Ultra-processed foods are a part of daily life and make up 60% to 70% of the American diet. This umbrella term covers a wide range of packaged foods, from snacks containing added sugar, salt, and saturated fat, to shelf-stable preservatives, flavor additives, eye-catching colorants, and chemicals such as bisphenols inside the packages. As the name suggests, processed meats also fall into this category.

But not all ultra-processed foods are the same. Whole-grain cereals and breads, yogurts, and some other dairy desserts also fit this label. JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women’s Hospital. Reported in Lancet Regional Health Last month, we conducted an extensive analysis of long-standing studies examining the links between ultra-processed foods and cardiovascular disease. Bottom line: One size doesn’t fit all.

Aiming to fill a gap in what is known about these foods, the researchers drew on data from three prospective cohort studies of more than 200,000 nurses and physicians over three decades and a meta-analysis of 22 international studies with 1.2 million participants. They found a significant increase in the risk of coronary heart disease (23%), overall cardiovascular disease (17%) and stroke (9%) in people who said they consumed the most processed foods, compared to those who said they consumed the least.

On closer inspection, some foods were more tightly linked to higher disease risk: sugar-sweetened beverages and processed meat were associated with higher risk, while breakfast cereals, yogurt, some dairy desserts and whole grains were associated with relatively lower risk.

Manson spoke to STAT about the study’s results last week, following a meeting of the Dietary Guidelines Committee for Americans that did not make recommendations on ultra-processed foods due to a lack of strong evidence. This conversation has been edited for length and clarity.

The committee tasked with making recommendations for U.S. dietary guidelines did not weigh in on ultraprocessed foods because of a lack of evidence. Why is this such a difficult question to answer?

This research was difficult to do because most dietary assessments across different research studies don’t really rigorously classify people based on their ultra-processed food intake. In order to get answers about the prevention of chronic diseases, randomized studies need to be very large and long-term. And that’s why it’s unrealistic.

In the last Lancet Regional Health publication, there were 1.2 million people in the meta-analysis, which is a huge number. This required looking at the relationship between ultra-processed food intake and cardiovascular disease risk, and then looking at the subtypes of ultra-processed foods where we saw diversity. It wasn’t one size fits all.

Were you surprised by what you found?

In fact, we were surprised to find several types of ultra-processed foods linked to a lower risk of cardiovascular disease. We didn’t expect this much diversity among ultra-processed food types.

Can certain types of these foods be part of a healthy diet?

I think we need to recognize that there is complexity and diversity in this relationship between ultra-processed foods and health. It is important to focus on a whole food diet, primarily plant-based. But this does mean that some types of ultra-processed foods can be included in a healthy diet. They do not need to be completely eliminated. There is no need for them to become taboo. We know this doesn’t work with diet rules.

Some of the other foods that fall into the UPF category (breakfast cereals, yogurt, whole grain bread) were not linked to an increased risk of cardiovascular disease in these large epidemiological studies. There may be some latitude in including certain types of ultra-processed foods in a healthy diet and not eliminating them completely. And we’ll see how the evidence accumulates over the next few years.

Should the next round of diet guides reflect this?
I think ultra-processed foods will be included in the 2030 nutritional guidelines. I think it will probably take a few more years to have a sufficient evidence base. But I think it’s moving in that direction, and more and more of the large group studies are being able to look at the relationship between cardiovascular disease, cancer, diabetes, all-cause mortality, cognitive outcomes, depression – many of these really important health outcomes. . Then I think we will have a much broader evidence base.

What can speed up the process?

Research is moving towards looking at more biomarkers of overprocessed intake: not just insulin resistance, glucose tolerance and weight change, but also looking at the impact on the microbiome, metabolomic patterns, changes in the body. DNA methylation markers for the proteome and subsequent epigenetic aging. All of this can be looked at in terms of chronic disease outcomes, and I think this will further accelerate research in this area.

I think there are ways to do random experiments. They probably won’t be like some of the trials we did with 25,000 participants. But these may be trials of 100 people studying changes in weight and changes in some of these biomarkers over several months.

What about alcoholic beverages?

Even moderate alcohol intake and greater risk for cardiovascular outcomes are identified. For example, atrial fibrillation, which has become very common, is linked to alcohol consumption. And hemorrhagic stroke. There are also concerns about breast cancer and other types of cancer. I think research on alcohol and health will increase. And again, just like with ultra-processed foods, it may be another few years before this is more broadly incorporated into guidelines. I think it’s moving in that direction.

We should never advise people who do not currently drink to start consuming alcohol to reduce their risk of heart disease. This is unlikely to improve health and can have very negative effects on health.

Are you seeing progress?

I am hopeful. I think research on dietary patterns is very useful. Identifying certain patterns that allow for flexibility, including some cultural influences and cultural differences, can really make a difference in not forcing people into these very restrictive types of recommendations.

I definitely agree with the recommendations to reduce and minimize ultra-processed foods. And if you’re going to have them, you can lean more toward those associated with lower risk, as opposed to increased risk, or those with neutral associations with cardiovascular disease or other chronic diseases, especially by reducing sugar-sweetened beverages and processed meats. .

Does the increasing use of obesity medications impact any of these guidelines?

I think it’s too early to know. I think we need more research on the long-term effects of GLP-1s. And I still think the composition of the diet will be important. I don’t think the answer will be just to throw medication at these huge chronic health problems. What we need is a much greater focus on prevention.

STAT’s coverage of chronic health conditions is supported by a grant. Bloomberg Philanthropies. Ours financial supporters We are not involved in any decisions regarding our journalism.