The intake of ultra-processed foods, all-cause, cancer and cardiovascular mortality in the Korean Genome and Epidemiology Study-Health Examinees (KoGES-HEXA) cohort

Abstract

The relationship between ultra-processed food (UPF) intake and mortality is unknown in Asian countries, yet the intake of UPF is on the rise in these countries. This study examined the association of UPF intake with all-cause, cancer and cardiovascular disease (CVD) mortality. Participants were 113,576 adults who responded to a 106-item food frequency questionnaire during recruitment of the 2004–2013 Health Examinees (HEXA) study, a prospective cohort study in Korea. UPF were defined using the NOVA classification and evaluated as quartiles of the proportion of UPF in the diet (% total food weight). Multivariable Cox regression and restricted cubic spline models were used to examine the association of UPF intake with all-cause and cause specific mortality. A total of 3456 deaths were recorded during a median follow-up of 10.6 (interquartile range, 9.5–11.9) years. There was no evidence of an association of UPF intake with all-cause, cancer or CVD mortality comparing the highest with the lowest quartiles of UPF intake (all-cause mortality, men: hazard ratio [HR] 1.08, 95% confidence interval [CI] 0.95–1.22; women: HR 0.95, 95% CI 0.81–1.11; cancer mortality, men: HR 1.02, 95% confidence interval [CI] 0.84–1.22; women: HR 1.02, 95% CI 0.83–1.26; CVD mortality, men: HR 0.88, 95% CI 0.64–1.22; women: HR 0.80, 95% CI 0.53–1.19). However, the risk of all-cause mortality increased in both men and women with high consumption of ultra-processed red meat and fish (men, HR 1.26, 95% CI 1.11–1.43); women, HR 1.22 95% CI 1.05–1.43); and in men with high consumption of ultra-processed milk (HR 1.13, 95% CI 1.01–1.26); and soymilk drink (HR 1.12, 95% CI 1.00–1.25). We found no evidence of an association between total UPF intake and all-cause, cancer or CVD mortality, but ultra-processed red meat and fish in both sexes, and milk and soymilk drinks in men were positively associated with all-cause mortality.

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

“…Interestingly, some have suggested the effect of UPFs may be more significant in women than in men, while others have reported no significant sex interaction for all-cause mortality [ 18 , 19 ] and incident CVD [ 14 ]. Similar to our study, Kityo et al [ 20 ] found no significant associations in both sexes for all-cause mortality. In this Korean population, the lower mortality rates may have been influenced by the middle-aged demographic and nutritional profile with a low UPF intake of 25.1%, and therefore the insignificant associations [ 20 ].…”

“…Similar to our study, Kityo et al [ 20 ] found no significant associations in both sexes for all-cause mortality. In this Korean population, the lower mortality rates may have been influenced by the middle-aged demographic and nutritional profile with a low UPF intake of 25.1%, and therefore the insignificant associations [ 20 ]. Studies have also demonstrated that a higher UPF intake was more associated with hypertension, type 2 DM, and obesity for women compared to men [ 8 – 10 ].…”

“…Differences in assessing UPF intake cannot be ruled, despite using the NOVA food classification system as did other studies. NOVA classification is a descriptive way of categorising UPF; FFQs do not always capture enough detail to adequately classify foods such as yoghurt or bread into the appropriate category [ 20 , 46 ]. Regarding the lack of associations for UPF intake with CVD or mortality in this middle-aged Australian population, factors, such as healthcare utilisation and higher socio-economics status, could have greater influence than dietary factors.…”

“…For all-cause mortality, the only two studies that performed sex-specific analyses demonstrated significant associations with higher UPF intake in both men and women, but no sex interaction [ 18 , 19 ]. A more recent study on all-cause mortality and UPF intake in a Korean population, however, found that there was no significant relationship in either men or women [ 20 ].…”

Ultra-processed food consumption and risk of cardiovascular events: a systematic review and dose-response meta-analysis

“… 19 , 20 One recent prospective cohort study showed that total UPF consumption was not associated with the risk of CVD mortality. 21 To further investigate the dose–response relationship between UPF consumption and the risk of CVEs, we conducted a systematic review and meta-analyses of articles that reported the CVEs in corresponding clinical studies. 22 …”