Xiao Liu, Shengwei Luo, Yunting Zeng, Nanqin Peng, Xinyi Chen, Jianan Tian, Ling Lin, Shan Zeng, Yewei Xie, Zexuan Wang, Jiaxue Xu, Lin Li, Deju Zhang, Wenli Gu, Xiang Gu, Jun Zhang, Menglu Liu, Yujie Zhao, Lihan Zhu, Mir Wajid Majeed, Zhiwei Yan, Wenting Wang, Peng Yu

The consumption of ultra-processed foods (UPFs) has increased globally. This study comprehensively investigated the impact of consuming UPFs on the risk of major chronic diseases in adults. A systematic search identified prospective cohort studies up to April 2026 on consumption of UPFs and major chronic outcomes. Consumption of UPFs was assessed by food frequency questionnaires (FFQs), 24-hour recalls, or dietary history. Adults (≥18 years) without restriction to specific clinical conditions at baseline. Fifty-one prospective cohort studies involving 8 819 894 participants were included. Consumption of UPFs was associated with cardiovascular events (Hazard Ratio (HR) 1.24, 95% Confidence Interval (CI) 1.14 to 1.36), cancer (HR 1.12, 95% CI 1.04 to 1.21), obesity/overweight (HR 1.23, 95% CI 1.17 to 1.30), metabolic syndrome (MetS)/diabetes (HR 1.24, 95% CI 1.08 to 1.42), depression/anxiety (HR 1.27, 95% CI 1.15 to 1.40), digestive diseases (HR 1.31, 95% CI 1.16 to 1.48) and all-cause mortality (HR 1.18, 95% CI 1.10 to 1.26). Dose-response analyses showed each additional 100 g/day associated with higher risks of cardiovascular events (HR 1.14, 95% CI 1.06 to 1.22), cancer (HR 1.04, 95% CI 1.02 to 1.06), all-cause mortality (HR 1.03, 95% CI 1.02 to 1.05), and MetS/diabetes (HR 1.02, 95% CI 1.01 to 1.04). Consuming UPFs was associated with higher risks of multiple chronic diseases and all-cause mortality with low or moderate evidence. Reducing dietary intake of UPFs may therefore be relevant for chronic disease prevention. CRD42023421092.