The impact of ultra-processed food consumption on frailty and sarcopenia: a systematic review

Abstract

Background and Aim: Ultra-processed foods (UPFs), foods with high levels of artificial additives and preservatives, often low in protein and essential nutrients despite being calorie-dense, have been associated with a range of adverse health outcomes, including cardiovascular and kidney diseases, obesity, Type 2 diabetes, and frailty. Despite growing evidence on the adverse effects of UPFs, no systematic review has comprehensively assessed their association with frailty and sarcopenia. This review synthesizes current evidence on UPF intake and frailty prevalence and severity in older adults while exploring its impact on sarcopenia-related outcomes, including muscle mass, strength and function. Materials and Methods: A systematic search of PubMed, MEDLINE (via Ovid), Cochrane Library, Web of Science and Scopus was conducted until December 4, 2024, including studies on adults (≥ 18 years) that examined UPF intake and frailty or sarcopenia. The study is reported following PRISMA guidelines and registered with PROSPERO (CRD42024615715). Results: Among 43 included studies, high UPF consumption was consistently associated with increased frailty risk, multimorbidity, systemic inflammation and sarcopenia. A dose-dependent relationship was evident, with higher UPF intake linked to reduced grip strength, slower gait speed, elevated inflammatory markers (CRP, IL-6, TNF-α) and lower muscle mass indices (MMI, AMMI). Mechanisms include chronic inflammation, metabolic dysregulation and muscle deterioration. UPFs also contribute to cardiometabolic disease and obesity, reinforcing frailty as a cumulative outcome of prolonged exposure. Some studies reported inconsistencies, particularly regarding obesity and physical activity as potential confounders. Conclusion: UPFs are a modifiable determinant of frailty, influencing inflammation, sarcopenia and metabolism. Reducing UPF intake may represent a viable strategy for frailty prevention and improved health outcomes. © 2025 Elsevier B.V., All rights reserved.