Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study

Juul, Filippa; Vaidean, Georgeta; Lin, Yong; Deierlein, Andrea; Parekh, Niyati

doi:10.1016/j.jacc.2021.01.047

Cited by 137 publications

(107 citation statements)

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“…All articles included in this review were recently published, issued in the last six years (2015-2021). regarding the design of the studies, four were prospective cohort studies (15)(16)(17)(18), four crosssectional studies (19)(20)(21)(22) and two model studies (23,24). Out of the 10 studies identified, most of them were carried out in high-income countries.…”

Section: Resultsmentioning

confidence: 99%

“…two studies had a sample size greater than 100,000 subjects (15,16); two studies had a sample size in between 10,000 and 99,999 subjects (17,20) and the smallest sample size was 56 (19). Participants in two of the identified studies (16,17) had to be middle aged or elderly subjects (aged 50-71 and 55-74).…”

Section: Resultsmentioning

confidence: 99%

“…Despite the homogeneity in the classification of foods according to the degree of processing, the operationalization of the exposure varied among the studied publications. two different methods for assessing the exposure to UPFs were found in this study: food frequency questionnaires and the 24-hour recall, used in 4 (16-18,21) and 4 (15,19,20,22) studies respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Zhang et. al's (2021) study (20) showed that percentage of calories from UPFs and cVH had a graded inverse association. study concluded that a higher consumption of UPFs was associated with a lower cVH, obtaining a decrease of 0.14 points in cVH score for every 5% increase in calories from UPF.…”

Section: Discussionmentioning

confidence: 98%

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Ultra-processed Food Intake and Risk of Cardiovascular Disease: a systematic review

Moral

Ishiyama

2021

an.ranf

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Cardiovascular disease (CVD) is the leading cause of mortality worldwide. An unhealthy diet, among other risk factors, can be involved in the development of the disease. This type of diet is usually characterized by being low in unprocessed foods (fruits, vegetables, etc.) and high in ultra-processed foods (UPFs). It has been suggested that a high consumption of UPFs could be related to the development of CVD. However, as UPFs are a broad group in which multiple foods with different compositions coexist, it is not only difficult but also a generalization to draw a conclusion about their possible association. The present systematic review studies the relationship between the consumption of UPFs and the risk of CVD. A systematic review was performed in the PubMed database. PRISMA criteria were applied to identify articles that met the following criteria: studies performed in humans, in English or Spanish, and be original articles, excluding meta-analyses and reviews. The search was performed using the terms “Ultra-processed food” or “Fast food” and “Cardiovascular disease” or “Cardiovascular risk factor”, with a total of 10 articles included: 4 prospective cohort studies, 4 cross-sectional studies and 2 modeling studies. An association between the consumption of UPFs and CVD was found in all the studies analyzed. However, there are limitations with respect to the use of different food classification systems according to the degree of processing. This systematic review concludes that more studies are needed to establish with greater evidence the relationship between the consumption of UPFs and risk of CVD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

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Ultra-processed Food Intake and Risk of Cardiovascular Disease: a systematic review

Moral

Ishiyama

2021

an.ranf

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“…[33] Recent large prospective observational studies have found higher consumption of ultra-processed foods associated with an increased risk of cardiovascular disease incidence and CVD mortality. [34,35] Data from 79 high-and middleincome countries show that ultra-processed products dominate the food supplies of high-income countries and that their consumption is now rapidly increasing in middle-income countries. [36] The finding that sodium negatively correlated with CVD worldwide (r=-0.213, 95% CI -0.234 to -0.192, p<0.0001) is contrary to an analysis of sodium intake versus cardiovascular deaths in 66 countries by Mozaffarian, et.…”

Section: Discussionmentioning

confidence: 99%

Dietary and other risk factors for cardiovascular disease analysed with Global Burden of Disease worldwide cohorts: lipid hypothesis versus fat-soluble vitamin hypothesis

Cundiff¹,

2021

Preprint

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Objective Using Global Burden of Disease (GBD) worldwide data, compare the lipid hypothesis of Ancel Keys, MD with the fat-soluble hypothesis that we introduce here. Design With GBD 2017 data from the Institute of Health Metrics and Evaluation (IHME) on cardiovascular disease deaths/100k/year, ages 15-69 years old in male and female cohorts (CVD) and dietary and other risk factors, we formatted and population weighted data from 195 countries. We correlated CVD with dietary and other risk factors worldwide and in appropriate subsets. Setting Post hoc ecological cohort study Participants Each of the 7846 rows of data (cohorts) represented about 1 million people, projected to represent about 7.8 billion people in 2020. Interventions Define a fat-soluble vitamin variable (FSVV) as the sum of kilocalories/day (KC/d) of processed meat + red meat + fish + milk + poultry + eggs + (saturated fatty acids (SFA) + polyunsaturated fatty acids (PUFA) + trans fatty acids (TFA)) * 0.46. Perform Pearson correlations on the formatted worldwide dataset and on relevant subsets. Main outcome measures The correlations of 43 dietary and other potential CVD risk factors and FSVV with CVD worldwide and in relevant subsets Results Low density lipoprotein cholesterol (LDL-c) correlated strongly positively with FSVV worldwide (r=0.780, 95% CI 0.771 to 0.788, p<0001, n=7846 cohorts), so we considered FSVV our marker variable to test the lipid hypothesis as well as our fat-soluble vitamin hypothesis. The FSVV correlated negatively with CVD worldwide (r= -0.329, 95% CI -0.349 to -0.309, p<0.0001), and FSVV correlated positively with CVD in high FSVV cohorts (when FSVV≥567.3 KC/d: r=0.523, 95% CI 0.476 to 0.567, p<0001, n=974 cohorts, compared with worldwide mean FSVV=285.4 KC/d, n=7846 cohorts). Conclusion Since FSVV correlated positively with CVD only in high FSVV cohorts (FSVV≥567.3 KC/d, n=974 cohorts), the lipid hypothesis is supported only in GBD cohorts (and by inference individuals) with high FSVV intake. These data support the fat-soluble vitamins hypothesis because FSVV correlated negatively with CVD worldwide, meaning the more fat-soluble vitamin containing animal foods and fat for gut absorption the less the CVD. This GBD cohort data analysis methodology could supplement prospective observational studies of individuals to be used in developing food policy and education strategies for improving public health.

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Trends in Consumption of Ultraprocessed Foods Among US Youths Aged 2-19 Years, 1999-2018

Wang

Steele

et al. 2021

JAMA

219

110

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IMPORTANCEThe childhood obesity rate has been steadily rising among US youths during the past 2 decades. Increasing evidence links consumption of ultraprocessed foods to excessive calorie consumption and weight gain, but trends in the consumption of ultraprocessed foods among US youths have not been well characterized. OBJECTIVETo characterize trends in the consumption of ultraprocessed foods among US youths. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional analysis using 24-hour dietary recall data from a nationally representative sample of US youths aged 2-19 years (n = 33 795) from 10 cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999-2000 to 2017-2018. EXPOSURES Secular time.MAIN OUTCOMES AND MEASURES Percentage of total energy consumed from ultraprocessed foods as defined by NOVA, an established food classification system that categorizes food according to the degree of food processing.RESULTS Dietary intake from youths were analyzed (weighted mean age, 10.7 years; 49.1% were girls). From 1999 to 2018, the estimated percentage of total energy from consumption of ultraprocessed foods increased from 61.4% to 67.0% (difference, 5.6% [95% CI, 3.5% to 7.7%]; P < .001 for trend), whereas the percentage of total energy from consumption of unprocessed or minimally processed foods decreased from 28.8% to 23.5% (difference, −5.3% [95% CI, −7.5% to −3.2%]; P < .001 for trend). Among the subgroups of ultraprocessed foods, the estimated percentage of energy from consumption of ready-to-heat and -eat mixed dishes increased from 2.2% to 11.2% (difference, 8.9% [95% CI, 7.7% to 10.2%]) and from consumption of sweet snacks and sweets increased from 10.7% to 12.9% (difference, 2.3% [95% CI, 1.0% to 3.6%]), but the estimated percentage of energy decreased for sugar-sweetened beverages from 10.8% to 5.3% (difference, −5.5% [95% CI, −6.5% to −4.5%]) and for processed fats and oils, condiments, and sauces from 7.1% to 4.0% (difference, −3.1% [95% CI, −3.7% to −2.6%]) (all P < .05 for trend). There was a significantly larger increase in the estimated percentage of energy from consumption of ultraprocessed foods among non-Hispanic Black youths (from 62.2% to 72.5%; difference, 10.3% [95% CI, 6.8% to 13.8%]) and Mexican American youths (from 55.8% to 63.5%; difference, 7.6% [95% CI, 4.4% to 10.9%]) than the increase among non-Hispanic White youths (from 63.4% to 68.6%; difference, 5.2% [95% CI, 2.1% to 8.3%]) (P = .04 for trends). CONCLUSIONS AND RELEVANCEBased on the NHANES cycles from 1999 to 2018, the estimated proportion of energy intake from consumption of ultraprocessed foods has increased among youths in the US and has consistently comprised the majority of their total energy intake.

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Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study

Cited by 137 publications

References 42 publications

Ultra-processed Food Intake and Risk of Cardiovascular Disease: a systematic review

Ultra-processed Food Intake and Risk of Cardiovascular Disease: a systematic review

Dietary and other risk factors for cardiovascular disease analysed with Global Burden of Disease worldwide cohorts: lipid hypothesis versus fat-soluble vitamin hypothesis

Trends in Consumption of Ultraprocessed Foods Among US Youths Aged 2-19 Years, 1999-2018

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