. 2025 Jul 24:23:101065.

doi: 10.1016/j.ajpc.2025.101065. eCollection 2025 Sep.

Association of ultra-processed food consumption and MRI-based carotid plaque characteristics: results from the Atherosclerosis Risk in Communities study

Shutong Du^{1

2}, Valerie K Sullivan^{1

2}, Kunihiro Matsushita^{1

2

3

4}, Seamus P Whelton^{3

4}, Lyn M Steffen⁵, Michael Fang^{1

2}, Lawrence J Appel^{1

2

6}, Bruce A Wesserman^{7

8}, Casey M Rebholz^{1

2

9}

Affiliations

¹ Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
² Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
³ Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA.
⁶ Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁸ Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
⁹ Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PMID: 40800002
PMCID: PMC12340399
DOI: 10.1016/j.ajpc.2025.101065

Association of ultra-processed food consumption and MRI-based carotid plaque characteristics: results from the Atherosclerosis Risk in Communities study

Shutong Du et al. Am J Prev Cardiol. 2025.

. 2025 Jul 24:23:101065.

doi: 10.1016/j.ajpc.2025.101065. eCollection 2025 Sep.

Authors

Affiliations

¹ Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
² Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
³ Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA.
⁶ Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁸ Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
⁹ Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PMID: 40800002
PMCID: PMC12340399
DOI: 10.1016/j.ajpc.2025.101065

Abstract

Background: Ultra-processed food and beverage consumption has been linked with adverse cardiovascular events, yet its association with sub-clinical disease remains less explored.

Methods: A total of 768 white participants from the Carotid MRI visit (2004-2005) in the Atherosclerosis Risk in Communities (ARIC) study were included. Participants were selected via stratified sampling to enrich for informative plaques while preserving population-level reference. Dietary intake was assessed using a 148-item food frequency questionnaire, with items classified by Nova processing levels. Carotid artery imaging was conducted via MRI and analyzed with semiautomated software. Weighted multivariable linear and logistic regression models assessed associations between quartiles of ultra-processed food intake and plaque measurements or lipid core presence.

Results: Higher ultra-processed food consumption was associated with unfavorable carotid plaque characteristics. Participants in quartile 4 of ultra-processed food consumption had greater total wall volume (standardized difference: β = 0.28, 95% CI, 0.07, 0.49), total lipid core volume (β = 0.55, 95% CI, 0.17, 0.92), maximum segmental wall thickness (β = 0.23, 95% CI, 0.01, 0.45), and maximum lipid core area (β = 0.49, 95% CI, 0.12, 0.86) vs. quartile 1. Replacing one daily serving of ultra-processed food with unprocessed or minimally processed food was associated with a reduction in total wall volume (β = -0.02, 95% CI, -0.05, -0.00).

Conclusions: Higher intake of ultra-processed food was associated with a greater burden of atherosclerotic plaque in the carotid artery. Our findings support the need for further investigation into the potential impact of ultra-processed food on atherosclerotic changes and the underlying mechanisms by which it may increase the future risk of cardiovascular disease development.

Keywords: ARIC study; Artery plaques; Carotid MRI; NOVA classification; Ultra-processed foods.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Casey Rebholz reports financial support was provided by National Heart Lung and Blood Institute. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Unlabelled image — Central illustration: Higher intake of ultra-processed food was associated with a greater burden of atherosclerotic plaque in the carotid artery.

**Fig. 1**
Proportion ( %) of each food group contributing to the frequency (servings/d) of ultra-processed food consumption in the Atherosclerosis Risk in Communities MRI Study.

**Fig. 2**
Associations between measures of plaque characteristics and ultra-processed food consumption in quartiles.

**Fig. 3**
Associations between measures of plaque characteristics and ultra-processed food consumption in servings per day represented by restricted cubic splines.

See this image and copyright information in PMC

References

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Association of ultra-processed food consumption and MRI-based carotid plaque characteristics: results from the Atherosclerosis Risk in Communities study

Affiliations

Association of ultra-processed food consumption and MRI-based carotid plaque characteristics: results from the Atherosclerosis Risk in Communities study

Authors

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Abstract

Conflict of interest statement

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Abstract

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