Cancer survivors who consume high amounts of ultraprocessed foods may face a significantly elevated risk of death, both from cancer and from all causes, according to new research published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research (AACR). The study, led by the Unit of Epidemiology and Prevention at IRCCS Neuromed, adds to mounting evidence that the degree of industrial food processing may have health consequences beyond nutrient content.
Traditionally, dietary recommendations for cancer survivors have emphasized nutrient composition, but emerging data suggest that the level of processing itself may influence outcomes. Substances introduced during industrial processing can disrupt metabolic homeostasis, alter gut microbiota, and promote systemic inflammation. Even when ultraprocessed foods are similar in macro- and micronutrient content to minimally processed alternatives, they may exert adverse biological effects.
The analysis based on the Moli-sani Study, a prospective cohort of 24,325 adults aged 35 years and older in Southern Italy, followed from March 2005 to December 2022. Among them, 802 cancer survivors (476 women and 326 men) had detailed dietary data collected via the European Prospective Investigation into Cancer and Nutrition (EPIC) food frequency questionnaire. Foods were categorized using the NOVA system, which classifies items based on the extent and purpose of industrial processing. Ultraprocessed food intake was assessed both as a weight ratio and an energy ratio, with participants stratified into tertiles based on consumption by weight.
Analyses adjusted for potential confounders including age, sex, body mass index, smoking status, physical activity, medical comorbidities, cancer type, and overall diet quality as measured by the Mediterranean Diet Score. Over a median follow-up of 14.6 years, 281 of the 802 cancer survivors died. Those in the highest tertile of ultraprocessed food consumption by weight had a 48% higher risk of all-cause mortality and a 57% higher risk of cancer-specific mortality compared with individuals in the lowest tertile. Energy-based measures produced similar associations for cancer-related death, though not for deaths from other causes.
The associations persisted after adjustment for overall diet quality, indicating that the adverse effects may be related to the processing itself rather than to nutrient composition alone. To explore potential biological mechanisms, the investigators evaluated inflammatory, metabolic, and cardiovascular biomarkers. Adjusting for inflammation and resting heart rate attenuated the association between ultraprocessed food intake and all-cause mortality by 37.3%, suggesting that systemic inflammation and metabolic dysregulation may partly mediate the observed risks.
The study also examined seven categories of ultraprocessed foods, including sugar-sweetened beverages, processed meats, salty snacks, dairy products, starchy foods, fatty spreads and sauces, and sugary confections. While some categories were associated with higher mortality, no single food consistently accounted for the observed risk, emphasizing the importance of considering ultraprocessed foods as part of a broader dietary pattern.
The authors recommend that cancer survivors focus on overall diet quality and reduce intake of ultraprocessed foods in favor of fresh, minimally processed, home-cooked options. Practical guidance includes evaluating food labels; products with more than five ingredients or containing additives are likely ultraprocessed.
The findings highlight the potential impact of ultraprocessed food consumption on long-term survival among cancer survivors. The results reinforce broader public health guidance promoting minimally processed, nutrient-rich diets as a strategy to improve outcomes in this high-risk population.
Reference
- Bonaccio M, Di Castelnuovo A, Costanzo S, Ruggiero E, Esposito S, Panzera T, et al. Ultra-processed food and mortality among long-term cancer survivors from the Moli-sani Study: prospective findings and analysis of biological pathways. Cancer Epidemiol Biomarkers Prev [Internet]. 2026 Feb 4 [cited 2026 Feb 11]; Available from: https://doi.org/10.1158/1055-9965.EPI-25-0808