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fatty liver disease (NAFLD) includes a spectrum of liver alterations that can result in severe disease and even death. Consumption of ultra-processed foods (UPF) has been associated with obesity and related comorbidities. However, the link between UPF and NAFLD has not been sufficiently assessed. We aimed to investigate the prospective association between UPF consumption and liver health biomarkers. Methods: We followed for 1 year 5867 older participants with overweight\/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus trial. A validated 143-item semi-quantitative food frequency questionnaire was used to evaluate consumption of UPF at baseline, 6, and 12 months. The degree of processing for foods and beverages (g\/day) was established according to the NOVA classification system. The non-invasive fatty liver index (FLI) and hepatic steatosis index (HSI) were used to evaluate liver health at three points in time. The associations between changes in UPF consumption (percentage of total daily dietary intake (g)) and liver biomarkers were assessed using mixed-effects linear models with repeated measurements. Results: In this cohort, UPF consumption at baseline was 8.19% (SD 6.95%) of total daily dietary intake in grams. In multivariable models, each 10% daily increment in UPF consumption in 1 year was associated with significantly greater FLI (\u03b2 1.60 points, 95% CI 1.24;1.96 points) and HSI (0.43, 0.29; 0.57) scores (all p-values &lt; 0.001). These associations persisted statistically significant after adjusting for potential dietary confounders and NAFLD risk factors. Conclusions: A higher UPF consumption was associated with higher levels of NAFLD-related biomarkers in older adults with overweight\/obesity and MetS.<\/jats:p>","DOI":"10.3390\/nu14194142","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T01:21:07Z","timestamp":1665364867000},"page":"4142","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Does Consumption of Ultra-Processed Foods Matter for Liver Health? Prospective Analysis among Older Adults with Metabolic Syndrome"],"prefix":"10.3390","volume":"14","author":[{"given":"Jadwiga","family":"Konieczna","sequence":"first","affiliation":[{"name":"Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), 07120 Palma de Mallorca, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Fiol","sequence":"additional","affiliation":[{"name":"Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), 07120 Palma de Mallorca, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5041-0778","authenticated-orcid":false,"given":"Antoni","family":"Colom","sequence":"additional","affiliation":[{"name":"Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), 07120 Palma de Mallorca, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3917-9808","authenticated-orcid":false,"given":"Miguel \u00c1ngel","family":"Mart\u00ednez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain"},{"name":"Department of Preventive Medicine and Public Health, IDISNA, University of Navarra, 31008 Pamplona, Spain"},{"name":"Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2700-7459","authenticated-orcid":false,"given":"Jordi","family":"Salas-Salvad\u00f3","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain"},{"name":"Universitat Rovira i Virgili, Departament de Bioqu\u00edmica i Biotecnologia, Unitat de Nutrici\u00f3, 43201 Reus, Spain"},{"name":"University Hospital of Sant Joan de Reus, Nutrition Unit, 43204 Reus, Spain"},{"name":"Institut d\u2019Investigaci\u00f3 Sanit\u00e0ria Pere Virgili (IISPV), 43204 Reus, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2366-4104","authenticated-orcid":false,"given":"Dolores","family":"Corella","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain"},{"name":"Department of Preventive Medicine, University of Valencia,46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5625-9033","authenticated-orcid":false,"given":"Mar\u00eda Trinidad","family":"Soria-Florido","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Fisiopatolog\u00eda de la Obesidad y la Nutrici\u00f3n (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain"},{"name":"Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones M\u00e9dicas Municipal d\u2019Investigaci\u00f3 M\u00e9dica (IMIM), 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5218-6941","authenticated-orcid":false,"given":"J. 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