Ultra-processed foods (UPFs) continue to garner attention from researchers and regulators who wonder about their contribution to chronic health diseases and whether the category should be defined and regulated to protect public health.

Now, researchers at Florida Atlantic University’s (FAU’s) Charles E. Schmidt College of Medicine are suggesting that UPF consumption is an “urgent public health priority” based on the findings of a new study published in the American Journal of Medicine that linked diets high in UPFs to a “statistically significant and clinically important” increased risk of heart attack or stroke.

High UPF Consumption Associated with 47 Percent Greater Risk of CVD

The study defined UPFs based on the widely accepted NOVA classification system, which describes UPFs as “industrially manufactured food products made up of several ingredients (formulations) including sugar, oils, fats, and salt and food substances of no or rare culinary use.”

Using this definition, the researchers analyzed data from the U.S. National Health and Nutrition Examination Survey (NHANES), which collects health, diet, and lifestyle information from a large, random sample of U.S. adults. They analyzed the 4,787 participants aged 18 and older from 2021–⁠2023 who had at least one day of detailed dietary records and information about heart attack or stroke. Participants reported everything they ate over two days, and researchers calculated what percentage of each person’s total calories came from UPFs. People were then grouped into four categories, ranging from low to high UPF food intake.

The researchers also accounted for covariants such as age, sex, race and ethnicity, smoking, and income. The average age of participants was 55 years, and 55.9 percent were women.

After adjusting for confounding factors, those in the highest quartile of UPF intake had a statistically significant and clinically important 47 percent higher risk of cardiovascular disease (CVD), mainly comprising heart attack or stroke, when compared with those in the lowest quartile.

The findings build upon prior studies that have shown that people who consume large amounts of UPFs have higher risks of metabolic syndrome, which includes being overweight or obese, hypertension, dyslipidemia, and insulin resistance, as well as increased levels of high-sensitivity C-reactive protein, a sensitive marker of inflammation and accurate predictor of future CVD.

Although large-scale randomized trials are needed, the researchers say that in the meantime, health care providers should advise patients to decrease consumption of UPFs.

Calls for a Broader Public Health Approach to Addressing UPF Consumption

The researchers compared the increasing public awareness and policy change around UPFs against that of tobacco use in the last century. They pointed out that changing consumption habits around UPFs will take time, and may be complicated in communities that face barriers to healthy food access.

“Addressing UPFs isn’t just about individual choices – it’s about creating environments where the healthy option is the easy option,” said Charles H. Hennekens, M.D., F.A.C.P.M., F.A.C.C., senior author, First Sir Richard Doll Professor of Medicine and Preventive Medicine and senior academic advisor, FAU Schmidt College of Medicine. “Clinical guidance and public health education are necessary to make nutritious foods accessible and affordable for everyone.”

Should UPFs Be Regulated? Problems with UPF Definitions and Research

In the U.S., moves are being made at the federal and state levels to curb UPF consumption.

For example, the new Dietary Guidelines for Americans 2025–⁠2030 include, for the first time, sweeping advice to avoid “highly processed” foods as a category. Controversially, the U.S. Food and Drug Administration (FDA) and the U.S. Department of Agriculture (USDA) are considering the definition of a uniform, recognized definition for UPFs. U.S. Health Secretary Robert F. Kennedy Jr. (RFK Jr.) recently said in a podcast interview that the federal definition will be unveiled as soon as April 2026.

Additionally, a recently introduced California state bill seeks to establish a “California Certified” seal for non-UPFs that can be displayed on the label of qualified food products, similar to the "USDA Organic" seal. The introduction of this legislation follows the passage of the Real Food, Healthy Kids Act, which directed state officials to define UPFs and phase out “particularly harmful” UPFs from schools.

Not everyone agrees with defining and regulating UPFs as a category; however, food scientists and industry stakeholders argue that it would villainize all forms of processing, even those that are necessary for food safety and quality preservation.

Moreover, some research has suggested that public health and regulatory initiatives targeting UPFs may have unintended consequences—such as penalizing nutrient-dense foods—if definitions for the category and mechanistic understandings of processing are not refined.

“Not to dismiss the value of UPF research to date… [but] If we want to move beyond associational UPF–disease cohort studies and towards a deeper causal understanding of ultra-processing itself, we must recognize the current limitations of the field, whereby causal inconsistency is one of the more important ones,” explained the Aarhus University researchers.