Ultra-processed food exposure and health outcomes: Current evidence, controversies, and future perspectives

Authors

  • Monica Dinu Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy https://orcid.org/0000-0003-1687-2527
  • Sofia Lotti Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy https://orcid.org/0000-0001-9288-5683
  • Farzaneh Asoudeh Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, 3220, Australia https://orcid.org/0000-0002-5083-376X
  • Deb Junyi Zhang Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, 3220, Australia https://orcid.org/0009-0000-2339-4610
  • Barbara Colombini Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy https://orcid.org/0000-0003-1397-9791
  • Sarah Gauci Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, 3220, Australia https://orcid.org/0000-0002-1907-1066
  • Daniela Martini Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133, Milan, Italy; Tel: +39 02503 16727; E-mail: daniela.martini@unimi.it https://orcid.org/0000-0001-8298-926X
  • Wolfgang Marx Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, 3220, Australia https://orcid.org/0000-0002-8556-8230

DOI:

https://doi.org/10.17179/excli2026-9423

Keywords:

UPFs, NOVA classification, cardiometabolic health, mental health, dietary guidelines, food processing

Abstract

Ultra-processed food (UPF) exposure has increased markedly worldwide and is now a major contributor to total energy intake in many countries. Evidence from large prospective cohort studies suggests that higher UPF exposure is associated with adverse health outcomes, including overweight and obesity, type 2 diabetes, cardiovascular disease, selected cancers, depression, and increased all-cause mortality. Short-term experimental studies further indicate that diets rich in UPFs can promote excess energy intake and weight gain, supporting biological plausibility. Several mechanisms have been proposed, including poor nutrient quality, high glycemic load, altered food structure and satiety signaling, exposure to additives and contaminants, gut microbiome perturbations, and displacement of minimally processed foods. Nevertheless, the field remains debated. Major controversies concern the Nova classification system, substantial heterogeneity within the UPF category, challenges in reproducible classification, and the extent to which observed associations reflect processing itself rather than nutrient profile, dietary patterns, or broader food environments. These issues hinder causal inference and sustain ongoing debate over whether UPFs act as independent etiological factors or function as markers of unhealthy diets. Policy responses vary internationally, ranging from explicit inclusion of UPFs in dietary guidelines to predominantly nutrient-based or hybrid frameworks. This narrative review summarizes current evidence linking UPF exposure to health outcomes, critically examines methodological and conceptual limitations, and discusses implications for future research and public health policy.

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Published

2026-07-09

How to Cite

Dinu, M., Lotti, S., Asoudeh, F., Zhang, D. J., Colombini, B., Gauci, S., … Marx, W. (2026). Ultra-processed food exposure and health outcomes: Current evidence, controversies, and future perspectives. EXCLI Journal, 25, 1037–1069. https://doi.org/10.17179/excli2026-9423

Issue

Vol. 25 (2026)

Section

Review articles

Categories

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Copyright (c) 2026 Monica Dinu, Sofia Lotti, Farzaneh Asoudeh, Deb Junyi Zhang, Barbara Colombini, Sarah Gauci, Daniela Martini, Wolfgang Marx

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