ASSOCIATIONS OF NOVA-CLASSIFIED ULTRA-PROCESSED FOOD CONSUMPTION WITH CANCER OUTCOMES IN ADULTS: A SYSTEMATIC REVIEW OF SITE-SPECIFIC INCIDENCE AND MORTALITY
Main Article Content
Abstract
Abstract
Aims: To assess whether higher consumption of NOVA-classified UPFs is associated with greater cancer risk in adults than lower consumption.
Methods: We searched PubMed, Scopus, Europe PMC, OpenAlex, and Semantic Scholar for English-language, peer-reviewed studies published from 2020 to 2026. Cohort studies and randomized trials reporting cancer incidence or cancer-specific mortality were eligible.
Results: The five database searches identified 1,677 records. After screening, 28 prospective cohort reports were included. Overall, higher UPF intake was associated with modest increases in some site-specific cancer incidences, but not with a consistent increase in overall cancer risk. The clearest associations were observed for colorectal cancer, particularly distal and right-sided colon cancer, and for lung cancer across major histological types. Positive associations were also observed for renal cell carcinoma and pancreatic cancer, whereas findings for liver, head and neck, and oesophageal cancers were less consistent. Cancer-specific mortality was generally null, with some positive site-specific signals.
Conclusion: Higher UPF consumption may be linked to site-specific cancers, but observational evidence does not show a consistent or causal association across cancer outcomes. Future studies should use repeated dietary assessment, standard exposure measures, site-specific outcomes, and independent cohorts.
Keywords
Keywords: Ultra-processed foods, NOVA classification, cancer incidence, cancer-specific mortality, dietary exposure.
Article Details
References
References
1. Monteiro CA, Cannon G, Moubarac JC et al. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr 2018;21(1):5–17. https://doi.org/10.1017/S1368980017000234.
2. Lane MM, Gamage E, Du S et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses, Research. BMJ 2024;384:e077310. https://doi.org/10.1136/bmj-2023-077310.
3. Menegassi B, Vinciguerra M. Ultraprocessed food and risk of cancer: Mechanistic pathways and public health implications. Cancers 2025;17(13):2064. https://doi.org/10.3390/cancers17132064.
4. Isaksen IM, Dankel SN. Ultra-processed food consumption and cancer risk: A systematic review and meta-analysis. Clin Nutr 2023;42(6):919–28. https://doi.org/10.1016/j.clnu.2023.03.018.
5. Vithayathil S, Walizada M, Siddi G et al. Navigating evidence on ultra-processed foods and cancer: A narrative review. Cureus 2025;17(11):e96173. https://doi.org/10.7759/cureus.96173.
6. Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, Research Methods & Reporting. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71.
7. Chang K, Gunter MJ, Rauber F et al. Ultra-processed food consumption, cancer risk and cancer mortality: a large-scale prospective analysis within the UK Biobank. eClinicalMedicine 2023;56:101840. https://doi.org/10.1016/j.eclinm.2023.101840.
8. Kliemann N, Rauber F, Bertazzi Levy R et al. Food processing and cancer risk in Europe: Results from the prospective EPIC cohort study. Lancet Planet Health 2023;7(3):e219–32. https://doi.org/10.1016/S2542-5196(23)00021-9.
9. Díez MJC, Vázquez-Ruiz Z, Huybrechts I et al. Degree of food processing and incidence of obesity-related cancers in the “Seguimiento Universidad de Navarra” project. J Nutr 2025;155(11):3987–96. https://doi.org/10.1016/j.tjnut.2025.08.031.
10. Wang L, Du M, Wang K et al. Association of ultra-processed food consumption with colorectal cancer risk among men and women: results from three prospective US cohort studies. BMJ 2022;378:e068921. https://doi.org/10.1136/bmj-2021-068921.
11. Mols R, Huybrechts I, Skeie G. High consumption of ultra-processed food and risk of colorectal cancer: The Norwegian Women and Cancer cohort study. Br J Nutr 2025;134(6):497–506. https://doi.org/10.1017/S0007114525105114.
12. Berden J, Langselius O, González-Gil EM et al. Assessing the role of ultra-processed foods in colorectal cancer incidence: insights from the EPIC cohort. BMC Public Health 2026;26(1). https://doi.org/10.1186/s12889-026-27225-3.
13. Zhao L, Zhang X, Yu D et al. Ultra-processed products and risk of liver cancer: A prospective cohort study. Clin Nutr 2024b;43(10):2298–304. https://doi.org/10.1016/j.clnu.2024.08.011.
14. Zhao L, Clay-Gilmour A, Zhang J et al. Higher ultra-processed food intake is associated with adverse liver outcomes: a prospective cohort study of UK Biobank participants. Am J Clin Nutr 2024a;119(1):49–57. https://doi.org/10.1016/j.ajcnut.2023.10.014.
15. Zhong G, Zhu Q, Cai D et al. Ultra‐processed food consumption and the risk of pancreatic cancer in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Int J Cancer 2022;152(5):835–44. https://doi.org/10.1002/ijc.34290.
16. Morales-Berstein F, Biessy C, Viallon V et al. Ultra-processed foods, adiposity and risk of head and neck cancer and oesophageal adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition study: a mediation analysis. Eur J Nutr 2024;63(2):377–96. https://doi.org/10.1007/s00394-023-03270-1.
17. Wang K, Zhao J, Yang D et al. Association between ultra-processed food consumption and lung cancer risk: a population-based cohort study. Thorax 2025;80(11):810–8. https://doi.org/10.1136/thorax-2024-222100.
18. Li YD, Fu YX, Gong LL et al. Ultra-processed food consumption and renal cell carcinoma incidence and mortality: results from a large prospective cohort. BMC Med 2024;22(1). https://doi.org/10.1186/s12916-024-03677-5.
19. Burns KF, Purdue MP, Khandpur N et al. Ultra-processed food intake and risk of renal cell carcinoma in the NIH-AARP Diet and health study: a prospective cohort analysis. Lancet Reg Health - Am 2026;62:101548. https://doi.org/10.1016/j.lana.2026.101548.
20. Chen B, Liu H, Wang R et al. Ultra-processed food consumption and the risk of breast cancer incidence and death: a prospective cohort study. Sci Rep 2025;16(1). https://doi.org/10.1038/s41598-025-29773-x.
21. O’Connell CP, Hong HG, Abar L et al. Ultraprocessed food intake and risk of ovarian and endometrial cancer in the NIH-AARP cohort: a prospective cohort analysis. Am J Clin Nutr 2025;122(2):513–22. https://doi.org/10.1016/j.ajcnut.2025.05.024.
22. Feinberg A, Rebholz CM, Lemaitre RN et al. Ultra-processed foods, plant and animal sources, and all-cause, cardiovascular, and cancer mortality in older adults in the United States: results from the Cardiovascular Health Study. Am J Clin Nutr 2025;122(2):523–34. https://doi.org/10.1016/j.ajcnut.2025.05.033.
23. Campanella A, Tatoli R, Bonfiglio C et al. Ultra-processed food consumption as a risk factor for gastrointestinal cancer and other causes of mortality in Southern Italy: A competing risk approach. Nutrients 2024;16(13):1994. https://doi.org/10.3390/nu16131994.
24. Torres-Collado L, Rychter A, González-Palacios S et al. A high consumption of ultra-processed foods is associated with higher total mortality in an adult Mediterranean population. Clin Nutr 2024;43(3):739–46. https://doi.org/10.1016/j.clnu.2024.01.014.
25. Mekonnen TC, Melaku YA, Shi Z et al. Ultra-processed food consumption and risk of chronic respiratory diseases mortality among adults: evidence from a prospective cohort study. Eur J Nutr 2024;63(4):1357–72. https://doi.org/10.1007/s00394-024-03356-4.
26. Kityo A, Lee SA. The intake of ultra-processed foods, all-cause, cancer and cardiovascular mortality in the Korean Genome and Epidemiology Study-Health Examinees (KoGES-HEXA) cohort. PLOS ONE 2023;18(5):e0285314. https://doi.org/10.1371/journal.pone.0285314.
27. Li YD, Gong LL, Jiang YB et al. Association of ultra-processed food consumption with all-cause and cause-specific mortality: population-based cohort study. Front Nutr 2026;13. https://doi.org/10.3389/fnut.2026.1820451.
28. Fang Z, Rossato SL, Hang D et al. Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study. BMJ 8 May 2024:e078476. https://doi.org/10.1136/bmj-2023-078476.
29. Wang L, Steele EM, Du M et al. Association between ultra-processed food consumption and mortality among US adults: Prospective cohort study of the national health and nutrition examination survey, 2003-2018. J Acad Nutr Diet 2025;125(7):875-887.e7. https://doi.org/10.1016/j.jand.2024.11.014.
30. Li Y, Li X, Pan A et al. Consumption of ultra-processed foods and risk of all-cause and cause-specific mortality: the Singapore Chinese health study. Nutr J 2025;24(1). https://doi.org/10.1186/s12937-025-01219-0.
31. Du Y, Zhang S, Schjølberg JS et al. Ultra-processed food consumption, plasma metabolite profile, and risk of all-cause and cause-specific mortality in a population-based cohort. Clin Nutr 2024;43(12):184–93. https://doi.org/10.1016/j.clnu.2024.10.023.
32. González-Gil EM, Matta M, Morales Berstein F et al. Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countries. Lancet Reg Health - Eur 2025;50:101208. https://doi.org/10.1016/j.lanepe.2024.101208.
33. Wang L, Pan XF, Munro HM et al. Consumption of ultra-processed foods and all-cause and cause-specific mortality in the Southern Community Cohort Study. Clin Nutr 2023;42(10):1866–74. https://doi.org/10.1016/j.clnu.2023.08.012.
34. Zhao Y, Chen W, Li J et al. Ultra-processed food consumption and mortality: Three cohort studies in the United Sates and United Kingdom. Am J Prev Med 2024;66(2):315–23. https://doi.org/10.1016/j.amepre.2023.09.005.
1. Monteiro CA, Cannon G, Moubarac JC et al. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr 2018;21(1):5–17. https://doi.org/10.1017/S1368980017000234.
2. Lane MM, Gamage E, Du S et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses, Research. BMJ 2024;384:e077310. https://doi.org/10.1136/bmj-2023-077310.
3. Menegassi B, Vinciguerra M. Ultraprocessed food and risk of cancer: Mechanistic pathways and public health implications. Cancers 2025;17(13):2064. https://doi.org/10.3390/cancers17132064.
4. Isaksen IM, Dankel SN. Ultra-processed food consumption and cancer risk: A systematic review and meta-analysis. Clin Nutr 2023;42(6):919–28. https://doi.org/10.1016/j.clnu.2023.03.018.
5. Vithayathil S, Walizada M, Siddi G et al. Navigating evidence on ultra-processed foods and cancer: A narrative review. Cureus 2025;17(11):e96173. https://doi.org/10.7759/cureus.96173.
6. Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, Research Methods & Reporting. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71.
7. Chang K, Gunter MJ, Rauber F et al. Ultra-processed food consumption, cancer risk and cancer mortality: a large-scale prospective analysis within the UK Biobank. eClinicalMedicine 2023;56:101840. https://doi.org/10.1016/j.eclinm.2023.101840.
8. Kliemann N, Rauber F, Bertazzi Levy R et al. Food processing and cancer risk in Europe: Results from the prospective EPIC cohort study. Lancet Planet Health 2023;7(3):e219–32. https://doi.org/10.1016/S2542-5196(23)00021-9.
9. Díez MJC, Vázquez-Ruiz Z, Huybrechts I et al. Degree of food processing and incidence of obesity-related cancers in the “Seguimiento Universidad de Navarra” project. J Nutr 2025;155(11):3987–96. https://doi.org/10.1016/j.tjnut.2025.08.031.
10. Wang L, Du M, Wang K et al. Association of ultra-processed food consumption with colorectal cancer risk among men and women: results from three prospective US cohort studies. BMJ 2022;378:e068921. https://doi.org/10.1136/bmj-2021-068921.
11. Mols R, Huybrechts I, Skeie G. High consumption of ultra-processed food and risk of colorectal cancer: The Norwegian Women and Cancer cohort study. Br J Nutr 2025;134(6):497–506. https://doi.org/10.1017/S0007114525105114.
12. Berden J, Langselius O, González-Gil EM et al. Assessing the role of ultra-processed foods in colorectal cancer incidence: insights from the EPIC cohort. BMC Public Health 2026;26(1). https://doi.org/10.1186/s12889-026-27225-3.
13. Zhao L, Zhang X, Yu D et al. Ultra-processed products and risk of liver cancer: A prospective cohort study. Clin Nutr 2024b;43(10):2298–304. https://doi.org/10.1016/j.clnu.2024.08.011.
14. Zhao L, Clay-Gilmour A, Zhang J et al. Higher ultra-processed food intake is associated with adverse liver outcomes: a prospective cohort study of UK Biobank participants. Am J Clin Nutr 2024a;119(1):49–57. https://doi.org/10.1016/j.ajcnut.2023.10.014.
15. Zhong G, Zhu Q, Cai D et al. Ultra‐processed food consumption and the risk of pancreatic cancer in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Int J Cancer 2022;152(5):835–44. https://doi.org/10.1002/ijc.34290.
16. Morales-Berstein F, Biessy C, Viallon V et al. Ultra-processed foods, adiposity and risk of head and neck cancer and oesophageal adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition study: a mediation analysis. Eur J Nutr 2024;63(2):377–96. https://doi.org/10.1007/s00394-023-03270-1.
17. Wang K, Zhao J, Yang D et al. Association between ultra-processed food consumption and lung cancer risk: a population-based cohort study. Thorax 2025;80(11):810–8. https://doi.org/10.1136/thorax-2024-222100.
18. Li YD, Fu YX, Gong LL et al. Ultra-processed food consumption and renal cell carcinoma incidence and mortality: results from a large prospective cohort. BMC Med 2024;22(1). https://doi.org/10.1186/s12916-024-03677-5.
19. Burns KF, Purdue MP, Khandpur N et al. Ultra-processed food intake and risk of renal cell carcinoma in the NIH-AARP Diet and health study: a prospective cohort analysis. Lancet Reg Health - Am 2026;62:101548. https://doi.org/10.1016/j.lana.2026.101548.
20. Chen B, Liu H, Wang R et al. Ultra-processed food consumption and the risk of breast cancer incidence and death: a prospective cohort study. Sci Rep 2025;16(1). https://doi.org/10.1038/s41598-025-29773-x.
21. O’Connell CP, Hong HG, Abar L et al. Ultraprocessed food intake and risk of ovarian and endometrial cancer in the NIH-AARP cohort: a prospective cohort analysis. Am J Clin Nutr 2025;122(2):513–22. https://doi.org/10.1016/j.ajcnut.2025.05.024.
22. Feinberg A, Rebholz CM, Lemaitre RN et al. Ultra-processed foods, plant and animal sources, and all-cause, cardiovascular, and cancer mortality in older adults in the United States: results from the Cardiovascular Health Study. Am J Clin Nutr 2025;122(2):523–34. https://doi.org/10.1016/j.ajcnut.2025.05.033.
23. Campanella A, Tatoli R, Bonfiglio C et al. Ultra-processed food consumption as a risk factor for gastrointestinal cancer and other causes of mortality in Southern Italy: A competing risk approach. Nutrients 2024;16(13):1994. https://doi.org/10.3390/nu16131994.
24. Torres-Collado L, Rychter A, González-Palacios S et al. A high consumption of ultra-processed foods is associated with higher total mortality in an adult Mediterranean population. Clin Nutr 2024;43(3):739–46. https://doi.org/10.1016/j.clnu.2024.01.014.
25. Mekonnen TC, Melaku YA, Shi Z et al. Ultra-processed food consumption and risk of chronic respiratory diseases mortality among adults: evidence from a prospective cohort study. Eur J Nutr 2024;63(4):1357–72. https://doi.org/10.1007/s00394-024-03356-4.
26. Kityo A, Lee SA. The intake of ultra-processed foods, all-cause, cancer and cardiovascular mortality in the Korean Genome and Epidemiology Study-Health Examinees (KoGES-HEXA) cohort. PLOS ONE 2023;18(5):e0285314. https://doi.org/10.1371/journal.pone.0285314.
27. Li YD, Gong LL, Jiang YB et al. Association of ultra-processed food consumption with all-cause and cause-specific mortality: population-based cohort study. Front Nutr 2026;13. https://doi.org/10.3389/fnut.2026.1820451.
28. Fang Z, Rossato SL, Hang D et al. Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study. BMJ 8 May 2024:e078476. https://doi.org/10.1136/bmj-2023-078476.
29. Wang L, Steele EM, Du M et al. Association between ultra-processed food consumption and mortality among US adults: Prospective cohort study of the national health and nutrition examination survey, 2003-2018. J Acad Nutr Diet 2025;125(7):875-887.e7. https://doi.org/10.1016/j.jand.2024.11.014.
30. Li Y, Li X, Pan A et al. Consumption of ultra-processed foods and risk of all-cause and cause-specific mortality: the Singapore Chinese health study. Nutr J 2025;24(1). https://doi.org/10.1186/s12937-025-01219-0.
31. Du Y, Zhang S, Schjølberg JS et al. Ultra-processed food consumption, plasma metabolite profile, and risk of all-cause and cause-specific mortality in a population-based cohort. Clin Nutr 2024;43(12):184–93. https://doi.org/10.1016/j.clnu.2024.10.023.
32. González-Gil EM, Matta M, Morales Berstein F et al. Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countries. Lancet Reg Health - Eur 2025;50:101208. https://doi.org/10.1016/j.lanepe.2024.101208.
33. Wang L, Pan XF, Munro HM et al. Consumption of ultra-processed foods and all-cause and cause-specific mortality in the Southern Community Cohort Study. Clin Nutr 2023;42(10):1866–74. https://doi.org/10.1016/j.clnu.2023.08.012.
34. Zhao Y, Chen W, Li J et al. Ultra-processed food consumption and mortality: Three cohort studies in the United Sates and United Kingdom. Am J Prev Med 2024;66(2):315–23. https://doi.org/10.1016/j.amepre.2023.09.005.