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Consumption of more ultra-processed foods corresponded with greater risk of incident cardiovascular disease (CVD) and mortality in the Framingham Offspring Cohort.

Each additional daily serving of these foods was associated with worse outcomes -- independent of a person's energy intake, adiposity, and other cardiovascular risk factors -- researchers found in their study of more than 3,000 people over age 18:

• Hard CVD (coronary death, myocardial infarction [MI], and stroke): adjusted HR 1.07 (95% CI 1.03-1.12)

• Coronary death and MI: adjusted HR 1.09 (95% CI 1.10-3.28)

• Overall CVD: adjusted HR 1.05 (95% CI 1.02-1.08)

• CVD mortality: adjusted HR 1.09 (95% CI 1.02-1.16)

"In contrast to previous studies, we did not observe an association between ultra-processed food consumption and total mortality," Niyati Parekh, MS, PhD, RD, of New York University's School of Global Public Health in New York City, and colleagues wrote online in the .

Ultra-processed foods provide 58% of daily calories in the average U.S. diet, the researchers noted, identifying bread, meat, and soft drinks in particular as potential drivers of poor cardiovascular outcomes.

The study helps fill the "void" of evidence that could inform cardiovascular guidelines on ultra-processed food consumption, said Robert Ostfeld, MD, MSC, of Montefiore Health System in New York City, and Kathleen Allen, MS, RD, of Geisel School of Medicine at Dartmouth in Hanover, New Hampshire, writing in an .

They urged "timely action" to curb consumption of these foods.

"From a public health perspective, our study suggests the need for increased efforts to implement population-wide strategies," Parekh and colleagues said. "These strategies may include fiscal measures, such as taxation of sugar-sweetened beverages and other ultra-processed foods, and recommendations regarding processing levels in national dietary guidelines."

"Importantly, policies should be designed to simultaneously increase the availability, accessibility, and affordability of nutritious minimally processed foods, especially in disadvantaged populations," the researchers said.

They added that clinicians can play their part too by providing evidence-based nutrition counseling to patients with the goal of designing individualized, patient-centered, heart-healthy diets.

"Ultimately, the goal should be to make the unhealthy choice the hard choice and the healthy choice the easy choice," Ostfeld and Allen said.

Framingham Offspring Cohort participants included in the study were 3,003 adults free from CVD at baseline (mean age 53.5 years, 55.1% of whom were women). Follow-up entailed clinical examinations and food frequency questionnaires administered every 4 years from 1991 to 2008.

Each person ate, on average, 7.5 energy-adjusted servings of ultra-processed foods per day at baseline.

The study was limited by its predominantly Caucasian population with higher levels of education and income than the general U.S. population, the researchers noted. Additionally, potential dietary measurement error and unmeasured confounding could not be excluded.

Nevertheless, the findings are generally consistent with the literature, including the smaller cohort.

Parekh and colleagues said that biological mechanisms behind the link between ultra-processed foods and CVD likely go beyond higher energy intakes and weight gain, given that the study controlled for these factors.

Other plausible mechanisms may be related to high intake of food components associated with heart disease (e.g., trans fats, sodium, and sugar), as well as additives that disrupt microbiota integrity and promote arterial calcification and oxidative stress.

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