Ultra-processed foods and stroke: An umbrella review

Background and aims: Increasing evidence suggests moderate to strong relationships between ultra processed foods (UPFs) and cardiovascular diseases (CVDs). However, whilst CVDs represent a set of heterogeneous diseases, detailed associations between UPFs and stroke risk remain unclear. We summarised the evidence from systematic reviews with or without meta-analyses between UPF consumption and stroke risk. Methods : Scopus, Web of Science, PubMed and MEDLINE were systematically searched for eligible publications analysing the association between UPF and stroke risk from inception to December 2025, with an updated search in June 2026. Study quality and certainty of evidence were appraised using AMSTAR-2 and GRADE, respectively. The protocol was registered at PROSPERO. Results : From the three included meta-analyses, the earliest publication revealed no significant association between UPF and stroke (RR = 0.98 (95% CI: 0.91–1.05)). However, in the 2nd study, a positive linear relationship between UPF intake and cardiovascular events (CVE) risk (including stroke), with 10% increase of UPF by daily weight proportion being associated with a 1.9% increase of CVE risk (95% CI: 1.007–1.031). Specifically, six individual studies investigated independent associations between chocolate, sugar-sweetened beverages (SSB) and stroke, with positive associations reported between SSB and stroke and inconsistent results reported for associations between chocolate and stroke. In the most recent review, a 9% increased risk of stroke (95% CI: 1.03–1.15) from the highest UPF intakes was reported. Methodological quality of the included reviews ranged from low to high, and none of the associations reached high certainty. Conclusions : The available evidence suggests that higher UPF consumption is associated with an increased risk of stroke, although the certainty of evidence remains low. Yet, with limited data on stroke prognosis, our study highlights the need for further research.