A cross-sectional study from Florida Atlantic University, published in the American Journal of Medicine, has added significant evidence to the growing body of research linking ultra-processed food consumption to cardiovascular disease. Analyzing data from 4,787 American adults aged 18 and older, the study found that those in the highest quartile of ultra-processed food consumption had a 47% higher risk of experiencing a major cardiovascular event — including heart attack or stroke — compared to those in the lowest quartile.
The data came from the National Health and Nutrition Examination Survey (NHANES), a nationally representative survey conducted between 2021 and 2023. Participants provided at least one day of detailed dietary records, which were used to calculate the proportion of daily calories from ultra-processed foods as defined by the NOVA classification system.
The NOVA system categorizes foods into four groups based on the extent and purpose of processing. Ultra-processed foods — NOVA Group 4 — are formulated from industrial ingredients like hydrogenated oils, high-fructose corn syrup, emulsifiers, flavor enhancers, and preservatives. Common examples include sodas, packaged snacks, instant noodles, frozen dinners, and processed meats. In the United States, these foods now constitute approximately 60% of adult caloric intake and 70% of children's diets.
A critical strength of the study is its adjustment for multiple confounding variables. The 47% increased risk persisted after controlling for age, sex, race/ethnicity, BMI, smoking status, physical activity, diabetes, hypertension, and household income. This multivariate adjustment is significant because it suggests the association is not simply a proxy for poverty, obesity, or other established risk factors that correlate with poor diet.
Several proposed mechanisms may explain the link: high sodium content can elevate blood pressure, added sugars may promote metabolic dysfunction and insulin resistance, food additives like emulsifiers may disrupt the gut microbiome and intestinal barrier function, and ultra-processed foods may displace nutrient-dense whole foods from the diet.
The study's limitations deserve attention. Dietary intake was assessed via a single 24-hour recall, which is inherently imprecise — a single day's eating may not represent habitual diet. The NOVA classification has been criticized for grouping nutritionally diverse foods together; a whole-grain fortified cereal and a sugary soda both qualify as ultra-processed despite vastly different nutritional profiles. Additionally, the observational design cannot establish causation — unmeasured confounders or reverse causality (sick individuals changing their diets) remain possible.
Despite these caveats, the study aligns with a broader pattern of evidence. Multiple meta-analyses and prospective cohort studies have linked high ultra-processed food intake to increased risks of obesity, type 2 diabetes, certain cancers, depression, and all-cause mortality. The researchers advocate for public health interventions including clearer labeling, potential regulation of food additives, and policies to improve access to minimally processed foods.