Cancer survivors who regularly consume ultra-processed foods face significantly higher risks of death, according to a new Italian study that tracked more than 800 survivors for nearly 15 years.
The research, published Wednesday in Cancer Epidemiology, Biomarkers & Prevention, found that cancer survivors who ate the most ultra-processed foods had a 48% higher relative risk of death from any cause and a 57% higher relative risk of dying from cancer compared with those who ate the least. Because the study was observational, the findings do not prove that ultra-processed foods cause increased mortality.
The findings add to growing concerns about ultra-processed foods, products such as sodas, packaged snacks, processed meats and pre-made meals that contain artificial additives, preservatives and high levels of added sugars and unhealthy fats.
“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,” said Dr. Marialaura Bonaccio, lead author and a researcher at IRCCS Neuromed in Pozzilli, Italy, in a statement.
15-year study tracked 802 cancer survivors
Researchers followed 802 cancer survivors from the Moli-sani Study, a long-term health project tracking residents of southern Italy’s Molise region. Participants were 35 or older and had a prior diagnosis of cancer. Over a follow-up period of about 15 years, 281 participants died.
The study classified foods using the NOVA system, which groups items based on their level of processing. Ultra-processed foods are those that have undergone extensive industrial processing and typically contain ingredients not found in home kitchens.
What may make these foods more harmful isn’t just their poor nutritional content, Dr. Bonaccio explained. Even when ultra-processed and natural foods have similar calories and nutrients on paper, the processed versions appear more damaging to health.
“The substances involved in the industrial processing of foods can interfere with metabolic processes, disrupt gut microbiota, and promote inflammation,” Dr. Bonaccio said. “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.”
The research team noted that these industrial substances may clarify how food processing itself contributes to worse outcomes. While the study was subject to survival bias because diet was assessed an average of 8.4 years after diagnosis, the findings suggest post-diagnostic dietary patterns are a meaningful factor in long-term survival.
How ultra-processed foods affect inflammation and heart rate
The research team examined biological markers to understand why ultra-processed foods might increase mortality risk. They found that inflammation and elevated resting heart rate together explained about 37.3% of the association between ultra-processed food consumption and death risk.
“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,” Dr. Bonaccio said.
Importantly, the negative health effects persisted even after researchers accounted for overall diet quality, suggesting that the processing itself, not just poor nutrition, may play an independent role in health outcomes.
The researchers examined seven categories of ultra-processed foods, including sugar-sweetened beverages, processed meats, salty snacks and sugary sweets. Some categories showed stronger associations with mortality than others, though the researchers cautioned against focusing on individual items.
How to reduce ultra-processed foods in your diet
“The main message for the public is that overall consumption of ultraprocessed foods matters far more than any individual item,” Dr. 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.”
She offered practical advice for consumers: “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.”
Other strategies include cooking at home more often, choosing whole fruits instead of fruit juices or fruit-flavored snacks, selecting plain yogurt over flavored varieties, and replacing packaged meals with simple combinations of fresh ingredients.
The study had limitations. Dietary information was self-reported and collected an average of 8.4 years after cancer diagnosis, meaning eating habits could have changed during the follow-up period. The relatively small number of deaths also limited statistical power, and researchers lacked information about cancer stage at diagnosis.
Federal guidelines now address processed foods
The findings come amid growing federal attention to ultra-processed foods and their health effects. The latest U.S. Dietary Guidelines for Americans, released in January, took a new stance on highly processed foods, urging consumers to avoid packaged, prepared and ready-to-eat foods that are salty or sweet, such as chips, cookies and candy.
Those guidelines emphasized eating whole foods and fresh vegetables while continuing to limit saturated fat consumption. The shift reflects mounting research linking ultra-processed foods to chronic diseases such as diabetes and obesity. Such foods make up more than half of the calories in the American diet, according to federal estimates.
The FDA and Agriculture Department are working on an official definition of ultra-processed foods, though experts say the process could take considerable time. Not all highly processed foods are equally unhealthy, nutrition researchers note, with some experts suggesting the focus should be specifically on highly processed carbohydrates rather than all processed items.
The study was funded by the Fondazione AIRC per la Ricerca sul Cancro ETS. Dr. Bonaccio reported no conflicts of interest.
Ultra-Processed Food Categories
To help readers identify which foods were specifically scrutinized in the Moli-sani Study, the researchers established seven distinct categories of ultra-processed products:
- Beverages and Sweets: Artificially and sugar-sweetened beverages, artificial sweeteners, and spirits.
- Dairy: Various dairy and cheese products.
- Processed Meats: Industrial meat products.
- Savory Snacks: Salty snacks and other savory prepared foods.
- Condiments: Fatty spreads and various sauces.
- Starchy Foods: Highly processed carbohydrate-based items.
- Confectionery: Sugary foods and sweets.
Dr. Bonaccio emphasized that these items should be viewed as a dietary pattern rather than isolated items, noting that the overall reduction of these foods is the most beneficial approach for long-term survival.
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