Dietary patterns high in ultra-processed foods (UPFs) have been associated with poor diet quality and health outcomes, and are displacing healthier dietary patterns-meals and dishes prepared with fresh and minimally processed foods-in most parts of the world. In the second paper of this Series, we propose a set of government policies aimed at halting and reversing the rise of UPFs worldwide. To date, policies have mainly focused on reducing consumption of foods high in added fats, sugar, and sodium, many of which are UPFs. However, we propose that these efforts be strengthened and expanded to address a broader set of food system drivers influencing the production, marketing, and consumption of UPFs. This Series paper addresses four food policy domains that correspond to the key dimensions of food system drivers of UPF production, marketing, and consumption: UPF products, UPF food environments, UPF manufacturers, fast-food corporations, and supermarket corporations retailers, and food supply chains. For each domain, we explore policy options and focus on large-scale food system measures that target areas in greatest need of change, and their potential impacts. We also examine policies to protect, incentivise, and support dietary patterns based on fresh and minimally processed foods, particularly for lower income households. Which policy actions governments decide to prioritise will depend on each country's level of UPF consumption, along with many other issues unique to each country. We emphasise the importance of advancing this agenda in all countries, irrespective of their development status, to promote healthier diets among populations.

This first paper in a three-part Lancet Series combines narrative and systematic reviews with original analyses and meta-analyses to assess three hypotheses concerning a dietary pattern based on ultra-processed foods. The first hypothesis-that this pattern is globally displacing long-established diets centred on whole foods and their culinary preparation as dishes and meals-is supported by decades of national food intake and purchase surveys, and recent global sales data. The second-that this pattern results in deterioration of diet quality, especially in relation to chronic disease prevention-is confirmed by national food intake surveys, large cohorts, and interventional studies showing gross nutrient imbalances; overeating driven by high energy density, hyper-palatability, soft texture, and disrupted food matrices; reduced intake of health-protective phytochemicals; and increased intake of toxic compounds, endocrine disruptors, and potentially harmful classes and mixtures of food additives. The third and final hypothesis-that this pattern increases the risk of multiple diet-related chronic diseases through various mechanisms-is substantiated by more than 100 prospective studies, meta-analyses, randomised controlled trials, and mechanistic studies, covering adverse outcomes across nearly all organ systems. The totality of the evidence supports the thesis that displacement of long-established dietary patterns by ultra-processed foods is a key driver of the escalating global burden of multiple diet-related chronic diseases. Two companion papers in this Series specify policy actions and wider public health strategies to promote, protect, and support diets based on fresh and minimally processed foods and prevent their displacement by ultra-processed foods.

The rise of ultra-processed foods (UPFs) in human diets is harming global public health. However, policy responses are still emerging-much like tobacco control efforts decades ago-indicating the need to understand root causes and accelerate global action. This paper, the third in a three-part Lancet Series, takes several steps to advance knowledge of these causes, and to inform a global public health response. First, we show that the UPF industry is a key driver of the problem, as its leading corporations and co-dependent actors have expanded and restructured food systems almost everywhere, in favour of ultra-processed diets. The higher profitability of UPFs compared with other types of food fuels this growth, by financially incentivising the ultra-processed business model over alternatives, and generating resources for continued expansion. Second, we highlight that the main barrier to advancing policy responses is the industry's corporate political activities, coordinated transnationally through a global network of front groups, multi-stakeholder initiatives, and research partners, to counter opposition and block regulation. These activities include direct lobbying, infiltrating government agencies, and litigation; promoting corporate-friendly governance models, forms of regulation, and civil societies; and framing debate, generating favourable evidence, and manufacturing scientific doubt. Third, we present strategies for reducing the UPF industry's power in food systems and for mobilising a global public health response. Reducing the UPF industry's power involves disrupting the ultra-processed business model and redistributing resources to other types of food producers; protecting food governance from corporate interference; and implementing robust conflict of interest safeguards in policy making, research, and professional practice. Mobilising a global response includes framing UPFs as a priority global health issue; building powerful global and country-level advocacy coalitions; generating legal, research, and communication capacities to empower advocacy and drive policy change; and ensuring a just transition to low-UPF diets. A coordinated, well resourced global response is essential-one that confronts corporate power, reclaims public policy space, and restructures food systems to prioritise health, equity, and sustainability over corporate profit.

Transcatheter devices designed for calcific aortic stenosis are not optimised for use in native aortic regurgitation, and data on aortic regurgitation-dedicated platforms are limited. The extended ALIGN-AR pivotal experience with a prospectively enrolled continued-access cohort and longer follow-up aimed to characterise the safety, valve function, and clinical outcomes of transcatheter aortic valve intervention (TAVI) with a dedicated device in aortic regurgitation.