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A landmark AHA science advisory reveals how ultra-processed foods harm heart health, urges targeting HFSS products first, and calls for bold policy reforms to reshape America’s diet.

Ultraprocessed Foods and Their Association With Cardiometabolic Health: Evidence, Gaps, and Opportunities: A Science Advisory From the American Heart Association. Image Credit: beauty-box / Shutterstock

Ultra-processed foods (UPFs) are reported to make up more than half the calories in the average American diet, with their health risks becoming increasingly apparent. In the recent science advisory published in the journal Circulation, researchers from the American Heart Association (AHA) synthesize current evidence on the relationship between high UPF consumption and cardiometabolic health, particularly in the United States (US).

Advisory findings confirm that most UPFs are nutritionally poor and that their intake is strongly associated with an increased risk of several chronic conditions, including a 25% to 58% higher risk of cardiometabolic outcomes and a 21% to 66% higher risk of mortality. Furthermore, the advisory highlights how the industrial manufacturing process leading to the production of UPFs itself can pose additional, independent risks (harmful additives, food matrix destruction, etc.). It emphasizes that risks may increase when UPFs exceed 10–15% of daily calories (≈2 servings) and calls for urgent policy changes aimed at curbing UPF consumption in the US through measures like front-of-package labeling, taxation of foods high in saturated fats/sugars/sodium (HFSS), additive bans, and reforming the FDA’s “generally recognized as safe” (GRAS) system.

Background

Modern technological advancements have fundamentally reshaped our food supply. Where once there was agriculture and home-cooked meals, ultra-processed foods (UPFs), industrial formulations made with additives or ingredients rarely used in home cooking, have become the cornerstone of ‘fast-food’ diets worldwide, especially in the United States (US). Alarmingly, UPFs now account for over half of all calories consumed and are estimated to make up over 70% of packaged foods in grocery stores. Critically, UPFs are disproportionately marketed to and consumed by lower-income communities and racial/ethnic minorities like Black and Hispanic populations due to targeted advertising and limited access to healthier alternatives. These foods’ industrial-scale production also threatens global agrobiodiversity, reducing crop diversity and disrupting traditional food systems.

Defined and identified using the international NOVA classification system criteria, UPFs are notably devoid of the healthy components that comprise a home kitchen, but instead comprise chemical processes and synthetic additives absent from domestic establishments. They include (but are not restricted to) sugary drinks, packaged snacks, processed meats, and ready-to-eat meals.

A growing body of “convincing” observational evidence highlights the adverse physiological impacts of UPFs, with high consumption strongly linked to a greater risk of cardiovascular disease, obesity, type 2 diabetes, and premature death.

While it would therefore be easy to dismiss UPFs as “junk food” and ban the lot of them, the practical picture is more complex. Some UPFs, like whole-grain breads or unsweetened plant-based dairy alternatives, may have a more favorable nutrient profile or serve vulnerable subpopulations by providing affordable, shelf-stable nutrition, a key consideration for nutrition security.

About the Advisory

The present AHA scientific advisory aims to clarify these nuances by summarizing current scientific evidence, identifying further knowledge gaps, and proposing a path forward for American public health. The report represents a consensus statement from a multidisciplinary panel of experts that collectively reviewed epidemiological studies, clinical trials, and mechanistic research to evaluate the impact of UPFs on cardiometabolic health.

Areas of Focus

The advisory focuses on specific areas of interest, including:

1. Defining UPFs – Establishing an operational UPF definition, leveraging NOVA classification and nine other global food processing classification systems while acknowledging ambiguities in current criteria.
2. Mechanisms of action – Collating data on both UPFs’ nutritional profiles and direct physiological impacts, including gut microbiome disruption and metabolic effects, while accounting for the effects of the industrial manufacturing process.
3. Policy and regulation – Evaluating the current regulatory landscape governing UPF use (including specifics about permitted additives and processing techniques) to provide recommendations for evidence-based reforms like California’s recent ban on harmful additives (brominated vegetable oils, potassium bromate, propylparaben, red dye 3).

Advisory Findings

An umbrella review of several meta-analyses investigating associations between UPFs and cardiometabolic health revealed that evidence linking UPFs to cardiovascular mortality was “convincing,” while associations with type 2 diabetes and obesity were “highly suggestive.” Specifically, UPF consumption was associated with a 25% to 58% greater risk of adverse cardiometabolic outcomes and a 21% to 66% greater risk of all-cause mortality.

Notably, these risks are not from individual reports or statistical hallucinations. A landmark randomized controlled crossover trial from the National Institutes of Health compared adults who consumed either unprocessed or ultra-processed diets and found that despite the diets being matched for calories, sugar, fat, and fiber, participants on the UPF diet spontaneously consumed ~500 extra calories daily and gained substantial weight, demonstrating how processing itself can drive overconsumption.

When assessing the industrial additives, the advisory observed that many may pose direct harm. For example, the common emulsifier “carboxymethylcellulose” was found to alter the gut microbiome and metabolome in healthy adults, leading to metabolic imbalances and gut dysbiosis. The advisory also notes that additives like these are often approved under the GRAS designation without rigorous safety review, and their cumulative long-term effects remain poorly understood.

Finally, the advisory highlights America’s current regulatory system, where nearly 10,000 additives are approved for use, many under the “generally recognized as safe” (GRAS) designation, which often bypasses rigorous premarket review by the FDA without sufficient epidemiological evidence. It calls for modernizing this system to prioritize consumer safety and emphasizes UPF production’s adverse environmental impacts, including biodiversity loss and resource-intensive farming practices linked to monoculture crops like corn, soy, and wheat.

Conclusions

The present AHA scientific advisory delivers a clear message – while not all processed foods are harmful, the overall UPF-dominated American diet poses a significant and multifaceted threat to the nation’s cardiometabolic health. The report advocates a practical approach: prioritize reducing HFSS UPFs (e.g., sugary drinks, processed meats) while allowing limited inclusion of nutrient-dense UPFs (e.g., whole-grain breads) where they support nutrition security.

The study calls for extensive policy changes, research, and dietary guidance alongside a fundamental shift in the prevalent food system, moving away from a reliance on industrial formulations towards whole and minimally processed foods. Multilevel strategies, including equitable access initiatives, additive regulation, industry incentives for healthier formulations, and sustainable agriculture practices to counter biodiversity loss, are essential to address disparities and improve population health.