Effect of ultraprocessed food intake on cardiometabolic risk is mediated by diet quality: a cross-sectional study

Abstract

ObjectiveTo examine the effect of the consumption of ultraprocessed food on diet quality, and cardiometabolic risk (CMR) in an occupational cohort.DesignCross-sectional.SettingOccupational cohort.Participants53 163 British police force employees enrolled (2004–2012) into the Airwave Health Monitoring Study. A total of 28 forces across the UK agreed to participate. 9009 participants with available 7-day diet record data and complete co-variate data are reported in this study.Main outcome measuresA CMR and Dietary Approaches to Stop Hypertension score were treated as continuous variables and used to generate measures of cardiometabolic health and diet quality. Secondary outcome measures include percentage of energy from fat, saturated fat, carbohydrate, protein and non-milk extrinsic sugars (NMES) and fibre grams per 1000 kcal of energy intake.ResultsIn this cohort, 58.3%±11.6 of total energy intake was derived from ultraprocessed (NOVA 4) foods. Ultraprocessed food intake was negatively correlated with diet quality (r=−0.32, p<0.001), fibre (r=−0.20, p<0.001) and protein (r = −0.40, p<0.001) and positively correlated with fat (r=0.18, p<0.001), saturated fat (r=0.14, p<0.001) and nmes (r=0.10, p<0.001) intake . Multivariable analysis suggests a positive association between ultraprocessed food (NOVA 4) consumption and CMR. However, this main effect was no longer observed after adjustment for diet quality (p=0.209). Findings from mediation analysis indicate that the effect of ultraprocessed food (NOVA 4) intake on CMR is mediated by diet quality (p<0.001).ConclusionsUltraprocessed food consumption is associated with a deterioration in diet quality and positively associated with CMR, although this association is mediated by and dependent on the quality of the diet. The negative impact of ultraprocessed food consumption on diet quality needs to be addressed and controlled studies are needed to fully comprehend whether the relationship between ultraprocessed food consumption and health is independent to its relationship with poor diet quality.

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

“…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].…”

Greater Ultra-Processed Food Intake during Pregnancy and Postpartum Is Associated with Multiple Aspects of Lower Diet Quality

“…Ultra-processed foods, that is, food products that are created from substances extracted from foods or derived from food constituents [ 14 ], contribute on average greater than half of energy intake in the general U.S. population [ 15 ]. Consistent evidence across countries indicates that ultra-processed food intake is associated with select nutrients, including lower intake of fiber [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]; higher total and saturated fat [ 16 , 17 , 18 , 19 , 20 , 23 ]; and higher free, added, or total sugar [ 16 , 17 , 20 , 21 , 22 , 23 , 24 , 25 ] in general population samples. Additionally, four studies have demonstrated an inverse relation of ultra-processed foods with overall diet quality [ 18 , 26 , 27 , 28 ].…”

“…Consistent evidence across countries indicates that ultra-processed food intake is associated with select nutrients, including lower intake of fiber [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]; higher total and saturated fat [ 16 , 17 , 18 , 19 , 20 , 23 ]; and higher free, added, or total sugar [ 16 , 17 , 20 , 21 , 22 , 23 , 24 , 25 ] in general population samples. Additionally, four studies have demonstrated an inverse relation of ultra-processed foods with overall diet quality [ 18 , 26 , 27 , 28 ]. Consumption of ultra-processed foods may adversely affect overall diet quality via excess intake of highly processed discretionary foods and also by displacing intake of unprocessed, whole plant foods; one study found that greater consumption of ultra-processed food was related to greater intake of sugar-sweetened beverages and processed meat, as well as lower intake of fruits/vegetables, nuts/seeds/legumes, and fish in a general population sample [ 26 ].…”

Application of a Platform for Gluten-Free Diet Evaluation and Dietary Advice: From Theory to Practice

“…The intake of ultra-processed foods has been widely linked to a greater cardiometabolic risk and mortality [ 77 , 78 , 79 , 80 ] and should thus not only be avoided among the general population but also among people with CD [ 81 , 82 ]. Therefore, the reduction of these kind of foods should also be another goal of all nutritional interventions performed in the celiac people.…”