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Review Open access Aug 2026

A systematic review to critically appraise methodological rigor in research on ultra-processed food and cardiovascular disease and hypertension.

Despite growing research linking ultra-processed food (UPF) consumption to risk of cardiovascular disease (CVD) and hypertension, no study has systematically evaluated the methodological rigor underlying these associations. We systematically searched major databases to identify eligible studies. Data were extracted for dietary assessment methods, UPF classification, covariate selection, confounding control, statistical modeling and effect estimates. Random-effects meta-analysis was conducted to pool effect estimates. Meta-regression and sensitivity analyses were performed to explore sources of heterogeneity. Substantial heterogeneity was observed in the application of the NOVA classification for categorizing UPFs across the 46 eligible studies. Only two studies employed a directed acyclic graph to inform confounder selection; 42 used models with suboptimal adjustment, and 38 were overfitted due to adjustment for potential mediators. Pooled analyses indicated that higher consumption of UPFs was associated with a 9% higher risk of CVD and a 16% higher risk of hypertension, with stronger associations observed for coronary heart and cerebrovascular diseases. While higher UPF intake is consistently associated with increased risks of CVD and hypertension, methodological limitations may attenuate the observed associations. Strengthening methodological rigor through harmonized UPF classification and causal frameworks is essential to better elucidate the effect of UPF consumption on cardiometabolic health.

T. C. Mekonnen, Z. Abebe, A. Dessie et al. · 0 citations
Open access Aug 2026

Association Between Prudent Dietary Pattern and Cardiometabolic Indicators in a Healthy Qatari Population: Evidence from the Qatar Biobank (QBB)

Background/Objectives: Diet is recognized as an important determinant of cardiometabolic health, yet evidence from Middle Eastern populations remains scarce. This cross-sectional study investigated the association between a Prudent dietary pattern and multiple indicators of obesity, type-2 diabetes, and cardiovascular disease in a metabolically healthy Qatari cohort. Methods: Data were obtained from 6919 Qatari adults from the Qatar Biobank study. Participants with diagnosed metabolic disorders, pregnancy, or non-fasting blood samples were excluded. Anthropometric, biochemical, and clinical measurements were collected using standardized protocols. Dietary intake was assessed using a 102-item food frequency questionnaire, and a Prudent dietary pattern was derived through factor loadings analysis. Participants were categorized into low and high intake groups of the Prudent dietary pattern. Associations between the Prudent dietary pattern and cardiometabolic markers were examined using generalized linear models adjusted for age, sex, adiposity, and physical activity with Bonferroni correction applied for multiple testing. Results: After correction for multiple testing, greater adherence to the Prudent dietary pattern was significantly associated with lower fat mass index (β = −0.02, p = 0.0001), fasting insulin (β = −0.05, p = 0.0021), and higher fat-free mass (β = 0.01, p = 5.7 × 10−5). Conclusions: Overall, in a metabolically healthy Qatari population, greater compliance to a Prudent dietary pattern was favorably associated with fat and muscle mass, and insulin regulation after adjusting for age, sex, BMI and physical activity. These findings support the role of dietary habits in greater cardiometabolic health in Middle Eastern Arab populations.

Maria M AlAnazi, J. Lovegrove, Zumin Shi et al. · 0 citations

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