Each daily serving of ultraprocessed foods raises the risk of a stroke, heart attack or cardiac arrest by 5%. That was the stark finding of a study published last month in the Journal of the American College of Cardiology, and it’s the latest research showing an association between industrially-made foods and health problems including diabetes, heart disease and obesity. 

From breakfast cereals to chicken nuggets to candy bars, ultraprocessed foods are mass-produced products that contain ingredients such as preservatives, emulsifiers and other additives that you wouldn’t find in a home kitchen.

Though some countries have policies aimed at reducing consumption of ultraprocessed foods, there is still a scientific debate about the root causes of the global epidemic of diet-related disease.

The food industry and some independent academics have argued that the category of ultraprocessed foods is too broad to be meaningful because it encompasses everything from soda and processed meats, which have well-known health risks, to more nutritious foods like whole-grain breads. Some experts say it’s misguided to focus on foods’ processing levels when other factors, such as density of calories or amount of sugar, salt or fat, are the true culprits. These arguments have often stalled or blocked policies meant to crack down on highly processed foods or promote whole foods.  

In a statement sent to The Examination, the Consumer Brands Association, a U.S. industry group for manufacturers of food, beverages and other packaged consumer goods, said there is no agreed-upon scientific definition of ultraprocessed foods and that companies adhere to federal safety and nutrition standards. Unfounded fears over these foods could leave American families with fewer choices and higher bills, a spokesperson said. 

Neha Khandpur, a professor at Wageningen University in the Netherlands, has written extensively about ultraprocessed foods and cardiac health, including co-authoring a major 2024 study that also found links to cardiovascular disease. We asked her to explain the latest science on ultraprocessed foods and heart disease and to tell us what it means for policymakers and everyday consumers.

The following interview has been edited for length and clarity.

I wanted to start with this recent study that has this very concrete, alarming finding about the added risk of cardiac events from each daily serving of ultraprocessed foods. How do you interpret this finding and how does it compare to your own research?

It was very interesting to read about yet another group of study participants, this time a more diverse sample, replicating a pattern that I think we've seen pretty consistently. This is a pattern that we have seen replicated across different samples, across different regions, within the U.S. but also globally.

It's essentially saying there is something about this cluster of seemingly diverse foods and beverages, when people are consuming large portions, that's likely to lead to adverse health consequences.

We've looked at Type 2 diabetes, chronic kidney disease, overweight or obesity, coronary heart disease or mortality, cardiovascular disease or mortality. Diets that are high in ultraprocessed foods compared to low-ultraprocessed foods are at a consistent, increased risk. There's always uncertainty, and there's always a range of increase in risk, but it is undeniably in the same direction.

Increasing caloric consumption is a very clear mechanism. When you have more ultraprocessed foods in your diet, you're likely to be consuming more calories. There are nutrient imbalances: increased added sugars, increased saturated fats. We also have decreased fiber and decreased micronutrients that are protective: potassium, zinc, magnesium. 

How strong would you describe the link between ultraprocessed foods and cardiovascular disease based on the current science? Is this a theory, is it an emerging pattern, or is this something that is well-established at this point?

When I look at the totality of evidence from the field of nutrition science, I think the evidence is strong enough for us to act on this. This is beyond emerging. This needs policy intervention. That is how convinced I am of the direction and the magnitude and the importance of what we're seeing here.

Your study and the recent study in the Journal of the American College of Cardiology found that ultraprocessed foods overall are associated with cardiac risks. When your group broke it down, those risks were strongly associated with processed meats and sugary beverages — but not breakfast cereals and yogurt, which reduced those risks. Are there specific types of products that are driving these negative cardiac effects?

There is no one uniform product. A Coke, for instance, is a plant-based product because it has no ingredient from an animal source. So a Coke could potentially fall within the umbrella of plant-based food, as could a homemade pot of lentils.

Ultraprocessed foods are similarly diverse. What unifies them is that they're all ready to heat, ready to eat, industrially processed products that have additives and ingredients that we wouldn't have otherwise added had these been cooked from scratch. They're also packaged, marketed, produced a certain way. So there's a lot of similarities within them, but that doesn't mean that one ultraprocessed item is identical to the other and therefore has identical health risks. What we're trying to say is that it's the sum total of all of the different ultraprocessed foods that you consume that is of concern. 

From a consumer perspective, do we know which types of ultraprocessed foods are worse for us?

We would prioritize targeting some ultraprocessed foods over others. For instance, sugar-sweetened beverages are a very clear target for policy because they provide very little else beyond fluid and sugar. And we know that at the population level, we're overconsuming sugar. Those are easier products to target, and I think there's going to be more political consensus to targeting those than, say, some of the not-so-sweet breakfast cereals and the whole-grain breads that are an important source of fiber in American diets.

There are parallels to alcohol and how alcoholic products are regulated. There's a continuum: Certain products with high alcohol content and higher risk for ill health are targeted differently than lower alcohol-containing products. That model is what we could potentially look to in addressing ultraprocessed food consumption.

Another striking finding from the study published last month is that Black Americans had a higher added risk of cardiac events from eating ultraprocessed foods than other ethnic groups. Are certain populations especially at risk from eating these products, and if so, why?

The food environment is experienced differently by different groups of people. In general, those who have fewer resources are more likely to consume something that is ready to heat and ready to eat, which is oftentimes ultraprocessed food. In the U.S., you see a higher prevalence of marketing in more deprived neighborhoods. They have a higher consumption of ultraprocessed foods and a higher risk of adverse health effects.

At the global level, there is one pattern that is exceptionally clear and very hard to ignore: There are more consumers of ultraprocessed foods at younger ages than there are at higher ages. Children and adolescents are the largest consumers of ultraprocessed foods.

Some researchers who are connected to the food industry are doing studies on ultraprocessed foods. What kinds of scientific arguments are these researchers making and does that influence policy?

I've actually written a paper on this, which should be published soon. A lot of the arguments that we see are that the category of ultraprocessed foods is so diverse that we aren't entirely sure which one mechanism is driving health risks. 

I think those arguments are distracting because we don't expect food to act like we expect medication, which is a single compound, to act. For instance, we don't expect that one single mechanism drives the benefits that we see from consuming a Mediterranean diet. There is variety there, much like there is within the ultraprocessed food diet. 

The impact of that distraction is to basically stall dialogue on policy. And stalling dialogue on policy only benefits the food industry because you are continuing with the status quo, and the status quo is exactly what the food industry wants. 

The beauty of ultraprocessed products, unlike cigarettes or alcohol, is that there exists a natural substitute. That is what we've been trying to promote through decades of research in nutrition science, and what a lot of our dietary guidelines talk about as well — to consume whole foods.

You’ve said some of the science on these products is being misinterpreted by the food industry and by some academics. What kinds of misinterpretations have you seen?

There's a lot of talk like, it isn't ultraprocessing, it is relative amounts of salt, sugar and fat among other nutrients. It's not ultraprocessing, but it's the texture of the product. It's not ultraprocessing, but it's the energy consumption rate — you eat these products faster. And I say this is misinterpreted because the question is not: Is it ultraprocessing or nutrition, ultraprocessing or texture, ultraprocessing or energy density that is leading to ill health? It is unlikely that it is one thing that is driving all of the health impacts we see. 

Why is winter associated with depression? You can focus on the cold or the snow or the gray, or you could say that it's a combination of all of that. Winter encompasses so many more dimensions than just looking at individual elements of it.

To take it one step further, that simplification has deep policy impacts. Because if we really believe that it only is the sugar, or only is the texture, or only is one dimension of this whole, then that's all we ever target through policy. And that is what we've always done. 

It's a disservice to say that all we need to do is limit one dimension of food and our problems will be solved. That's absolutely been shown time and time again to be untrue.