Ultra-processed food intake tied to higher heart failure risk

Clinical takeaway: Ask patients at risk for heart failure about high ultra-processed food intake; the association with heart failure with preserved ejection fraction was clearest. Consider adding reduction in UPFs to their dietary counseling, though whether cutting back lowers risk is untested. 

Ultra-processed foods supply more than half of the calories US adults consume, and prospective cohorts have linked them to atherosclerotic disease, stroke, and cardiovascular death. Heart failure has drawn far less attention, even though healthier diet patterns, including the Mediterranean diet, have been associated with lower rates of it. 

Heart failure with preserved ejection fraction (HFpEF) is where that omission may matter most. The condition is increasingly recognized as a cardiometabolic syndrome driven by obesity, insulin resistance, and hypertension, the same problems ultra-processed foods have been linked to. Few prospective data tested whether these foods predict heart failure, or whether the answer differs by ejection fraction. This cohort analysis addresses both questions. 

Each additional daily serving of ultra-processed food tracked with about 5% higher risk of heart failure. The association held after adjustment for overall diet quality and for cardiometabolic risk factors. 

HFpEF showed the clearest association: each daily serving accompanied 9.6% higher risk, and the association held in every adjusted model. Heart failure with reduced ejection fraction lost its association once lifestyle factors entered the models, though the study did not test the difference between the two types. An exploratory comparison, chosen after the main results, found more than double the HFpEF risk among the top four fifths of intake versus the lowest fifth. 

In an exploratory mediation analysis, waist-to-height ratio, a measure of central adiposity, statistically accounted for 51% of the association with total heart failure and 49% of the association with HFpEF. A second modeling approach put the shares at 44% and 49%. The association did not weaken in the model that added waist-to-height ratio alongside other cardiometabolic factors. Inflammatory markers, blood pressure, and lipids showed weaker indirect effects, mostly nonsignificant. 

The analysis included 6,531 adults aged 45 to 84 from the Multi-Ethnic Study of Atherosclerosis, a prospective cohort across six US communities. All were free of cardiovascular disease at enrollment in 2000 to 2002. Investigators classified items on a food frequency questionnaire, completed at enrollment, by Nova processing category, and diet was not reassessed during follow-up. Of 509 heart failure events, 79 lacked ejection fraction data and counted toward total heart failure but not the phenotype results. 

The data cannot separate food processing from what these foods tend to carry: added sugars, sodium, and unhealthy fats. The authors caution that the association persisting after adjustment for diet quality does not establish an independent effect of processing. Sugar-sweetened beverages were the category most consistently tied to both total heart failure and HFpEF, though those category analyses were exploratory and rested on a few questionnaire items each. 

“These findings extend the growing body of evidence linking UPF intake with adverse cardiovascular outcomes and identify heart failure, particularly HFpEF, as a potential consequence of diets high in ultra-processed foods,” the authors conclude. “Collectively, these results warrant further investigation of UPF reduction as a potential strategy for heart failure prevention. Further research is needed to clarify the biological mechanisms underlying these associations and to identify effective population-level approaches for reducing UPF consumption.” 

Source: Haidar A, et al. (2026 Nov 2) JACC Heart Fail. Ultra-Processed Food Consumption and Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis