Characterizing co-occurrence patterns of potentially disease-relevant markers of ultra-processed food

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 Forum contribution ‘From individual markers to reformulable processing signatures in hypertension prevention’, by Y. Z. Huang, https://doi.org/10.1093/eurheartj/ehag842. We thank Dr. Huang for his interest in our study on markers of ultra-processed food (MUPs) and incident arterial hypertension in the UK Biobank and his thoughtful comments. We agree that an important translational opportunity lies in moving beyond individual MUP analyses towards MUP patterns that can inform food reformulation. As MUPs co-occur within the same foods, associations observed for individual markers may partly reflect shared underlying product characteristics. We therefore consider the proposed investigation of MUP co-occurrence patterns an important direction for future research. An important step towards characterizing these MUP co-occurrences is to define potentially disease-relevant MUPs and distinguish them from MUPs without evidence of adverse health associations. Thus, identifying MUPs that are consistently associated with adverse health outcomes using Cox proportional hazards regression models can provide an important starting point for investigating the biological mechanisms that may underlie these associations. Together with our findings on incident arterial hypertension,1 evidence from two further UK Biobank studies on mortality2 and depression risk3 suggests that added flavour, colouring agent, and sweetener may represent potentially disease-relevant MUPs. Future studies should investigate whether these MUPs are also associated with further adverse health outcomes, including other cardiometabolic diseases and various types of cancer. The next step should include mechanistic studies investigating the pathways by which these disease-relevant MUPs might affect human physiology and health. Randomized controlled crossover trials, building on previous studies investigating the effects of ultra-processed foods (UPF),4 could further characterize these MUPs by comparing otherwise closely matched foods or diets with and without these MUPs and assessing relevant clinical outcomes.