review · Critical Reviews in Food Science and Nutrition
Higher consumption of ultra-processed food links to increased cardiovascular disease and hypertension risk, but methodological rigour varies significantly across studies. A systematic review and meta-analysis of forty-six eligible studies evaluated dietary assessments, classification systems, and statistical modelling. Substantial heterogeneity was identified in how the NOVA classification was applied to categorise ultra-processed foods. Furthermore, most studies featured suboptimal adjustment or overfitting through the inclusion of potential mediators, with only two employing directed acyclic graphs to guide confounder selection. Pooled analyses revealed that higher ultra-processed food intake is associated with a 9% increased risk of cardiovascular disease and a 16% increased risk of hypertension, with even stronger links to coronary heart and cerebrovascular diseases. Existing methodological weaknesses may weaken the observed associations, highlighting the necessity for standardised food classification and stronger causal frameworks.
Cardiovascular diseases and hypertension represent major global health burdens. While evidence links ultra-processed foods to these conditions, weaknesses in research design and food classification make it difficult to determine the exact degree of risk. Improving methodological rigour ensures that future public health recommendations, dietary guidelines, and clinical advice are founded on robust and accurate scientific evidence.
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Despite growing research linking ultra-processed food (UPF) consumption to risk of cardiovascular disease (CVD) and hypertension, no study has systematically evaluated the methodological rigor underlying these associations. We systematically searched major databases to identify eligible studies. Data were extracted for dietary assessment methods, UPF classification, covariate selection, confounding control, statistical modeling and effect estimates. Random-effects meta-analysis was conducted to pool effect estimates. Meta-regression and sensitivity analyses were performed to explore sources of heterogeneity. Substantial heterogeneity was observed in the application of the NOVA classification for categorizing UPFs across the 46 eligible studies. Only two studies employed a directed acyclic graph to inform confounder selection; 42 used models with suboptimal adjustment, and 38 were overfitted due to adjustment for potential mediators. Pooled analyses indicated that higher consumption of UPFs was associated with a 9% higher risk of CVD and a 16% higher risk of hypertension, with stronger associations observed for coronary heart and cerebrovascular diseases. While higher UPF intake is consistently associated with increased risks of CVD and hypertension, methodological limitations may attenuate the observed associations. Strengthening methodological rigor through harmonized UPF classification and causal frameworks is essential to better elucidate the effect of UPF consumption on cardiometabolic health.
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DOI: 10.1080/10408398.2026.2719168
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