Dose–response meta-analysis of ultra-processed food with the risk of cardiovascular events and all-cause mortality: evidence from prospective cohort studies

Yuan, Lijun; Hu, Hifang; Li, Tianze; Zhang, Jinli; Feng, Yifei; Yang, Xingjin; Li, Yang; Wu, Yuying; Li, Xi; Huang, Hao; Hu, Fulan; Chen, Chuanqi; Zhang, Ming; Zhao, Yang; Hu, Dongsheng

doi:10.1039/d2fo02628g

Cited by 20 publications

(39 citation statements)

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“…Additionally, we found evidence of excess significance bias in nine (32%) of the 28 pooled analyses with three or more original research articles listed in supplementary table G. This bias was evident in associations between higher ultra-processed food exposure and all cause mortality (dose-response and non-dose-response),43 hypertension,44 abdominal obesity,42 metabolic syndrome,45 non-alcoholic fatty liver disease,46 obesity (dose-response and non-dose-response),42 and type 2 diabetes 47. Small study effects were evident in five (18%) of the 28 pooled analyses with three or more original research articles, as indicated in supplementary table G. We observed these effects in associations between higher ultra-processed food exposure and all cause mortality (dose-response and non-dose-response),43 breast cancer,40 metabolic syndrome,45 and obesity (dose-response) 42…”

Section: Resultsmentioning

confidence: 80%

“…The systematic search identified 430 de-duplicated articles (fig 1). After applying the eligibility criteria, we included 14 meta-analysis studies with 45 distinct pooled analyses 1718404142434445464748495051…”

Section: Resultsmentioning

confidence: 99%

“…Each of the meta-analysis studies examined the non-dose-response associations between exposure to ultra-processed foods and adverse health outcomes. However, an additional analysis involving dose-response modelling of the ultra-processed food exposure variable was conducted in 13 pooled analyses across five meta-analysis studies 4042434751. The outcomes considered using this approach included all cause mortality and cardiovascular disease events, such as cardiovascular disease morbidity and mortality, associated with each increase in daily servings of ultra-processed food 43.…”

Section: Resultsmentioning

confidence: 99%

“…However, an additional analysis involving dose-response modelling of the ultra-processed food exposure variable was conducted in 13 pooled analyses across five meta-analysis studies 4042434751. The outcomes considered using this approach included all cause mortality and cardiovascular disease events, such as cardiovascular disease morbidity and mortality, associated with each increase in daily servings of ultra-processed food 43. One meta-analysis study specifically pooled heart disease related deaths, such as ischaemic heart disease related mortality and cerebrovascular disease related mortality, with each 10% increase in total ultra-processed food exposure 51.…”

Section: Resultsmentioning

confidence: 99%

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Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Lane,

Gamage,

et al. 2024

BMJ

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ObjectiveTo evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes.DesignSystematic umbrella review of existing meta-analyses.Data sourcesMEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manual searches of reference lists from 2009 to June 2023.Eligibility criteria for selecting studiesSystematic reviews and meta-analyses of cohort, case-control, and/or cross sectional study designs. To evaluate the credibility of evidence, pre-specified evidence classification criteria were applied, graded as convincing (“class I”), highly suggestive (“class II”), suggestive (“class III”), weak (“class IV”), or no evidence (“class V”). The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, categorised as “high,” “moderate,” “low,” or “very low” quality.ResultsThe search identified 45 unique pooled analyses, including 13 dose-response associations and 32 non-dose-response associations (n=9 888 373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence (class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% confidence interval 1.37 to 1.63; GRADE=very low) and type 2 diabetes (dose-response risk ratio 1.12, 1.11 to 1.13; moderate), as well as higher risks of prevalent anxiety outcomes (odds ratio 1.48, 1.37 to 1.59; low) and combined common mental disorder outcomes (odds ratio 1.53, 1.43 to 1.63; low). Highly suggestive (class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all cause mortality (risk ratio 1.21, 1.15 to 1.27; low), heart disease related mortality (hazard ratio 1.66, 1.51 to 1.84; low), type 2 diabetes (odds ratio 1.40, 1.23 to 1.59; very low), and depressive outcomes (hazard ratio 1.22, 1.16 to 1.28; low), together with higher risks of prevalent adverse sleep related outcomes (odds ratio 1.41, 1.24 to 1.61; low), wheezing (risk ratio 1.40, 1.27 to 1.55; low), and obesity (odds ratio 1.55, 1.36 to 1.77; low). Of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (class III-IV) and 13 were graded as no evidence (class V). Overall, using the GRADE framework, 22 pooled analyses were rated as low quality, with 19 rated as very low quality and four rated as moderate quality.ConclusionsGreater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to develop and evaluate the effectiveness of using population based and public health measures to target and reduce dietary exposure to ultra-processed foods for improved human health. They also inform and provide support for urgent mechanistic research.Systematic review registrationPROSPERO CRD42023412732.

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Section: Resultsmentioning

confidence: 80%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Lane,

Gamage,

et al. 2024

BMJ

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“…The systematic search identified 430 deduplicated articles (Figure 1). After applying the eligibility criteria, 14 meta-analysis studies with 45 distinct pooled analyses were included 18,[41][42][43][44][45][46][47][48][49][50][51][52][53] .…”

Section: Resultsmentioning

confidence: 99%

Ultra-Processed Food Exposure and Adverse Health Outcomes: An Umbrella Review of Epidemiological Meta-Analyses

Lane,

Gamage,

et al. 2023

Preprint

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Objective: To evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes. Design: Systematic umbrella review of existing meta-analyses. Data Sources: MEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manually searching reference lists from 2009 to June 2023. Inclusion Criteria: Systematic reviews and meta-analyses of cohort, case-control, and/or cross-sectional study designs that evaluated the associations between exposure to ultra-processed foods and adverse health outcomes in humans across the lifespan. Results: The search identified 45 unique pooled analyses, including 13 dose-response and 32 non-dose-response associations (n=9,888,373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health outcome domains spanning cardiometabolic, gastrointestinal, and respiratory conditions, cancer, mental health, and mortality. Based on a pre-specified evidence classification criteria, convincing evidence (Class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease-related mortality (RR: 1.50; 95%CIs: 1.37 to 1.63), type two diabetes (dose-response RR: 1.12; 95%CIs: 1.11 to 1.13), and depressive outcomes (HR: 1.21; 95%CIs: 1.16 to 1.28), as well as higher risks of prevalent anxiety outcomes (OR: 1.48; 95%CIs: 1.37 to 1.59) and combined common mental disorder outcomes (OR: 1.53; 95%CIs: 1.43 to 1.63). Highly suggestive (Class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all-cause mortality (RR: 1.21; 95%CIs: 1.15 to 1.27), heart disease-related mortality (dose-response HR: 1.66; 95%CIs: 1.51 to 1.84), and type two diabetes (OR: 1.40; 95%CIs: 1.23 to 1.59), together with higher risks of prevalent obesity (OR: 1.55; 95%CIs: 1.36 to 1.77), adverse sleep-related outcomes (OR: 1.41; 95%CIs: 1.24 to 1.60), and wheezing (RR: 1.40; 95%CIs: 1.27 to 1.55). Out of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (Class III-IV) and 13 were graded as no evidence (Class V). Using the GRADE framework, 22 pooled analyses were rated as "Low" quality, with 19 rated as "Very Low” and four rated as "Moderate" quality. Conclusions: Higher exposure to ultra-processed food was associated with a greater risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to evaluate the effectiveness of using population-based measures to target and reduce dietary exposure to ultra-processed foods for improved human health. Systematic Review Registration: PROSPERO CRD42023412732.

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Ultra-processed foods and incident cardiovascular disease and hypertension in middle-aged women

Pant,

Gribbin,

Machado

et al. 2023

Eur J Nutr

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Purpose Ultra-processed food (UPF) intake has increased in recent decades, yet limited knowledge of long-term effects on cardiovascular health persists and sex-specific data is scant. We determined the association of UPF intake with incident cardiovascular disease (CVD) and/or hypertension in a population-based cohort of women. Methods In the Australian Longitudinal Study on Women’s Health, women aged 50–55 years were prospectively followed (2001–2016). UPFs were identified using NOVA classification and contribution of these foods to total dietary intake by weight was estimated. Primary endpoint was incident CVD (self-reported heart disease/stroke). Secondary endpoints were self-reported hypertension, all-cause mortality, type 2 diabetes mellitus, and/or obesity. Logistic regression models assessed associations between UPF intake and incident CVD, adjusting for socio-demographic, medical comorbidities, and dietary variables. Results We included 10,006 women (mean age 52.5 ± 1.5; mean UPF intake 26.6 ± 10.2% of total dietary intake), with 1038 (10.8%) incident CVD, 471 (4.7%) deaths, and 4204 (43.8%) hypertension cases over 15 years of follow-up. In multivariable-adjusted models, the highest [mean 42.0% total dietary intake] versus the lowest [mean 14.2% total dietary intake] quintile of UPF intake was associated with higher incident hypertension [odds ratio (OR) 1.39, 95% confidence interval (CI) 1.10–1.74; p = 0.005] with a linear trend (ptrend = 0.02), but not incident CVD [OR 1.22, 95% CI 0.92–1.61; p = 0.16] or all-cause mortality (OR 0.80, 95% CI 0.54–1.20; p = 0.28). Similar results were found after multiple imputations for missing values. Conclusion In women, higher UPF intake was associated with increased hypertension, but not incident CVD. These findings may support minimising UPFs within a healthy diet for women.

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Dose–response meta-analysis of ultra-processed food with the risk of cardiovascular events and all-cause mortality: evidence from prospective cohort studies

Abstract: Background: Previous meta-analyses included abundant cross-sectional studies, and/or only assessed high versus low categories in UPF consumption. We conducted this meta-analysis based on prospective cohort studies to estimate the dose–response...

Cited by 20 publications

References 48 publications

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Ultra-Processed Food Exposure and Adverse Health Outcomes: An Umbrella Review of Epidemiological Meta-Analyses

Ultra-processed foods and incident cardiovascular disease and hypertension in middle-aged women

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