Ultra-processed foods are a major public health concern for their potential adverse effects on health. Now a study by the Department of Epidemiology and Prevention of the I.R.C.C.S. Neuromed in Pozzilli (Italy) explores the health effects of a large dietary share of ultra-processed food on people already suffering from cardiovascular diseases.

The findings indicate a higher risk of a second heart attack (or stroke), this time fatal. Moreover, another observation emerges from this study: even in people generally following the Mediterranean diet, but consuming too many ultra-processed foods, health risks are higher.

The study, published in the European Heart Journal, the European Society of Cardiology journal, followed 1,171 people participating in the Moli-sani epidemiological project for over ten years. All of them already had cardiovascular disease at the time of inclusion in the study.

Regarding the diet followed by participants, the researchers focused on the consumption of ultra-processed foods, made in part or entirely with substances not routinely used in cooking (hydrolysed proteins, maltodextrins, hydrogenated fats, for example) and which generally contain various additives, such as dyes, preservatives, antioxidants, anticaking agents, flavour enhancers and sweeteners.

This category includes sugary and carbonated drinks, pre-packaged meals, spreads and some apparently "unsuspected" products, such as rusks, breakfast cereals, crackers and fruit yoghurt. These foods were classified using the NOVA system, which rates foods according to the degree of processing rather than on their nutritional value.

We saw that people with a higher consumption of ultra-processed foods have a two-thirds increased risk of a second heart attack or stroke, this time fatal, compared to participants eating these foods less frequently. The probability of dying from any cause is also 40% higher. It is important to underline that the definition of ultra-processed food is not linked to the nutritional content, but rather to the process used for its preparation and storage. In other words, even if a food is nutritionally balanced, it might still be considered ultra-processed. Clearly, it is not the single food consumed occasionally that makes the difference, rather a diet that, as a whole, contains too many products coming from supermarket shelves. A diet based on the consumption of fresh, minimally processed products should be always preferred, as the Mediterranean tradition has been teaching us for centuries".

Marialaura Bonaccio, Study First Author and Researcher, Department of Epidemiology and Prevention, Instituto Neurologico Mediterraneo Neuromed

"This study – says Licia Iacoviello – Director of the Department of Epidemiology and Prevention at Neuromed – conveys an important message: it is time to overcome the distinction between healthy and unhealthy food solely on the basis of the nutrient value. In other words, a person could follow a Mediterranean diet, perhaps rich in legumes or vegetables, a healthy diet we would say. But the simple definition of 'Mediterranean' does not tell us 'how' those foods were prepared. Fresh vegetables are not the same as pre-cooked and seasoned vegetables, and the same goes for many other foods. It is a factor to be increasingly considered when advising citizens about proper nutrition. Our proposal is that the level of industrial processing of foods should be added to the front-of-pack labels, which until now only provide nutritional information".