Cohort studyindependent cross-checkabstract checked I-UPF-106 standard review
Ultra-processed foods and heart disease
Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies.
Overview
Mendoza K et al.. Lancet Reg Health Am 2024 · PMID 39286398 · DOI 10.1016/j.lana.2024.100859
People eating the most ultra-processed food had 11% more cardiovascular disease; sweet drinks and processed meats drove the link, while some UPF like cereals and yoghurt did not.
Does the study support the specific claim? Partly · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
To link UPF with cardiovascular disease.
- How was the study done?
Three cohorts plus meta-analysis.
- How many people, animals or samples were studied?
About 207,000 adults; 22 studies.
- What was actually found?
Higher CVD and CHD risk with more UPF; differences by food group.
- How large was the observed effect?
CVD HR 1.11 (1.06-1.16).
- What do the results mean in everyday life?
Cutting sugary drinks and processed meat matters most.
- What are the study's limitations?
Observational.
- What does it say about Elawady's specific claim?
Supports C-UPF-03 for CVD.
- Do the results apply to Germany and Europe?
Includes European data.
- What can explicitly not be concluded from this study?
Cannot prove causation.
Scientific in-depth review
1. Full reference
- Authors
- Mendoza K et al.
- Journal
- Lancet Reg Health Am
- Year
- 2024
- Identifier
- PMID 39286398 DOI 10.1016/j.lana.2024.100859 · PMC11403639
- Verification
- verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
COI statement in record: The authors declare no conflict of interest.
2. Research question
Are total and group-specific UPF intakes associated with CVD, CHD and stroke?
3. Study design and population
- Study design
- Cohort study – Three prospective cohorts (NHS, NHSII, HPFS) plus systematic review and meta-analysis of 22 prospective studies
- Population
US adults (cohorts); multinational (meta-analysis)
- Country
USA; multinational
- Period
Literature to 5 April 2024
- Sample size
206,957 in cohorts (16,800 CVD cases); 22 studies in meta-analysis
- Inclusion and exclusion criteria
Prospective studies
4. Methods and endpoints
- Exposure / intervention
Total and group-specific UPF
- Comparator
Lowest intake
- Endpoints
CVD, CHD, stroke
- Statistical methods
Cox models pooled by fixed effects; random-effects meta-analysis; NutriGrade
5. Actual results
- Results
Cohorts, highest vs lowest quintile: CVD HR 1.11 (1.06-1.16), CHD 1.16 (1.09-1.24), stroke 1.04 (0.96-1.12). Sugar-/artificially sweetened drinks and processed meats associated with higher CVD; bread/cold cereals, yoghurt/dairy desserts and savoury snacks inversely associated. Meta-analysis: CVD +17% (11-24%), CHD +23% (12-34%), stroke +9% (3-15%); meta-evidence high for CHD, moderate for CVD, low for stroke.
- Absolute risks
not reported in abstract
- Authors' conclusion
Total UPF intake was adversely associated with CVD and CHD risk; group-specific UPF showed divergent associations.
6. Strengths
- Large cohorts + updated meta-analysis
- Subgroup analysis
7. Weaknesses
- Observational
- Overlap between cohorts and meta-analysis
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Observational.
9. Assessment of the statistical interpretation
Consistent modest associations; subgroup heterogeneity important.
10. Relevance to the specific claim
Supports CVD association of total UPF; shows that some UPF groups are neutral or inversely associated.
11. Independent contrary findings
I-UPF-105 Fang for mortality.
12. Transferability to Germany and Europe
Meta-analysis includes European cohorts.
13. Overall methodological judgement
Supports the CVD part of C-UPF-03 as an association.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Causal mechanisms.