Association of ultra-processed food consumption with cardiovascular mortality in the US population: long-term results from a large prospective multicenter study

Abstract

Background Ultra-processed foods have now become dominant in the global food system. Whether their consumption is associated with cardiovascular mortality remains controversial. Moreover, data on ultra-processed foods and cardiovascular outcomes are scarce in the US population. We aimed to examine the association of ultra-processed food consumption with cardiovascular mortality in a US population. Methods A population-based cohort of 91,891 participants was identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Dietary data were collected through a validated 137-item food frequency questionnaire. Ultra-processed foods were defined by the NOVA classification. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular mortality. Restricted cubic spline regression was used to test nonlinearity. Subgroup analyses were conducted to identify the potential effect modifiers. Results After an average follow-up of 13.5 years (1,236,049.2 person-years), 5490 cardiovascular deaths were documented, including 3985 heart disease deaths and 1126 cerebrovascular deaths. In the fully adjusted model, participants in the highest vs. the lowest quintiles of ultra-processed food consumption had higher risks of death from cardiovascular disease (HRquintile 5 vs. 1, 1.50; 95% CI, 1.36–1.64) and heart disease (HRquintile 5 vs. 1, 1.68; 95% CI, 1.50–1.87) but not cerebrovascular disease (HRquintile 5 vs. 1, 0.94; 95% CI, 0.76–1.17). A nonlinear dose–response pattern was observed for overall cardiovascular and heart disease mortality (all Pnonlinearity < 0.05), with a threshold effect observed at ultra-processed food consumption of 2.4 servings/day and 2.3 servings/day, respectively; below the thresholds, no significant associations were observed for these two outcomes. Subgroup analyses showed that the increased risks of mortality from ultra-processed foods were significantly higher in women than in men (all Pinteraction < 0.05). Conclusions High consumption of ultra-processed foods is associated with increased risks of overall cardiovascular and heart disease mortality. These harmful associations may be more pronounced in women. Our findings need to be confirmed in other populations and settings.

A Systematic Review of Worldwide Consumption of Ultra-Processed Foods: Findings and Criticisms

“…Regarding the variability within the same country, Brazil showed levels of UPF consumption ranging from 7.7% in 64 subjects aged 25–57 years [ 57 ] to 51.2% of total energy intake in over 4200 subjects [ 58 ]. A lower variability was identified in studies performed in the United States, with levels of intake ranging from 50% to 70%, with the only exception being a study observing an energy intake of 35.5% in almost 92,000 subjects aged 55–74 years [ 59 ].…”

“…Since Monteiro et al proposed the NOVA classification to categorize foods based on the degree of processing [4], several studies have been conducted to estimate the level of consumption of UPF and its association with several health markers [24,35,52,67,120] as well as with disease risk and mortality [55,59,87,121,122], adjusting the models for energy intake and other potential confounding factors. It was hypothesized that a high level of UPF consumption may represent a health issue, being associated with weight gain and worsening of cardiovascular risk factors such as high waist circumference and low HDL cholesterol [11].…”

Socioeconomic Characteristics and Trends in the Consumption of Ultra-Processed Foods in Korea from 2010 to 2018

“…Growing evidence has accumulated that the consumption of ultra-processed foods has positive associations with metabolic health [7,13,[53][54][55][56][57][58][59] such as obesity, hypertension, dyslipidemia, and diabetes, cardiovascular diseases [12,14], cancer [60,61], and mortality [9,62,63]. The adverse impacts of ultra-processed foods on human health have been explained by the poor nutrient profile of these foods [3,17], the low dietary quality [3,4,11,33] associated with the consumption of these foods, and the addictive eating behaviors induced by these foods, which may lead to overconsumption [7,64].…”

Food Waste and Nutrition Quality in the Context of Public Health: A Scoping Review

“…Packaged food and beverages are predominantly categorized as ultra-processed or highly processed foods on the basis of the NOVA and/or Poti et al classification systems, and they are generally defined as unhealthy, with less favorable nutrient profiles than less processed foods [ 39 , 40 , 41 , 42 , 43 ]. The consumption of these packaged ultra-processed foods has been linked to poorer diet quality and numerous adverse health outcomes [ 43 , 44 , 45 , 46 , 47 , 48 ]. There is also the potential for chemicals to transfer from plastic food packaging into items of food, which can impact human health via endocrine disruptions [ 49 , 50 ].…”