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. 2025 Apr 17;24(1):62.
doi: 10.1186/s12937-025-01125-5.

The link between ultra-processed food consumption, fecal microbiota, and metabolomic profiles in older mediterranean adults at high cardiovascular risk

Alessandro Atzeni  1   2   3 , Adrián Hernández-Cacho  4   5   6 , Nadine Khoury  4   5   6 , Nancy Babio  4   5   6 , Clara Belzer  7 , Jesús Vioque  8   9 , Dolores Corella  4   10 , Montserrat Fitó  4   11 , Clary Clish  12 , Josep Vidal  13   14 , Prokopis Konstanti  7 , Sandra Gonzales-Palacios  8   9 , Oscar Coltell  4   15 , Albert Goday  4   11   16 , Isabel Moreno Indias  4   17 , Silvia Carlos Chillerón  18   19 , Miguel Ruiz-Canela  4   18   19 , Francisco J Tinahones  4   17 , Frank B Hu  20   21 , Jordi Salas-Salvadó  22   23   24
Affiliations

The link between ultra-processed food consumption, fecal microbiota, and metabolomic profiles in older mediterranean adults at high cardiovascular risk

Alessandro Atzeni et al. Nutr J. .

Abstract

Background: Ultra-processed food (UPF) consumption has been linked to adverse metabolic outcomes, potentially mediated by alterations in gut microbiota and metabolite production.

Objective: This study aims to explore the cross-sectional and longitudinal associations between NOVA-classified UPF consumption, fecal microbiota, and fecal metabolome in a population of Mediterranean older adults at high cardiovascular risk.

Methods: A total of 385 individuals, aged between 55 and 75 years, were included in the study. Dietary and lifestyle information, anthropometric measurements, and stool samples were collected at baseline and after 1-year follow-up. Fecal microbiota and metabolome were assessed using 16 S rRNA sequencing and liquid chromatography-tandem mass spectrometry, respectively.

Results: At baseline, higher UPF consumption was associated with lower abundance of Ruminococcaceae incertae sedis (β = - 0.275, P = 0.047) and lower concentrations of the metabolites propionylcarnitine (β = - 0.0003, P = 0.013) and pipecolic acid (β = - 0.0003, P = 0.040) in feces. Longitudinally, increased UPF consumption was linked to reduced abundance of Parabacteroides spp. after a 1-year follow-up (β = - 0.278, P = 0.002).

Conclusions: High UPF consumption was associated with less favorable gut microbiota and metabolite profiles, suggesting a possible link to reduced short-chain fatty acid (SCFA) production, altered mitochondrial energy metabolism, and impaired amino acid metabolism. These findings support the reduction of UPF consumption and the promotion of dietary patterns rich in fiber for better gut health. Further research is needed to confirm these associations and clarify the underlying mechanisms.

Trial registration: ISRCTN89898870 ( https://doi.org/10.1186/ISRCTN89898870 ).

Keywords: Cardiovascular disease; Fecal metabolites; Fecal microbiota; Mediterranean diet; Ultra-processed foods.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This trial was approved by the institutional review board of all participating institutions and was registered on the ISRCTN registry (ISRCTN89898870) on July 24, 2014. All participants provided written informed consent, and the procedures were implemented in accordance with the ethical standards of the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: J.S-S reports serving on the board of and receiving grant support through his institution from the International Nut and Dried Fruit Council, serving on the board of the Instituto Danone Spain and the International Danone institute. None of the other authors declare competing interests.

Figures

Fig. 1
Fig. 1
Differentially abundant taxa associated with baseline ultra-processed foods (UPF) consumption. Multivariable association tested with generalized liner model adjusted for sex, age, education (primary, secondary, tertiary), recruiting center (Alicante, Barcelona, Reus, Valencia), smoking status (never, former, smoker), diabetes, hypertension, hypercholesterolemia prevalence, body mass index, waist circumference, physical activity, alcohol intake, fiber intake, NOVA Group 1, Group 2, and Group 3 foods consumption. Values in x axe indicate UPF consumption in g/day, values in y axe indicate genera centered log-ratio relative abundance with Benjamini-Hochberg adjusted P < 0.05
Fig. 2
Fig. 2
Differentially abundant taxa 1-year change associated with ultra-processed foods (UPF) consumption 1-year change. Multivariable longitudinal association tested with generalized liner model adjusted for time (baseline, 1 year), sex, age, education (primary, secondary, tertiary), recruiting center (Alicante, Barcelona, Reus, Valencia), smoking status (never, former, smoker), diabetes, hypertension, hypercholesterolemia prevalence, body mass index, waist circumference, physical activity, alcohol intake, fiber intake, NOVA Group 1, Group 2, and Group 3 foods consumption. Participants’ ID was specified as random effect. Values in x axe indicate UPF consumption 1-year change in g/day, values in y axe indicate genera centered log-ratio relative abundance with Benjamini-Hochberg adjusted P < 0.05
Fig. 3
Fig. 3
Mean coefficients of baseline fecal metabolites concentration selected 10 times in the 10-fold cross-validations of the binomial elastic net regression for the baseline ultra-processed foods consumption
Fig. 4
Fig. 4
Baseline fecal metabolites selected by the binomial elastic net regression significantly associated with baseline ultra-processed foods (UPF) consumption. Association tested with linear regression adjusted for sex, age, education (primary, secondary, tertiary), recruiting center (Alicante, Barcelona, Reus, Valencia), smoking status (never, former, smoker), diabetes, hypertension, hypercholesterolemia prevalence, body mass index, waist circumference, physical activity, alcohol intake, fiber intake, NOVA Group 1, Group 2, and Group 3 foods consumption. Values in x axe indicate UPF consumption in g/day, values in y axe indicate rank-based inverse normal transformation of metabolite concentration with P < 0.05
Fig. 5
Fig. 5
Mean coefficients of fecal metabolites concentration 1-year change selected 10 times in the 10-fold cross-validations of the binomial elastic net regression for the ultra-processed foods consumption 1-year change
See this image and copyright information in PMC

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