Cancer survivors who consumed higher amounts of ultraprocessed foods (UPF) as part of their standard diet had a significantly increased risk of both all-cause and cancer-specific death.
This conclusion is based on the outcomes of a study, funded by the Fondazione AIRC per la Ricerca sul Cancro ETS and published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research (AACR).[1]
In the study, Marialaura Bonaccio, Ph.D., of the Research Unit of Epidemiology and Prevention at IRCCS Neuromed in Pozzilli, Italy, describes how a diet of ultra-processed food may influence outcomes in long-term cancer survivors.
Unhealthy
Nearly all foods we consume are, to some extent, processed, if only by preservation. However, not all food is processed to the same degree. Hence, criticizing foods as ‘processed’ does not help the overall understanding of a healthy diet. And while various food classifications have been developed that pay special attention to processing types, not all are specific, coherent, clear, comprehensive, or workable.
“Ultraprocessed foods can be considered unhealthy because they are often low in essential nutrients such as vitamins, minerals, and fiber, and the industrial processing methods used to produce them introduce additives, artificial flavorings, preservatives, emulsifiers, and high levels of added sugars and unhealthy fats that the body is not well adapted to handle,” Bonaccio explained.
“With the consumption of ultraprocessed foods on the rise in many countries,” Bonaccio said, “it is important to better understand whether reducing ultraprocessed food intake could help cancer survivors live longer and healthier lives.”
“What people eat after a cancer diagnosis may influence survival, but most research in this population has focused only on nutrients, not how processed the food is,” Bonaccio explained.
“The substances involved in the industrial processing of foods can interfere with metabolic processes, disrupt gut microbiota, and promote inflammation. As a result, even when an ultraprocessed food has a similar calorie content and nutritional composition on paper compared to a minimally processed or ‘natural’ food, it could still have a more harmful effect on the body,” she added.
Study design
In the Moli-sani Study, a prospective cohort study, Bonaccio and colleagues followed 24,325 individuals aged 35 or older at study initiation who lived in the Southern Italian region of Molise from March 2005 to December 2022. Within this cohort, they identified 802 cancer survivors at baseline (476 women and 326 men) who had provided thorough information about their diet via the European Prospective Investigation into Cancer and Nutrition (EPIC) food frequency questionnaire.
In 2026, to better understand the effects of differentially processed foods on our health, Carlos Monteiro, MD, Ph.D., from the University of São Paulo in Brazil, and colleagues developed the now commonly used NOVA classification scale.
The NOVA classification system, which assigns foods into one of four groups based on the level and purpose of (industrial) processing, was used to classify whether a food was ultraprocessed. This classification considers all physical, biological, and chemical methods used in food manufacturing, including the use of additives.[2][3]
The amount of ultraprocessed foods in each individual’s diet was then calculated in two ways: weight ratio (which divided the total weight of ultraprocessed foods consumed each day by the total weight of food and beverages consumed each day) and the energy ratio, which divided the total calories from ultraprocessed foods each day by the total calories consumed each day.
Individuals were then divided into three groups based on the weight ratio of ultraprocessed foods consumed.
The researchers also adjusted for multiple factors, including demographic characteristics, smoking status, body mass index, leisure-time physical activity, medical history, cancer type, and overall diet quality, measured by the Mediterranean Diet Score.
Study outcomes Results
During a median follow-up of 14.6 years, there were a total of 281 deaths among the 802 cancer survivors. Individuals in the highest third of ultraprocessed food consumption by weight ratio had a 48% higher rate of death from any cause and a 59% higher rate of death from cancer compared with those in the lowest third. A higher energy ratio of ultraprocessed foods showed similar results for cancer death, but not for other causes.
“Some foods may weigh a lot but contribute few calories, or vice versa, which is why the results can differ depending on the measure used,” Bonaccio explained.
“But the fact that the association between ultraprocessed foods and all-cause death persisted even after adjusting for overall diet quality suggests that the negative health effects are not explained solely by poor nutrient profiles, but that the level and nature of industrial food processing itself play an independent role in influencing long-term health outcomes.”
Biological mechanisms
To examine potential biological mechanisms affected by ultraprocessed foods, Bonaccio and colleagues analyzed inflammatory, metabolic, and cardiovascular biomarkers using samples and data collected from participants. Among the biomarkers examined, adjusting for inflammatory scores and resting heart rate attenuated the association between ultraprocessed foods and all-cause death by 37.3%.
“These results suggest that increased inflammation and elevated resting heart rate may partially explain the link between higher consumption of ultraprocessed foods and increased mortality, and help to clarify how food processing itself could contribute to worse outcomes among cancer survivors,” Bonaccio said.
To better understand if the nutritional content of health made a difference, the researchers established and examined data for seven groups of ultraprocessed foods: artificially and sugar-sweetened beverages, artificial sweeteners, and spirits; dairy and cheese products; processed meat; salty snacks and savory foods; fatty spreads and sauces; starchy foods; and sugary foods and sweets.
Some groups were linked to higher mortality, while others showed no clear pattern. However, interpreting individual ultraprocessed foods is challenging, and they are best considered as a dietary pattern rather than isolated items, Bonaccio said.
“The main message for the public is that overall consumption of ultraprocessed foods matters far more than any individual item,” Bonaccio said.
“Focusing on the diet as a whole and reducing ultraprocessed foods overall and shifting consumption toward fresh, minimally processed, home-cooked foods is the most meaningful and beneficial approach for health. A practical way to do this is by checking labels: Foods with more than five ingredients, or even only one food additive, are likely to be ultraprocessed,” Bonaccio concluded.
Study Limitations
Limitations of this study include the fact that, as an observational study, causality cannot be inferred, dietary intakes were self-reported, making them susceptible to misreporting, dietary habits could have changed over the course of the follow-up period, and the study was subject to survival bias as diet was assessed an average of 8.4 years after cancer diagnosis.
Additionally, the study had a small number of deaths, which limits its statistical power, and a lack of data regarding cancer stage at the time of diagnosis.
__
Reference
[1] Bonaccio M, Di Castelnuovo A, Costanzo S, Ruggiero E, Esposito S, Panzera T, Di Costanzo G, De Curtis A, Magnacca S, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. Ultra-processed food and mortality among long-term cancer survivors from the Moli-sani Study: prospective findings and analysis of biological pathways. Cancer Epidemiol Biomarkers Prev. 2026 Feb 4. doi: 10.1158/1055-9965.EPI-25-0808. Epub ahead of print. PMID: 41634927.
[2] Monteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada ML, Rauber F, Khandpur N, Cediel G, Neri D, Martinez-Steele E, Baraldi LG, Jaime PC. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019 Apr;22(5):936-941. doi: 10.1017/S1368980018003762. Epub 2019 Feb 12. PMID: 30744710; PMCID: PMC10260459.
[3] Moubarac JC, Parra DC, Cannon G, Monteiro CA. Food Classification Systems Based on Food Processing: Significance and Implications for Policies and Actions: A Systematic Literature Review and Assessment. Curr Obes Rep. 2014 Jun;3(2):256-72. doi: 10.1007/s13679-014-0092-0. PMID: 26626606.
Featured image courtesy 2023 – 2026 Andrej Lišakov licensed under the Unsplash+ License. Used with permission.
DOI
