Ultra-processed food consumption is associated with increased risk of all-cause and cardiovascular mortality in the Moli-sani Study

Abstract

Background Consumption of ultra-processed food (UPF) is gaining growing attention in relation to disease/mortality risk, but less is known on the main nutritional factors or biological mechanisms potentially underlying such associations. Objectives We aimed to assess the association between UPF and mortality risk in a large sample of the Italian adult population and test which nutritional factors were on the pathway of this relation. Established risk factors for cardiovascular disease (CVD) were analyzed as potential biological mechanisms linking UPF to mortality. Methods Longitudinal analysis was conducted on 22,475 men and women (mean ± SD age: 55 ± 12 y) recruited in the Moli-sani Study (2005–2010, Italy) and followed for 8.2 y. Food intake was assessed using a semiquantitative FFQ. UPF was defined using the NOVA classification according to degree of processing, and UPF intakes were categorized as quartiles of the ratio (%) of UPF (g/d) to total food consumed (g/d). Results Individuals reporting the highest intake of UPF (Q4, >14.6% of total food), as opposed to the lowest (Q1, UPF < 6.6%), experienced increased risks of CVD mortality (HR: 1.58; 95% CI: 1.23, 2.03), death from ischemic heart disease (IHD)/cerebrovascular disease (HR: 1.52; 95% CI: 1.10, 2.09), and all-cause mortality (HR: 1.26; 95% CI: 1.09, 1.46). High sugar content explained 36.3% of the relation of UPF with IHD/cerebrovascular mortality, whereas other nutritional factors (e.g., saturated fats) were unlikely to be on the pathway. Biomarkers of renal function accounted for 20.1% of the association of UPF with all-cause mortality, and 12.0% for that of UPF with CVD mortality. Conclusions A high proportion of UPF in the diet was associated with increased risk of CVD and all-cause mortality, partly through its high dietary content of sugar. Some established biomarkers of CVD risk were likely to be on the pathway of such associations. These findings should serve as an incentive for limiting consumption of UPF, and encouraging natural or minimally processed foods, as several national nutritional policies recommend.

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].…”

What Is the Nutritional Composition of Ultra-Processed Food Marketed in Italy?

“…Furthermore, given the relevant contribution of UPF to daily energy intake, it has been evaluated whether UPF intake is associated with adverse health outcomes. Interestingly, observational studies have suggested that the consumption of UPF is associated with a higher risk of cardiovascular diseases, metabolic diseases, cancer, and all-cause and cardiovascular mortality [ 7 , 8 , 9 , 10 ].…”

Machine Learning Prediction of Food Processing

“…We calculated iF P ro for 20,047 individuals with dietary records in a representative U.S. national sample from NHANES 1999-2006. As Figure 3C shows, the median iF P ro W C for the American population is 0.7872, confirming a high reliance on intake on ultra-processed food [24][25][26]. More importantly, iF P ro allows us to identify differential reliance on processed food.…”

“…• Ultra-processed food consumption is associated with increased risk of all-cause and cardiovascular mortality in the Moli-sani Study [26] Molise, Italy (Moli-sani)…”