Ultra-Processed Foods, Additives, and Disease: Biomarker and Mediation Evidence
Abstract
Background: Ultra-processed foods (UPFs) and some food additives have been associated with adverse health outcomes, but underlying biological mechanisms remain unclear. We examined associations of UPFs and food additives with biomarkers of inflammation, oxidative stress, and metabolism, and assessed their mediating role in chronic disease risk.
Methods: Among 6101 adults from the NutriNet-Santé cohort (2009–2022; 66.8% women; mean age 54.0 years), dietary intakes were assessed using repeated 24-hour records including branded products. UPFs were defined using NOVA. Additive exposures were estimated from composition databases and laboratory assays; mixtures were derived using non-negative matrix factorisation. Cross-sectional associations between UPFs (main analysis), additives (individual and mixtures; exploratory), and biomarkers were assessed using multivariable Spearman correlations. Mediation analyses evaluated the role of these biomarkers in associations with hypertension, type 2 diabetes, cardiovascular disease, and cancer.
Results: Mean UPF intake was 15.0% (SD 7.0) of total diet weight. Higher UPF consumption was associated with higher CRP, triglycerides, bile acids (deoxycholic and glycoursodeoxycholic acids), and LysoPC(12:0), and lower LysoPC(15:0) and LysoPC(17:0). Several biomarkers were identified as potential mediators of associations with type 2 diabetes, cardiovascular disease, coronary heart disease, and hypertension. Exploratory analyses identified multiple associations between additives and biomarkers, and potential mediators of chronic disease risk.
Conclusions: UPF consumption and exposure to multiple food additives were associated with distinct inflammatory and metabolic biomarker profiles. These biomarkers partly mediated associations with chronic disease risk, providing insight into biological pathways. Although confirmation is needed, these findings strengthen the plausibility of a causal link by supporting biologically plausible mechanisms.
Key messages: • Inflammation, microbiota, and metabolic changes may partly mediate links between ultra-processed foods, additives, and increased risk of multiple chronic diseases.
• These findings support biologically plausible mechanisms, reinforcing recommendations to limit ultra-processed foods and additives and to implement policies reducing population exposure.
Related
- Ultra-Processed Food Consumption and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Evidence Synthesis, Methodological Appraisal, and Mechanistic Insights
- CD38-targeted therapies in kidney disease: evidence maturity, disease-stage dependence, and biomarker-guided retreatment.
- Gut Dysbiosis, Uremic Toxins, and NLRP3 Signaling in Chronic Kidney Disease: From Mechanistic Evidence to Clinical Biomarker Evaluation.
- Iron Supplementation and Copper Homeostasis: Evidence for Potential Copper Depletion, Biomarker Challenges, and Clinical Implications
- High-Throughput Proteomics in Lymphangioleiomyomatosis: Premelanosome Protein as a Diagnostic Biomarker, Construction of a Diagnosis Score, and Evidence of Neutrophil Involvement
BibTeX
@article{hasenbohler2026ultraprocessed,
title = {{Ultra-Processed Foods, Additives, and Disease: Biomarker and Mediation Evidence}},
author = {A Hasenböhler and M Payen de la Garanderie and S Shah and S Rinaldi and JF Landrier and C Diaz and I Huybrechts and M Deschasaux-Tanguy and B Srour and M Touvier},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1842},
url = {https://doi.org/10.1093/eurpub/ckag169.1842},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Ultra-Processed Foods, Additives, and Disease: Biomarker and Mediation Evidence
AU - A Hasenböhler
AU - M Payen de la Garanderie
AU - S Shah
AU - S Rinaldi
AU - JF Landrier
AU - C Diaz
AU - I Huybrechts
AU - M Deschasaux-Tanguy
AU - B Srour
AU - M Touvier
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1842
UR - https://doi.org/10.1093/eurpub/ckag169.1842
AB - Background: Ultra-processed foods (UPFs) and some food additives have been associated with adverse health outcomes, but underlying biological mechanisms remain unclear. We examined associations of UPFs and food additives with biomarkers of inflammation, oxidative stress, and metabolism, and assessed their mediating role in chronic disease risk. Methods: Among 6101 adults from the NutriNet-Santé cohort (2009–2022; 66.8% women; mean age 54.0 years), dietary intakes were assessed using repeated 24-hour records including branded products. UPFs were defined using NOVA. Additive exposures were estimated from composition databases and laboratory assays; mixtures were derived using non-negative matrix factorisation. Cross-sectional associations between UPFs (main analysis), additives (individual and mixtures; exploratory), and biomarkers were assessed using multivariable Spearman correlations. Mediation analyses evaluated the role of these biomarkers in associations with hypertension, type 2 diabetes, cardiovascular disease, and cancer. Results: Mean UPF intake was 15.0% (SD 7.0) of total diet weight. Higher UPF consumption was associated with higher CRP, triglycerides, bile acids (deoxycholic and glycoursodeoxycholic acids), and LysoPC(12:0), and lower LysoPC(15:0) and LysoPC(17:0). Several biomarkers were identified as potential mediators of associations with type 2 diabetes, cardiovascular disease, coronary heart disease, and hypertension. Exploratory analyses identified multiple associations between additives and biomarkers, and potential mediators of chronic disease risk. Conclusions: UPF consumption and exposure to multiple food additives were associated with distinct inflammatory and metabolic biomarker profiles. These biomarkers partly mediated associations with chronic disease risk, providing insight into biological pathways. Although confirmation is needed, these findings strengthen the plausibility of a causal link by supporting biologically plausible mechanisms. Key messages: • Inflammation, microbiota, and metabolic changes may partly mediate links between ultra-processed foods, additives, and increased risk of multiple chronic diseases. • These findings support biologically plausible mechanisms, reinforcing recommendations to limit ultra-processed foods and additives and to implement policies reducing population exposure.
SN - 1101-1262
SN - 1464-360X
ER -