Association Between Ultraprocessed Food Consumption and Risk of Mortality Among Middle-aged Adults in France

Abstract

IMPORTANCE Growing evidence indicates that higher intake of ultraprocessed foods is associated with higher incidence of noncommunicable diseases. However, to date, the association between ultraprocessed foods consumption and mortality risk has never been investigated. OBJECTIVE To assess the association between ultraprocessed foods consumption and all-cause mortality risk. DESIGN, SETTING, AND PARTICIPANTS This observational prospective cohort study selected adults, 45 years or older, from the French NutriNet-Santé Study, an ongoing cohort study that launched on May 11, 2009, and performed a follow-up through December 15, 2017 (a median of 7.1 years). Participants were selected if they completed at least 1 set of 3 web-based 24-hour dietary records during their first 2 years of follow-up. Self-reported data were collected at baseline, including sociodemographic, lifestyle, physical activity, weight and height, and anthropometrics. EXPOSURES The ultraprocessed foods group (from the NOVA food classification system), characterized as ready-to-eat or-heat formulations made mostly from ingredients usually combined with additives. Proportion (in weight) of ultraprocessed foods in the diet was computed for each participant. MAIN OUTCOMES AND MEASURES The association between proportion of ultraprocessed foods and overall mortality was the main outcome. Mean dietary intakes from all of the 24-hour dietary records available during the first 2 years of follow-up were calculated and considered as the baseline usual food-and-drink intakes. Mortality was assessed using CépiDC, the French national registry of specific mortality causes. Hazard ratios (HRs) and 95% CIs were determined for all-cause mortality, using multivariable Cox proportional hazards regression models, with age as the underlying time metric. RESULTS A total of 44 551 participants were included, of whom 32 549 (73.1%) were women, with a mean (SD) age at baseline of 56.7 (7.5) years. Ultraprocessed foods accounted for a mean (SD) proportion of 14.4% (7.6%) of the weight of total food consumed, corresponding to a mean (SD) proportion of 29.1% (10.9%) of total energy intake. Ultraprocessed foods consumption was associated with younger age (45-64 years, mean [SE] proportion of food in weight, 14.50% [0.04%]; P < .001), lower income (<€1200/mo, 15.58% [0.11%]; P < .001), lower educational level (no diploma or primary school, 15.50% [0.16%]; P < .001), living alone (15.02% [0.07%]; P < .001), higher body mass index (calculated as weight in kilograms divided by height in meters squared; Ն30, 15.98% [0.11%]; P < .001), and lower physical activity level (15.56% [0.08%]; P < .001). A total of 602 deaths (1.4%) occurred during follow-up. After adjustment for a range of confounding factors, an increase in the proportion of ultraprocessed foods consumed was associated with a higher risk of all-cause mortality (HR per 10% increment, 1.14; 95% CI, 1.04-1.27; P = .008). CONCLUSIONS AND RELEVANCE An increase in ultraprocessed foods consumption appears to be associated with an o...

Consumption of Ultra-Processed Foods and Mortality: A National Prospective Cohort in Spain

“…Our results are in line with those obtained in the NutriNet-Santé Study. 29 According to our results, the strength of the association is probably higher than that presented in the NutriNet-Santé Study. This is especially important because young generations are increasing their consumption of ultra-processed food, and its consequences will be seen in the future.…”

“…Very recently, a cohort study conducted in France (the NutiriNet.Santé Study) assessed the association between ultraprocessed food consumption and the risk of mortality among middle-aged adults (45 years old and older). 29 Participants were highly selected (mainly women, and more health conscious than the general population), 30 and all the information was based on electronic data. The authors found a positive relationship between ultra-processed food intake and the risk of mortality.…”

Ultra-processed foods, incident overweight and obesity, and longitudinal changes in weight and waist circumference: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

“…In fact, evidence to support its risk is growing, now extending also to incident cancer (30) and overall mortality (31) . With regard to obesity, our findings confirm the role of ultra-processed foods in incident overweight and obesity found by Mendonça et al and by one small study of weight gain in pregnancy (32) , as well cross-sectional evidence originated in different countries and settings, which almost uniformly suggests risk (10,27,(33)(34)(35) .…”

Nutrition Transition and Cancer

“…[15,22]. In addition to the poor nutritional value (high in calories, saturated fat, refined CHO, and salt, low in fiber), there are also concerns regarding the industrial processes involved, due to the use of contaminants and food additives [23,24]. Recently, Schnabel et al summarized different plausible risk factors linking the overconsumption of ultra-processed foods with cancer, as follows: (1) the high temperature of food processing may lead to formation of contaminants; (2) acrylamide may have a carcinogenic and genotoxic effect;…”

“…(3) the overconsumption of processed meat could predispose people to a high risk of stomach and colorectal cancer; (4) additives like titanium dioxide may be associated with increased risk of intestinal inflammation and carcinogenesis; (5) emulsifiers and abuse of artificial sweeteners may alter the gut microbiota, causing predisposition to colorectal cancer; and (6) food packaging may facilitate contact with toxic chemicals like bisphenol A, which is supposed to have endocrine-disrupting properties [23]. In conclusion, the overconsumption of ultra-processed foods may increase neoplastic risk due to exposure to potentially carcinogenic chemicals.…”