hard CVD, hard coronary heart disease (CHD), overall CVD, and CVD mortality. Multivariable models were adjusted for age, sex, education, alcohol consumption, smoking, and physical activity.Results During follow-up (1991 to 2014/2017), the authors identified 251, 163, and 648 cases of incident hard CVD, hard CHD, and overall CVD, respectively. On average, participants consumed 7.5 servings per day of ultra-processed foods at baseline. Each additional daily serving of ultra-processed foods was associated with a 7% (95% confidence interval [CI]: 1.03 to 1.12), 9% (95% CI: 1.04 to 1.15), 5% (95% CI: 1.02 to 1.08), and 9% (95% CI: 1.02 to 1.16) increase in the risk of hard CVD, hard CHD, overall CVD, and CVD mortality, respectively.Conclusions The current findings support that higher consumption of ultra-processed foods is associated with increased risk of CVD incidence and mortality. Although additional research in ethnically diverse populations is warranted, these findings suggest cardiovascular benefits of limiting ultra-processed foods.
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Reducing saturated fat without considering the replacement macronutrient can lead to increased intake of added sugars and ultra-processed foods, resulting in adverse metabolic effects including increased risk of coronary heart disease and type 2 diabetes.
“reducing saturated fat without considering the replacement macronutrient can lead to an increased intake of added sugars and ultra-processed foods, resulting in adverse metabolic effects, including an increased risk of coronary heart disease and type 2 diabetes”
From Lifestyle Medicine for Obesity in the Era of Highly Effective Anti-Obesity Treatment (2025) · cites this paper as [208]
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- Authors
- Juul, F., Vaidean, G., Lin, Y., Deierlein, A. L., & Parekh, N.
- Affiliations
- New York University (US)
- Northwell Health (US)
- Rutgers, The State University of New Jersey (US)
- Corresponding author
- Parekh, Niyati
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 77
- Issue
- 12
- Pages
- 1520-1531
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W3138575867
- Cited by
- 227
- References
- 48
- Citations by year
- 2026: 31 · 2025: 48 · 2024: 50 · 2023: 48 · 2022: 34 · 2021: 16
- FWCI
- 31.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agricultural Research Service (58-1950-7-707, 58-1950-4-401, 58-1950-9-001, 53-3k06-5-10)
- Boston University (N01-HC-25195)
- National Heart, Lung, and Blood Institute
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Consumer Attitudes and Food Labeling
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- ultra-processed foods, cardiovascular disease incidence, cardiovascular mortality, coronary artery disease, NOVA classification, dietary intake, Framingham Offspring Study, diet and cardiovascular risk
- MeSH terms
- Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Prospective Studies, Incidence, Fast Foods
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