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factorswhichdidshowsignificantpositiveassociationsPrevalenceofMetsincreasedby28%inthe5thpercentile(highestUPFconsumption) compared to the1stpercentile(lowestUPF consumption)thesefindingswereparticularlystrongamongyoungadultsagedbetween20and39yearsanddecreasedwithagespecifically,theassociationbetweentheprevalenceofMetsandUPFconsumptionincreasedby12%amongpeopleaged20-39whileforsubjectsamong40-59theassociationsstrengthdroppedtoathirdtheexplanation thestudysuggests for thisphenomenonis that withincreasingage theremaybeadecreasein the strength of theassociationbetweenconsumptionofUPFsandMetsduetotheemergenceofotherrisk factors(obesity, sedentarylifestyle otheraging-relateddisordersetc)thatcompetewithdietastriggersformetabolicsyndrome As to therationale ofall the obtainedresults some studies(152021)explainthatthispositiverelationshipbetweentheconsumptionofprocessedfoodsandtheriskofcVDismainlyduetotheirhighcontentofnutritionallypoorernutrientssuchassodiumenergy,fatssugarsandtheirlowfibercontentwhichhavealreadybeendemonstrated tobehighrisk factors for cardiometabolichealthMoreover,severalstudies(152021)agreedthatanincreasedriskofcVDinhighconsumersofUPFsmayalsopartlybedue to thedisplacementofminimallyprocessedfoodsresultinginlowintakeoffruitandvegetablesthelowconsumptionofthesefoodscanaffecttheresultssincetheyareknowntobebeneficialinpreventingcVD(56)Furthermoretheabove-mentionedstudies(152021)referthatanothercauseofspecialconcernfortheobtainedresultsmaybe thehigh content on additives onUPFsHigh doses of sulphitesmonosodiumglutamateemulsifiers(particularlycarboxymethylcelluloseandpolysorbate-80)carrageenanandnon-caloricartificialsweetenerswereshowntoincreasetheriskofcVDorcardiovascularriskfactorssuchasobesity,metabolicsyndromeorinsulinresistance(37-40)Inaddition Zhangetal.(2021)(20)mentions thehigh flavoring onUPFsmakes theseproducts verypalatable whichmayresultinreplacingofthenaturalsatietymechanismsmakingpeopleeatmore without evenbeinghungry.Lastly, studies allude the associationwasalsoduetocompoundsformedduringfoodprocessingsuchasacrylamide as well as contaminationby contactmaterials such asbisphenol AbothofwhichareassociatedwithanincreasedriskofcVD(41 42)Given thepaucity of studiesmore epidemiological evidenceisneededin the future tobetterunderstand therelationshipbetweenUPFsconsumptionandcVDriskFurtherresearchneedstobedoneinordertoidentifywhichspecificUPFscompoundsandprocesseshaveasignificantrolein theassociationbetweenUPFsconsumptionandincreased cardiovascularrisknotably, arecentreview addressespotentialmechanismslinkingultra-processed foods tocVDrisk(43)versialthismayposealimitationassrouretal.(2019)(15)concludedthatfurtherstudiesshouldbecarriedouttoconfirmtheresultsobtainedintheirstudy.Moreiraetal.(2018)(24)justifiedtheirassumptionswithstudieswhichfocusedonconsumptionofadded sugar, sodiumor fats(compounds whichultra-processed foodshaveahighcontentof)and thedevelopmentofcVDLikewise thismayposeaweaknesssinceitisassumedthatallultra-processedfoodsincludethesecompoundsZhongetal.’s(2021)study(17)ismorerecentthanMoreiraetal.’s(2018)study(24)whichmaybeastrengthforthefirststudyintermsofavailabilityofliteratureinthisfieldHowever,thepaucityofscientificresearchconductedinthis field todateappears tobealimitation forboth studies(17 24)Inregardtocardiovascularriskestimatedfromintermediateriskfactors thecross-sectional studydoneon 56postmenopausal womenwithrheumatoidarthritisis worthmentioning(19) thisstudyshowed thatahighconsumptionofUPFsin thesepatients wasassociatedwithahigherestimatedcardiovascularriskandaworsemetabolicprofileconversely,ahigherconsumptionofunprocessedorminimallyprocessedfoodswasassociatedwithabettercardiovascularriskprofilehavingalower10-yearriskofdevelopingcVDMonteroHetal.’s(2020)(21)exploredtheassociationbetweensubclinicalcoronaryatherosclerosisandhighconsumptionofUPFinmiddle-agedmenthisstudyfoundoutthatpeoplewithahighintakeofUPFdoubledtheriskofdevelopingsubclinicalcoronaryatherosclerosisHowever,subjectsinthehighestpercentileofUPFconsumptionweremorefrequentlyobesehadlowerHDLcholesterollevelsandperformedlessphysicalactivityAlltheseabove-mentionedfactorspredisposetocardiovascularriskevents(822)Moreover,thisstudyusedcoronarycalciumAgatstonscore(cAcs)asanindicatorofcalciumdeposits threecategories forcAcswereestablished0 for thelowestcategory(meaningnopresenceofcalcium)>0and<100forthemiddlecategory(presenceofcalcium)and≥100 for thehighest category(moderate to severe subclinicalcoronaryatherosclerosis)calciumdepositsfallingintothislast categoryhavebeendemonstrated toincrease coronaryheartdisease While study founda significantdose-responserelationbetweenhigher consumption ofUPFandrisk ofprogressing from the firstandsecond category to thehighest onenoassociation was foundbetweentheriskofprogressingfromthelowestcategorytothemiddleandhighestonesanddailyconsumptionofUPF.MartínezsteeleEetal.(2019)(22)studyfocusedontherelationbetweenUPFsandmetabolicsyndrome(Mets)whichhasbeendemonstratedtoincreasecVDrisk(6)Inthisstudy,ahigherdietary contribution ofUPFs wasassociated withahigherprevalenceofMetsHowever,association wasnot statistically significantifit werenotfortheadjustedmodelsonageandotherpotentialcofounding346ANALESRANFwwwanalesranfcomConsumo de alimentos ultraprocesados y enfermedad cardiovascular unarevisión sistemáticaAmeliaMartidelMoral ySofíaAimiArrúeIshiyamaAnRealAcadFarmVol87Nº3(2021)·pp339-350