Ultra-processed foods and multiple sclerosis: Evidence, pitfalls and perspectives.

Ultra-processed foods are increasingly recognised as drivers of adverse health outcomes, yet their implications for multiple sclerosis remain underexamined. Emerging evidence suggests that ultra-processed food-rich dietary patterns are associated with greater central adiposity, pro-inflammatory metabolic signatures, microbiota disruption and adverse neuroimmune profiles relevant to multiple sclerosis. Major conceptual pitfalls, including the heterogeneity of ultra-processed foods and the scarcity of longitudinal or interventional studies addressing neuroimmune outcomes, continue to limit interpretation. Ultra-processed food-driven comorbidities, such as obesity, hypertension, dyslipidaemia, insulin resistance and depression, may further accelerate disability accumulation and reduce treatment efficacy in multiple sclerosis, underscoring the need for integrated dietary-immune models. This review integrates evidence from epidemiology, mechanistic studies, microbiome research and exposome science to provide a coherent framework for interpreting ultra-processed food-multiple sclerosis interactions. Recognising ultra-processed food exposure as a potentially modifiable contributor to multiple sclerosis activity may inform future preventive and therapeutic strategies.