image: p Examples of foods grouped by processing level and diet quality. Quadrant A represents low processing levels and high diet quality; Quadrant B represents high processing levels and high diet quality; Quadrant C represents low processing levels and low diet quality; and Quadrant D represents high processing levels and low diet quality. From: Xiaowen Wang, Qi Sun. Ultra-Processed Foods and the Impact on Cardiometabolic Health: The Role of Diet Quality. Diabetes Metab J. 2024;48(6):1047-1055.

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Credit: Xiaowen Wang and Qi Sun / Diabetes Metab J.

National Harbor, Md. (July 28, 2026) — A new analysis challenges a popular dietary message: when it comes to cardiometabolic risk over decades, food processing level may matter less than nutritional quality.

Researchers tracked more than 200,000 U.S. adults across studies spanning the 1980s through the 2020s. They report that the overall healthfulness of a person’s diet was strongly linked with outcomes including heart disease, type 2 diabetes, and premature death.

Crucially, these associations did not meaningfully change across levels of processing. In other words, the “better diet” group remained lower risk whether their plant foods were classified as minimally processed or ultra-processed, while the “worse diet” group stayed higher risk in both processing categories.

Lead researcher Xiaowen Wang, PhD, argues that processing is not inherently toxic. Ultra-processed items often displace nutrient-dense foods and tend to be high in added sugars, sodium, and refined carbohydrates, which can damage metabolic health. But that pattern is not universal.

Her framing centers on a core statistical problem in nutrition science: nutritional quality and processing are frequently correlated. To disentangle them, the team used a plant-based diet index to quantify how participants balanced plant-derived food choices, and then mapped those choices onto the NOVA system for processing level.

The analysis intentionally emphasized plant-derived components to enable consistent comparisons. Participants were then grouped into four diet archetypes combining plant-based diet quality (healthy versus unhealthy) with processing level (minimally processed versus ultra-processed). Examples ranged from fortified whole-grain cereals with plant milk (healthy/ultra-processed) to soda and packaged desserts (unhealthy/ultra-processed).

Across follow-up, roughly half of participants experienced major events or died. The gradient of risk tracked diet quality far more clearly than processing status, producing nearly identical risk profiles within each processing stratum when diet quality was held constant.

Wang warns that blanket advice to “avoid ultra-processed foods” could inadvertently lower overall diet quality. “Healthy ultra-processed foods are beneficial,” she said, while some minimally processed foods can still be harmful if they drive excess refined starches or sugars.

In the upcoming presentation at NUTRITION 2026, the team suggests guidelines should continue prioritizing established healthy dietary patterns—such as Mediterranean-style or healthful plant-forward diets—while encouraging reformulation of packaged foods to improve nutrient density.

Note: Abstracts at NUTRITION 2026 are peer-reviewed by a selection committee but not necessarily through the journal peer-review process.

Subject of Research: Dietary quality vs. food processing level and long-term cardiometabolic outcomes
Article Title: Ultra-Processed Foods and the Impact on Cardiometabolic Health: The Role of Diet Quality
News Publication Date: July 28, 2026
Web References: https://cdmcd.co/YK3598 ; https://www.dropbox.com/scl/fi/bzvtf3ywox42odnfzh7ki/Wang-plant-based-diets-abstract.pdf?rlkey=d33dvaqm4rcwfupg0n6wswvjl&dl=0
References: Xiaowen Wang, Qi Sun. Diabetes Metab J. 2024;48(6):1047-1055.
Image Credits: Xiaowen Wang and Qi Sun / Diabetes Metab J.

Keywords

diet quality; ultra-processed foods; NOVA; plant-based diet index; cardiometabolic risk; type 2 diabetes; heart disease; chronic disease prevention

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