Ultra-Processed Foods and Cardiometabolic Risk: From Evidence to Policy

Ultra-Processed Foods and Cardiometabolic Risk: From Evidence to Policy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF comment Ultra-Processed Foods and Cardiometabolic Risk: From Evidence to Policy Hayley O'Neill This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8430013/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Ultra-processed foods (UPFs) dominate diets in high-income countries and pose health risks beyond nutrient composition. Controlled trials show UPF-rich diets increase energy intake and weight gain. Mechanisms include high energy density, disrupted food matrices, faster eating rates, additives affecting gut, and hyper-palatable formulations. Observational evidence associates higher UPF intake with obesity, cardiovascular disease, type 2 diabetes and all-cause mortality. This Comment outlines evidence and policy strategies to reduce UPF exposure. Health sciences/Diseases Health sciences/Endocrinology Health sciences/Health care Health sciences/Risk factors Introduction Ultra-processed foods (UPFs) account for a substantial share of daily energy in the US, UK, Canada, Australia, and across Europe, with health impacts that extend beyond nutrient content 1 , 2 . Although the term “UPF” lacks universal definition, NOVA classification system is most widely used, distinguishing UPFs by their processing and use of additives 3 . UPFs are industrial formulations composed of fractionated ingredients (eg. refined starches, hydrogenated oils, protein isolates, high-fructose corn syrup) combined with cosmetic additives (eg. emulsifiers, flavours, colours, preservatives, sweeteners) and subjected to industrial processes such as extrusion and pre-frying 3 . These techniques enhance palatability, convenience, affordability, and shelf life, exemplified by products like breakfast cereals, sugar-sweetened beverages (SSBs), packaged bakery items, mass-produced bread, and ready-made meals 3 . While processing has improved preservation and access, growing evidence suggests that the degree and purpose of processing may independently disrupt appetite regulation, gut microbiota, and metabolic signalling contributing to elevated elevate cardiometabolic risk 2 , 4 , 5 . As global UPF sales continue to rise, understanding these implications is critical for effective nutrition policy 2 , 3 . Evidence at a Glance Observational syntheses Overviews of reviews and systematic reviews generally report positive associations between higher UPF intake and obesity, type 2 diabetes, cardiovascular disease, and all-cause mortality; certainty ranges from weak to moderate depending on design and bias assessment 2 , 6 . Some reviews (eg. Monteiro 2025 2 ) have not applied standardized frameworks (e.g., GRADE (Grading of Recommendations Assessment, Development and Evaluation)) to formally assess all of the evidence reviewed) or ROBINS-E (Risk of Bias In Non-randomized Studies of Exposure) despite being more appropriate for dietary exposure studies than commonly used Newcastle-Ottawa Scale; limiting transparent evaluation and risking overstatement of findings from predominantly observational studies 7 . Burden-of-Proof reappraisal A recent Burden-of-Proof study examined the health risks of processed meats, SSBs, and trans fats 8 . This approach uses Bayesian meta-regression to model dose-response relationships relative to zero intake, establishing conservative risk estimates while accounting for between-study heterogeneity. The findings indicate that consumption of processed meat (upto 57 g/day) is associated with 11% higher type 2 diabetes risk and 7% higher colorectal cancer risk; SSBs (upto 390 g/day) with 8% higher type 2 diabetes risk and 2% higher ischaemic heart disease (IHD) risk; and trans fats (upto 2.5% of daily energy) with > 3% higher IHD risk 8 . Most ratings were “two-star,” indicating weak or inconsistent evidence, yet continued limitation remains prudent and aligns with current guidance (e.g., free sugars < 25 g/day [~ 6 tsp], SSBs < 1 serving/week [~ 200–355 mL], TFAs < 2% energy) 8 , 9 . Important limitations include potential residual confounding from unmeasured variables (e.g., total energy intake) and reliance on self-reported dietary intake despite statistical adjustment 8 , 10 . Select Randomized Controlled Trials (RCTs) UPF feeding trials remain limited (n ≈ 10–55; duration 2 days–8 weeks) but converge on unfavourable acute effects on energy intake and weight 11 – 16 . In Hall’s landmark inpatient crossover RCT (n = 20 overweight; 2 weeks), UPF diets yielded ~ 500 kcal/day greater intake and ~ 0.9 kg weight gain versus unprocessed diets, despite matched calories, macronutrients, sugar, sodium, and fibre 11 . The UPDATE trial (crossover RCT; n = 55 overweight/obesity; 8 weeks) extended these findings under UK Eatwell Guide conditions: ad libitum minimally processed food (MPF) patterns produced greater weight loss (− 2% vs − 1%) and improvements in LDL-cholesterol, apoB, and HbA1c versus UPF patterns, under matched nutrient targets 17 . These trials provide high-quality data on short-term responses, yet are limited by: small sample sizes and durations, lack of formal risk of bias assessment, specific populations and settings (overweight/obesity, inpatient vs free living, affecting generalisability), challenges in dietary assessment methods and adherence monitoring, and logistical and financial demands of all-food provision, collectively reducing statistical power to detect modest clinical effects 11 , 17 . How Processing Drives Risk (Proposed Mechanisms) Energy density & eating rate UPFs are typically softer, energy-dense, and faster to consume, enabling excess intake before satiety signals register, with potential implications in modifying gut-brain axis 18 . Experimental meals classified as “soft UPF” (eg. coleslaw vs steamed vegetables) increase energy intake versus “hard MPF” (eg. boiled rice vs potato fries) comparators in 50 healthy-weight participants (4 ab libitum meals, each separated by > 7d) 15 . Reduced chewing frequency per calorie correlates with higher intake (~ 814 kcal/day) and short-term weight gain (1.1 kg in one week) in crossover RCT involving 50 adults with overweight/obesity 14 . Protein leverage Small reductions in dietary protein percentage (e.g., 14% vs 15–16%) can trigger compensatory intake of fat and carbohydrate, elevating total energy intake; consistent with excess intake observed in UPF vs MPF diets 11 , 19 . Lower protein may also reduce satiety-linked branched-chain amino acids and blunt energy expenditure 20 . However, protein enrichment of UPFs (30% versus 13%, crossover RCT, n = 21 healthy/overweight, 54hours) only modestly reduced energy intake (likely due to slower eating rate) but not overeating 13 . Food matrix & additives Industrial processing disrupts natural matrices, increasing nutrient bioavailability while reducing delivery of intact fibre to the distal gut, diminishing substrates for fermentation and impairing short-chain fatty acid and satiety hormone production (eg. Glucagon-like peptide) 4 . Emulsifiers (e.g., carboxymethylcellulose, polysorbate-80) may compromise gut barrier integrity and promote low-grade inflammation in experimental models, with human data emerging 10 , 21 . High-fructose corn syrup (HFCS) and free sugars HFCS, an industrial sweetener (42–55% fructose), widely added to SSBs and processed foods, promotes hepatic de novo lipogenesis, dyslipidaemia, and fatty liver, with lower energy efficiency and blunted insulin/leptin responses relative to glucose, reducing satiety and energy expenditure 22 . Fructose metabolism may elevate uric acid, contributing to insulin resistance and hypertension; however, recent systematic reviews show little effect on energy intake or cardiometabolic markers when fructose replaces glucose/sucrose, though substantial heterogeneity limits firm conclusions 22 . Trans fatty acids (TFAs) TFAs (unsaturated fats with trans double bonds) arise mainly from partially hydrogenated oils (PHOs) in margarine and many processed foods (e.g., pastries, fried fast foods, popcorn). TFAs raise LDL, lower HDL cholesterol, impair endothelial function and fatty acid metabolism, increase inflammation, and elevate risks of CVD and all-cause mortality; even intakes > 1% energy increase CHD risk 23 – 25 . TFAs are banned in many countries (Denmark, EU, US, UK, Canada), but not Australia 23 . Hyper-palatability & reward Many UPFs are engineered with supernormal combinations of fat, sugar, salt, and flavour additives that reinforce overconsumption and may elicit addiction-like eating 4 , 26 . Common UPF macro-combinations include: fat and sugar (> 20% of calories from each); carbohydrates and sodium (> 40% of calories from carbs and ≥ 0.20% sodium by weight); fat and sodium (> 25% of calories from fat and ≥ 0.30% sodium by weight)) 26 . Evidence on non-nutritive sweeteners and metabolic outcomes (obesity, weight gain, insulin sensitivity, glycaemic control, and gut permeability) is mixed and context-dependent 27 . Brain and endocrine signals Cohort neuroimaging studies show higher UPF intake is associated with reduced volumes in reward-related and cortical regions of brain 28 . Packaging/thermal processing may increase exposure to potential endocrine disruptors (phthalates, bisphenols, acrylamide), though causal pathways require stronger human evidence 4 . Diet quality UPF-rich diets are typically lower in protective compounds (anti-inflammatory nutrients, flavonoids) and associated with poorer overall diet quality 29 , 30 . Improving diet quality (e.g., increasing vegetables and fruit) may attenuate metabolic effects of UPFs 31 – 33 Challenges for Assessment and Policy Defining ultra-processing. NOVA (Group 4 for UPFs) is widely used but broad; heterogeneity invites misclassification and debate yet remains practical for surveillance and policy 3 , 34 . Measuring intake. Free-living assessments rely on self-report (FFQ, 24-hour recall), with measurement error, residual confounding, incomplete ingredient data, and rapidly evolving food supplies complicating classification. Objective biomarkers/ “omics” platforms and AI-assisted tools could strengthen epidemiology and trials 8 , 10 , 35 , 36 . Socioeconomic realities. UPFs are often cheaper and more accessible than MPFs (e.g., $ 106/week vs $ 151/week for 2,000 kcal/day in one comparison), so policies must avoid widening inequities 11 . Reductionism. Processing level and nutrient quality should be considered together; focusing solely on either risks oversimplification. Some UPFs (e.g., certain wholegrain breads, low-sugar yoghurts, tomato sauces, nut/bean spreads) can contribute to healthy patterns and affordability and should be monitored and reformulated if harms emerge 37 . Implications for Dietary Guidelines In the US, the 2025–2030 Dietary Guidelines Advisory Committee judged UPF evidence too limited for formal recommendations given definitional and exposure inconsistencies, and re-emphasised pattern-based guidance limiting processed meats, saturated fat, and added sugars (including SSBs) 38 . Several countries already address UPFs explicitly or implicitly: Brazil advises avoiding UPFs 39 ; Uruguay promotes fresh/minimally processed patterns 39 ; Israel prioritises home-cooked minimally processed foods and limiting highly processed items 40 ; France limits charcuterie/SSBs but cautions against relying solely on processing classifications 41 , 42 ; Spain (AESAN, 2022) integrates healthy/sustainable advice 39 ; the UK SACN maintains a cautious stance, emphasising nutrient-based limits on fat, salt, and sugar as UPF-outcome associations may overlap with existing advice 4 , 43 ; Australian dietary guidelines are currently under review 44 . Professional societies converge on pattern-based dietary recommendations: the American Heart Association (AHA) advises choosing MPFs over UPFs within heart-healthy diets and recommends replacing most UPFs with healthier options (eg. vegetables, fruits, whole grains, beans, nuts, seeds, healthy oils, and lean proteins) for cardiometabolic health 37 , 45 . While AHA acknowledges labelling foods as “ultra-processed” can be misleading when nutrient-dense items are also included (eg. nut butters) and assessing risks from processing techniques beyond nutrient quality remains challenging, as high UPF diets typically have poor overall quality and high-quality diets rich in UPFs are rare 37 . On specific risk components, industrial TFA (iTFA) elimination is a proven, high-impact action (e.g., Denmark’s TFA legislation reduced CVD mortality, promoting global action including WHO’s “REPLACE” initiative and bans across Europe, and US PHO elimination) 23 , 45 . Australian modelling indicates a national iTFA ban would be cost-effective and prevent thousands of IHD events, yet such bans are not legislated 46 . Finally, broader health-and-sustainability syntheses (e.g., EAT–Lancet) support planet-forward, minimally processed dietary patterns to reduce premature mortality and food-system emissions 47 . Beyond Individual Choice: A Systems Approach Evidence on UPFs demands a shift from personal responsibility to systemic change. Despite decades of policy approaches centered on personal responsibility (eg. calorie counting, nutrition education campaigns), obesity rates continue to rise in the US, UK, and Australia, where UPFs supply 40–60% of energy intake 2 , 4 . This failure reflects a mismatch between intervention strategies and root cause: food environments, not knowledge, shape diets. UPFs are engineered for palatability and profit, while minimally processed foods cost more. Meaningful progress requires structural solutions (pricing, marketing restrictions, procurement standards, and labelling) to make healthier choices accessible and affordable. Research Priorities and the Path to Action Disaggregate UPFs to identify attributes driving risk (matrix softness, energy density, additive classes, or their interactions); ongoing trials (e.g., UPDATE) will help 12 . Develop objective exposure biomarkers and harmonised trial protocols to improve reproducibility and generalisability. Reformulation : incentivise industry to reduce harmful attributes (e.g., specific emulsifiers, added sugars, sodium, iTFAs) while preserving affordability and convenience. Pragmatic trials at scale to evaluate real-world implementation and impacts on population health; behaviour change interventions aimed at reducing UPF intake may yield greatest benefit in those at greater risk/ higher UPF intake 48 . From Evidence to Action: A Multi-Pronged Playbook Guidance : integrate processing level alongside nutrient content; offer practical swaps and preparation tips for time- and budget-constrained households. Procurement & pricing : leverage schools/hospitals/public programmes to improve availability and affordability of MPFs; pair with front-of-pack labelling that includes processing cues. Industry standards : set targets for added sugars, sodium, and select emulsifier classes; prioritise categories with strongest evidence of harm (processed meats, SSBs, TFAs) 8 . Protect children : implement comprehensive marketing restrictions for HFSS/UPF products across media, aligned with WHO 2023 guidance 49 . Food literacy : invest in community-co-designed cooking and food skills programmes, tailored to vulnerable populations. Evaluate : fund longer, pragmatic trials to test real-world roll-outs focusing on improving overall dietary patterns. Conclusion Controlled feeding trials demonstrate that processing per se can drive excess calorie consumption and adverse metabolic responses. Observational studies associate high UPF intake with obesity, cardiometabolic disease and all-cause mortality across diverse populations. The question is no longer whether UPFs harm health, but how policymakers will confront commercial pressures and redesign food systems so that healthier, minimally processed options become the default; affordable, accessible, and convenient. Integrating processing considerations into dietary guidelines alongside nutrient-based recommendations offers a pragmatic path forward. While complete avoidance of UPFs is unrealistic, feasible reductions supported by policy represent a necessary public-health imperative. Declarations Acknowledgments The author thanks Dianne Reidinger, Sharon Sanders, and Tiffany Atkins for helpful review and feedback. Authors information Author & Affiliation Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia Hayley M. O’Neill Funding This research received no external funding. Competing Interests H.O. declares no competing interests. Author Contributions H.O. conceptualised and drafted the original manuscript. H.O. edited, reviewed and approved final manuscript. Corresponding author Correspondence to Hayley M O’Neill [email protected] References Coyle, D. H. et al. Socio-economic difference in purchases of ultra-processed foods in Australia: an analysis of a nationally representative household grocery purchasing panel. Int J Behav Nutr Phys Act 19, 148 (2022). https://doi.org:10.1186/s12966-022-01389-8 Monteiro, C. A. et al. Ultra-processed foods and human health: the main thesis and the evidence. The Lancet https://doi.org:10.1016/S0140-6736(25)01565-X Monteiro, C. A. et al. Ultra-processed foods: what they are and how to identify them. 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Supplementary Files UPFnpjMetabolicHealthandDiseaseHayleyONeillFINALGraphicalabstract.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 19 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviews received at journal 01 Mar, 2026 Reviewers agreed at journal 26 Feb, 2026 Reviewers agreed at journal 24 Feb, 2026 Reviewers agreed at journal 22 Feb, 2026 Reviewers invited by journal 14 Jan, 2026 Editor assigned by journal 29 Dec, 2025 Submission checks completed at journal 28 Dec, 2025 First submitted to journal 22 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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17:40:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":841545,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8430013/v1/88e06e41-5fa7-490f-985a-d39cb43fc3e5.pdf"},{"id":100613271,"identity":"5297b8f2-919f-461f-a19f-1e6189165853","added_by":"auto","created_at":"2026-01-19 17:05:24","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":2234110,"visible":true,"origin":"","legend":"","description":"","filename":"UPFnpjMetabolicHealthandDiseaseHayleyONeillFINALGraphicalabstract.docx","url":"https://assets-eu.researchsquare.com/files/rs-8430013/v1/095bc68a5814e9b4bbd71d60.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eUltra-Processed Foods and Cardiometabolic Risk: From Evidence to Policy\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUltra-processed foods (UPFs) account for a substantial share of daily energy in the US, UK, Canada, Australia, and across Europe, with health impacts that extend beyond nutrient content \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Although the term \u0026ldquo;UPF\u0026rdquo; lacks universal definition, NOVA classification system is most widely used, distinguishing UPFs by their processing and use of additives \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. UPFs are industrial formulations composed of fractionated ingredients (eg. refined starches, hydrogenated oils, protein isolates, high-fructose corn syrup) combined with cosmetic additives (eg. emulsifiers, flavours, colours, preservatives, sweeteners) and subjected to industrial processes such as extrusion and pre-frying \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. These techniques enhance palatability, convenience, affordability, and shelf life, exemplified by products like breakfast cereals, sugar-sweetened beverages (SSBs), packaged bakery items, mass-produced bread, and ready-made meals \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. While processing has improved preservation and access, growing evidence suggests that the degree and purpose of processing may independently disrupt appetite regulation, gut microbiota, and metabolic signalling contributing to elevated elevate cardiometabolic risk \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. As global UPF sales continue to rise, understanding these implications is critical for effective nutrition policy \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eEvidence at a Glance\u003c/h3\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eObservational syntheses\u003c/h2\u003e \u003cp\u003eOverviews of reviews and systematic reviews generally report positive associations between higher UPF intake and obesity, type 2 diabetes, cardiovascular disease, and all-cause mortality; certainty ranges from weak to moderate depending on design and bias assessment \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Some reviews (eg. Monteiro 2025 \u003csup\u003e2\u003c/sup\u003e) have not applied standardized frameworks (e.g., GRADE (Grading of Recommendations Assessment, Development and Evaluation)) to formally assess all of the evidence reviewed) or ROBINS-E (Risk of Bias In Non-randomized Studies of Exposure) despite being more appropriate for dietary exposure studies than commonly used Newcastle-Ottawa Scale; limiting transparent evaluation and risking overstatement of findings from predominantly observational studies \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eBurden-of-Proof reappraisal\u003c/h3\u003e\n\u003cp\u003eA recent Burden-of-Proof study examined the health risks of processed meats, SSBs, and trans fats \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. This approach uses Bayesian meta-regression to model dose-response relationships relative to zero intake, establishing conservative risk estimates while accounting for between-study heterogeneity. The findings indicate that consumption of processed meat (upto 57 g/day) is associated with 11% higher type 2 diabetes risk and 7% higher colorectal cancer risk; SSBs (upto 390 g/day) with 8% higher type 2 diabetes risk and 2% higher ischaemic heart disease (IHD) risk; and trans fats (upto 2.5% of daily energy) with \u0026gt;\u0026thinsp;3% higher IHD risk \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Most ratings were \u0026ldquo;two-star,\u0026rdquo; indicating weak or inconsistent evidence, yet continued limitation remains prudent and aligns with current guidance (e.g., free sugars\u0026thinsp;\u0026lt;\u0026thinsp;25 g/day [~\u0026thinsp;6 tsp], SSBs\u0026thinsp;\u0026lt;\u0026thinsp;1 serving/week [~\u0026thinsp;200\u0026ndash;355 mL], TFAs\u0026thinsp;\u0026lt;\u0026thinsp;2% energy) \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Important limitations include potential residual confounding from unmeasured variables (e.g., total energy intake) and reliance on self-reported dietary intake despite statistical adjustment \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eSelect Randomized Controlled Trials (RCTs)\u003c/h3\u003e\n\u003cp\u003eUPF feeding trials remain limited (n\u0026thinsp;\u0026asymp;\u0026thinsp;10\u0026ndash;55; duration 2 days\u0026ndash;8 weeks) but converge on unfavourable acute effects on energy intake and weight \u003csup\u003e\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. In Hall\u0026rsquo;s landmark inpatient crossover RCT (n\u0026thinsp;=\u0026thinsp;20 overweight; 2 weeks), UPF diets yielded\u0026thinsp;~\u0026thinsp;500 kcal/day greater intake and ~\u0026thinsp;0.9 kg weight gain versus unprocessed diets, despite matched calories, macronutrients, sugar, sodium, and fibre \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. The UPDATE trial (crossover RCT; n\u0026thinsp;=\u0026thinsp;55 overweight/obesity; 8 weeks) extended these findings under UK Eatwell Guide conditions: ad libitum minimally processed food (MPF) patterns produced greater weight loss (\u0026minus;\u0026thinsp;2% vs \u0026minus;\u0026thinsp;1%) and improvements in LDL-cholesterol, apoB, and HbA1c versus UPF patterns, under matched nutrient targets \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. These trials provide high-quality data on short-term responses, yet are limited by: small sample sizes and durations, lack of formal risk of bias assessment, specific populations and settings (overweight/obesity, inpatient vs free living, affecting generalisability), challenges in dietary assessment methods and adherence monitoring, and logistical and financial demands of all-food provision, collectively reducing statistical power to detect modest clinical effects \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eHow Processing Drives Risk (Proposed Mechanisms)\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eEnergy density \u0026amp; eating rate\u003c/h2\u003e \u003cp\u003eUPFs are typically softer, energy-dense, and faster to consume, enabling excess intake before satiety signals register, with potential implications in modifying gut-brain axis \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Experimental meals classified as \u0026ldquo;soft UPF\u0026rdquo; (eg. coleslaw vs steamed vegetables) increase energy intake versus \u0026ldquo;hard MPF\u0026rdquo; (eg. boiled rice vs potato fries) comparators in 50 healthy-weight participants (4 ab libitum meals, each separated by \u0026gt;\u0026thinsp;7d) \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Reduced chewing frequency per calorie correlates with higher intake (~\u0026thinsp;814 kcal/day) and short-term weight gain (1.1 kg in one week) in crossover RCT involving 50 adults with overweight/obesity \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eProtein leverage\u003c/h2\u003e \u003cp\u003eSmall reductions in dietary protein percentage (e.g., 14% vs 15\u0026ndash;16%) can trigger compensatory intake of fat and carbohydrate, elevating total energy intake; consistent with excess intake observed in UPF vs MPF diets \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Lower protein may also reduce satiety-linked branched-chain amino acids and blunt energy expenditure \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. However, protein enrichment of UPFs (30% versus 13%, crossover RCT, n\u0026thinsp;=\u0026thinsp;21 healthy/overweight, 54hours) only modestly reduced energy intake (likely due to slower eating rate) but not overeating \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFood matrix \u0026 additives\u003c/h3\u003e\n\u003cp\u003eIndustrial processing disrupts natural matrices, increasing nutrient bioavailability while reducing delivery of intact fibre to the distal gut, diminishing substrates for fermentation and impairing short-chain fatty acid and satiety hormone production (eg. Glucagon-like peptide) \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Emulsifiers (e.g., carboxymethylcellulose, polysorbate-80) may compromise gut barrier integrity and promote low-grade inflammation in experimental models, with human data emerging \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eHigh-fructose corn syrup (HFCS) and free sugars\u003c/h3\u003e\n\u003cp\u003eHFCS, an industrial sweetener (42\u0026ndash;55% fructose), widely added to SSBs and processed foods, promotes hepatic de novo lipogenesis, dyslipidaemia, and fatty liver, with lower energy efficiency and blunted insulin/leptin responses relative to glucose, reducing satiety and energy expenditure \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Fructose metabolism may elevate uric acid, contributing to insulin resistance and hypertension; however, recent systematic reviews show little effect on energy intake or cardiometabolic markers when fructose replaces glucose/sucrose, though substantial heterogeneity limits firm conclusions \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTrans fatty acids (TFAs)\u003c/h2\u003e \u003cp\u003eTFAs (unsaturated fats with trans double bonds) arise mainly from partially hydrogenated oils (PHOs) in margarine and many processed foods (e.g., pastries, fried fast foods, popcorn). TFAs raise LDL, lower HDL cholesterol, impair endothelial function and fatty acid metabolism, increase inflammation, and elevate risks of CVD and all-cause mortality; even intakes\u0026thinsp;\u0026gt;\u0026thinsp;1% energy increase CHD risk \u003csup\u003e\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. TFAs are banned in many countries (Denmark, EU, US, UK, Canada), but not Australia \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eHyper-palatability \u0026amp; reward\u003c/h2\u003e \u003cp\u003eMany UPFs are engineered with supernormal combinations of fat, sugar, salt, and flavour additives that reinforce overconsumption and may elicit addiction-like eating \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Common UPF macro-combinations include: fat and sugar (\u0026gt;\u0026thinsp;20% of calories from each); carbohydrates and sodium (\u0026gt;\u0026thinsp;40% of calories from carbs and \u0026ge;\u0026thinsp;0.20% sodium by weight); fat and sodium (\u0026gt;\u0026thinsp;25% of calories from fat and \u0026ge;\u0026thinsp;0.30% sodium by weight)) \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Evidence on non-nutritive sweeteners and metabolic outcomes (obesity, weight gain, insulin sensitivity, glycaemic control, and gut permeability) is mixed and context-dependent \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBrain and endocrine signals\u003c/h2\u003e \u003cp\u003eCohort neuroimaging studies show higher UPF intake is associated with reduced volumes in reward-related and cortical regions of brain \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Packaging/thermal processing may increase exposure to potential endocrine disruptors (phthalates, bisphenols, acrylamide), though causal pathways require stronger human evidence \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eDiet quality\u003c/h2\u003e \u003cp\u003eUPF-rich diets are typically lower in protective compounds (anti-inflammatory nutrients, flavonoids) and associated with poorer overall diet quality \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Improving diet quality (e.g., increasing vegetables and fruit) may attenuate metabolic effects of UPFs \u003csup\u003e\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eChallenges for Assessment and Policy\u003c/h2\u003e \u003cp\u003e \u003cb\u003eDefining ultra-processing.\u003c/b\u003e NOVA (Group 4 for UPFs) is widely used but broad; heterogeneity invites misclassification and debate yet remains practical for surveillance and policy \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMeasuring intake.\u003c/b\u003e Free-living assessments rely on self-report (FFQ, 24-hour recall), with measurement error, residual confounding, incomplete ingredient data, and rapidly evolving food supplies complicating classification. Objective biomarkers/ \u0026ldquo;omics\u0026rdquo; platforms and AI-assisted tools could strengthen epidemiology and trials \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSocioeconomic realities.\u003c/b\u003e UPFs are often cheaper and more accessible than MPFs (e.g., \u003cspan\u003e$\u003c/span\u003e106/week vs \u003cspan\u003e$\u003c/span\u003e151/week for 2,000 kcal/day in one comparison), so policies must avoid widening inequities \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eReductionism.\u003c/b\u003e Processing level and nutrient quality should be considered together; focusing solely on either risks oversimplification. Some UPFs (e.g., certain wholegrain breads, low-sugar yoghurts, tomato sauces, nut/bean spreads) can contribute to healthy patterns and affordability and should be monitored and reformulated if harms emerge \u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Dietary Guidelines\u003c/h2\u003e \u003cp\u003eIn the US, the 2025\u0026ndash;2030 Dietary Guidelines Advisory Committee judged UPF evidence too limited for formal recommendations given definitional and exposure inconsistencies, and re-emphasised pattern-based guidance limiting processed meats, saturated fat, and added sugars (including SSBs) \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSeveral countries already address UPFs explicitly or implicitly: Brazil advises avoiding UPFs\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e; Uruguay promotes fresh/minimally processed patterns \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e; Israel prioritises home-cooked minimally processed foods and limiting highly processed items \u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e; France limits charcuterie/SSBs but cautions against relying solely on processing classifications \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e; Spain (AESAN, 2022) integrates healthy/sustainable advice \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e; the UK SACN maintains a cautious stance, emphasising nutrient-based limits on fat, salt, and sugar as UPF-outcome associations may overlap with existing advice \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e; Australian dietary guidelines are currently under review \u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eProfessional societies converge on pattern-based dietary recommendations: the American Heart Association (AHA) advises choosing MPFs over UPFs within heart-healthy diets and recommends replacing most UPFs with healthier options (eg. vegetables, fruits, whole grains, beans, nuts, seeds, healthy oils, and lean proteins) for cardiometabolic health \u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. While AHA acknowledges labelling foods as \u0026ldquo;ultra-processed\u0026rdquo; can be misleading when nutrient-dense items are also included (eg. nut butters) and assessing risks from processing techniques beyond nutrient quality remains challenging, as high UPF diets typically have poor overall quality and high-quality diets rich in UPFs are rare \u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOn specific risk components, industrial TFA (iTFA) elimination is a proven, high-impact action (e.g., Denmark\u0026rsquo;s TFA legislation reduced CVD mortality, promoting global action including WHO\u0026rsquo;s \u0026ldquo;REPLACE\u0026rdquo; initiative and bans across Europe, and US PHO elimination) \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. Australian modelling indicates a national iTFA ban would be cost-effective and prevent thousands of IHD events, yet such bans are not legislated \u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFinally, broader health-and-sustainability syntheses (e.g., EAT\u0026ndash;Lancet) support planet-forward, minimally processed dietary patterns to reduce premature mortality and food-system emissions \u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eBeyond Individual Choice: A Systems Approach\u003c/h2\u003e \u003cp\u003eEvidence on UPFs demands a shift from personal responsibility to systemic change. Despite decades of policy approaches centered on personal responsibility (eg. calorie counting, nutrition education campaigns), obesity rates continue to rise in the US, UK, and Australia, where UPFs supply 40\u0026ndash;60% of energy intake \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. This failure reflects a mismatch between intervention strategies and root cause: food environments, not knowledge, shape diets. UPFs are engineered for palatability and profit, while minimally processed foods cost more. Meaningful progress requires structural solutions (pricing, marketing restrictions, procurement standards, and labelling) to make healthier choices accessible and affordable.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eResearch Priorities and the Path to Action\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDisaggregate UPFs\u003c/b\u003e to identify attributes driving risk (matrix softness, energy density, additive classes, or their interactions); ongoing trials (e.g., UPDATE) will help \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDevelop \u003cb\u003eobjective exposure biomarkers\u003c/b\u003e and \u003cb\u003eharmonised trial protocols\u003c/b\u003e to improve reproducibility and generalisability.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eReformulation\u003c/b\u003e: incentivise industry to reduce harmful attributes (e.g., specific emulsifiers, added sugars, sodium, iTFAs) while preserving affordability and convenience.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePragmatic trials\u003c/b\u003e at scale to evaluate real-world implementation and impacts on population health; behaviour change interventions aimed at reducing UPF intake may yield greatest benefit in those at greater risk/ higher UPF intake \u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eFrom Evidence to Action: A Multi-Pronged Playbook\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eGuidance\u003c/b\u003e: integrate processing level alongside nutrient content; offer practical swaps and preparation tips for time- and budget-constrained households.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eProcurement \u0026amp; pricing\u003c/b\u003e: leverage schools/hospitals/public programmes to improve availability and affordability of MPFs; pair with front-of-pack labelling that includes processing cues.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eIndustry standards\u003c/b\u003e: set targets for added sugars, sodium, and select emulsifier classes; prioritise categories with strongest evidence of harm (processed meats, SSBs, TFAs) \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eProtect children\u003c/b\u003e: implement comprehensive marketing restrictions for HFSS/UPF products across media, aligned with WHO 2023 guidance \u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFood literacy\u003c/b\u003e: invest in community-co-designed cooking and food skills programmes, tailored to vulnerable populations.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eEvaluate\u003c/b\u003e: fund longer, pragmatic trials to test real-world roll-outs focusing on improving overall dietary patterns.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eControlled feeding trials demonstrate that processing per se can drive excess calorie consumption and adverse metabolic responses. Observational studies associate high UPF intake with obesity, cardiometabolic disease and all-cause mortality across diverse populations. The question is no longer whether UPFs harm health, but how policymakers will confront commercial pressures and redesign food systems so that healthier, minimally processed options become the default; affordable, accessible, and convenient. Integrating processing considerations into dietary guidelines alongside nutrient-based recommendations offers a pragmatic path forward. While complete avoidance of UPFs is unrealistic, feasible reductions supported by policy represent a necessary public-health imperative.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author thanks Dianne Reidinger, Sharon Sanders, and Tiffany Atkins for helpful review and feedback.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor \u0026amp; Affiliation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFaculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia \u003c/p\u003e\n\u003cp\u003eHayley M. O\u0026rsquo;Neill\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH.O. declares no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH.O. conceptualised and drafted the original manuscript. H.O. edited, reviewed and approved final manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Hayley M O\u0026rsquo;Neill\u003cstrong\[email protected]\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCoyle, D. 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Geneva: World Health Organization\u003c/em\u003e, \u0026lt;\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240082410%3E\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240082410%3E\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"npj-metabolic-health-and-disease","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [npj Metabolic Health and Disease](https://www.nature.com/npjmetabhealth)","snPcode":"44324","submissionUrl":"https://submission.springernature.com/new-submission/44324/3","title":"npj Metabolic Health and Disease","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8430013/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8430013/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eUltra-processed foods (UPFs)\u003c/b\u003e dominate diets in high-income countries and pose health risks beyond nutrient composition. Controlled trials show UPF-rich diets increase energy intake and weight gain. Mechanisms include high energy density, disrupted food matrices, faster eating rates, additives affecting gut, and hyper-palatable formulations. Observational evidence associates higher UPF intake with obesity, cardiovascular disease, type 2 diabetes and all-cause mortality. \u003cb\u003eThis Comment outlines evidence and policy strategies to reduce UPF exposure.\u003c/b\u003e\u003c/p\u003e","manuscriptTitle":"Ultra-Processed Foods and Cardiometabolic Risk: From Evidence to Policy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 16:02:28","doi":"10.21203/rs.3.rs-8430013/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-19T07:09:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-19T02:11:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-02T01:27:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"312145004874245395195283169427234238236","date":"2026-02-26T13:11:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"161004791201157256701625586207123690141","date":"2026-02-24T21:24:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315247779824977877194308446952729181739","date":"2026-02-22T23:24:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-15T02:50:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-30T02:16:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-29T03:54:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"npj Metabolic Health and Disease","date":"2025-12-23T04:25:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"npj-metabolic-health-and-disease","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [npj Metabolic Health and Disease](https://www.nature.com/npjmetabhealth)","snPcode":"44324","submissionUrl":"https://submission.springernature.com/new-submission/44324/3","title":"npj Metabolic Health and Disease","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f9d44aed-0e82-43d8-9341-5c82807601b0","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":61382546,"name":"Health sciences/Diseases"},{"id":61382547,"name":"Health sciences/Endocrinology"},{"id":61382548,"name":"Health sciences/Health care"},{"id":61382549,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-05-12T10:47:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 16:02:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8430013","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8430013","identity":"rs-8430013","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}