From individual markers to reformulable processing signatures in hypertension prevention

This commentary refers to ‘Markers of ultra-processed food and incident arterial hypertension in the UK Biobank’, by K. M. Krost et al., https://doi.org/10.1093/eurheartj/ehag614 and the discussion piece ‘Characterizing co-occurrence patterns of potentially disease-relevant markers of ultra-processed food’, by K. M. Krost et al., https://doi.org/10.1093/eurheartj/ehag843. Krost et al.1 should be commended for moving the ultra-processed food debate from a binary label towards ingredient-level markers. In 101 560 UK Biobank participants, they identified four marker-of-ultra-processing (MUP) categories associated with incident arterial hypertension and, importantly, showed that several other categories were not.1 Their key translational opportunity may lie one level above individual MUPs: constructing processing-marker signatures that can be linked to food reformulation. The Marker Likelihood Index (MLI) converts each reported food item into marker-bearing food mass according to the marker’s frequency across matched commercial products.1 Consequently, flavour, colouring agent, sweetener, and varieties of sugar may encode a recurring product phenotype rather than four separable exposures. Supplementary Figure 2 makes this co-occurrence empirically visible.1 The resulting percentage of total food intake represents marker-bearing food exposure rather than the ingested dose of the marker itself: a 50-g portion with an MLI of 0.6 contributes 30 g of marker-bearing food, not 30 g of additive.1 We view these features not as weaknesses, but as an opportunity to ask a more policy-relevant question: which combinations of markers characterize foods whose replacement is associated with lower hypertension risk?