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Not all ultra-processed foods are created equal: a review
Hana Kahleova1,2, Joseph Himmelfarb1, Neal D Barnard1,3
1Physicians Committee for Responsible Medicine, Washington, District of Columbia, USA.
BMJ Nutrition, Prevention & Health
|August 1, 2026
Summary
Ultra-processed foods show mixed health impacts. Some increase cardiometabolic disease risk, while others, like breads and cereals, may lower it, suggesting processing type matters.
Area of Science:
- Nutrition Science
- Public Health
- Food Science
Background:
- The Nova system categorizes foods by processing degree, with 'ultra-processed' indicating extensive modification.
- Ultra-processed foods exhibit heterogeneous associations with chronic diseases, impacting public health policy.
- Existing research highlights varied health outcomes linked to different ultra-processed food categories.
Purpose of the Study:
- To review and summarize studies on the association between ultra-processed foods and cardiometabolic disease risk.
- To analyze how different sub-groups of ultra-processed foods impact health outcomes.
- To inform potential improvements to the Nova classification system.
Main Methods:
- Systematic literature search of PubMed yielding 309 records.
- Inclusion of 14 publications that differentiated between ultra-processed food groups.
- Analysis of associations between specific ultra-processed food categories and cardiometabolic risks.
Main Results:
- Processed meats, sweetened beverages (sugar and artificially), fats, spreads, and sauces are positively associated with adverse health outcomes.
- Breads, biscuits, breakfast cereals, and whole grains, despite being processed, show associations with reduced risk.
- Randomized trials indicate health benefits from replacing animal-based with plant-based foods, even processed ones.
Conclusions:
- The Nova system's broad 'ultra-processed' category requires refinement.
- Differentiating between animal-based and plant-based ultra-processed foods is crucial for accurate health risk assessment.
- Dietary guidelines may need to consider the source (animal vs. plant) and specific type of processing for ultra-processed foods.
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