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

Abstract

Objective: To assess the prospective association between ultra-processed food consumption and allcause mortality and to examine the effect of theoretical iso-caloric non-processed foods substitution. Patients and Methods: A population-based cohort of 11,898 individuals (mean age 46.9 years, and 50.5% women) were selected from the ENRICA study, a representative sample of the noninstitutionalized Spanish population. Dietary information was collected by a validated computer-based dietary history and categorized according to their degree of processing using NOVA classification. Total mortality was obtained from the National Death Index. Follow-up lasted from baseline (2008)(2009)(2010) to mortality date or December 31 th , 2016, whichever was first. The association between quartiles of consumption of ultra-processed food and mortality was analyzed by Cox models adjusted for the main confounders. Restricted cubic-splines were used to assess dose-response relationships when using iso-caloric substitutions. Results: Average consumption of ultra-processed food was 385 g/d (24.4% of the total energy intake). After a mean follow-up of 7.7 years (93,599 person-years), 440 deaths occurred. The hazard ratio (and 95% CI) for mortality in the highest versus the lowest quartile of ultra-processed food consumption was 1.44 (95% CI, 1.01-2.07; P trend¼.03) in percent of energy and 1.46 (95% CI, 1.04-2.05; P trend¼.03) in grams per day per kilogram. Isocaloric substitution of ultra-processed food with unprocessed or minimally processed foods was associated with a significant nonlinear decrease in mortality. Conclusion: A higher consumption of ultra-processed food was associated with higher mortality in the general population. Furthermore, the theoretical iso-caloric substitution ultra-processed food by unprocessed or minimally processed foods would suppose a reduction of the mortality risk. If confirmed, these findings support the necessity of the development of new nutritional policies and guides at the national and international level.

Ultra-Processed Food Consumption among the Paediatric Population: An Overview and Call to Action from the European Childhood Obesity Group

“…A tendency of higher consumption of added sugar (refined sugar, honey, corn syrup) and UPF was found among children with overweight, diagnosed with food addiction [28]. A high UPF intake has also been associated with an increased waist circumference [29], dyslipidaemia [30], metabolic syndrome [31], asthma and wheezing among children [32], hypertension [33], metabolic syndrome [34], myocardial infarction and stroke [35], gastrointestinal disorders, total and breast cancer [36], depression, and all-cause mortality among adults [37].…”

Association of Ultra-processed Food Consumption With Cardiovascular Mortality in the US Population: Long-term Results From a Large Prospective Multicenter Study

“…As cancer is most common cause of death in this study population, we also performed a supplementary analysis to examine the association between ultra-processed food consumption and overall cancer mortality. To validate our study design and methods, we used all-cause mortality as a positive control outcome, given the well-established association of ultra-processed food consumption with all-cause mortality [15,16,24,35]. The statistical signi cance level was set at P < 0.05 under a two-tailed test.…”

“…In the present study, we focused on ultra-processed foods, which include sour cream, cream cheese, ice cream, frozen yogurt, fried foods, breads, cookies, cakes, pastries, salty snacks, breakfast cereals, instant noodles and soups, sauces, oils and fats, candy, soft drinks, fruit drinks, restaurant/industrial hamburgers, hot dogs, and pizza. Based on a reported categorization method [24], all ultra-processed foods were further categorized into nine food groups for relevant analyses, namely soft drinks, cereals, ultra-processed fruits and vegetables, ultra-processed dairy products, meat and sh, sauces and dressings, salty snacks, sugary products, and oils and fats. Table S1 shows the full list of ultra-processed foods in each food group.…”

Consumption of Ultra-Processed Foods and Drinks and Colorectal, Breast and Prostate Cancer in the Multicase-Control Study (MCC)-Spain

“…Since the development of the NOVA classi cation of foods and drinks according to the degree of processing [3], numerous epidemiological studies have evaluated the association between ultra-processed food and drink consumption and adverse health outcomes [5], such as cardiovascular disease [16] and mortality [4,[17][18][19]. In 2018, based on the French NutriNet-Santé prospective cohort of approximately 105,000 participants of median age 42.8 years, the rst and, as far as we know, the only study on ultra-processed food and drink consumption and cancer risk was published.…”

“…Several epidemiological studies have applied the NOVA classi cation into their dietary data and have linked ultraprocessed food and drink consumption to intermediate risk factors (i.e. body weight gain [10,11], high blood pressure [12], chronic in ammation [13], and the metabolic syndrome [14]) as well as disease outcomes, including type 2 diabetes [15], cardiovascular disease [16] and mortality [4,[17][18][19]. Many of these studies have a prospective design [4,10,12,[16][17][18][19][20].…”