Ultra-processed foods and mortality: Analysis from the prospective urban and rural epidemiology study

• Published in: The American Journal of Clinical Nutrition
• Main Authors: Dehghan, Mahshid, Mente, Andrew, Rangarajan, Sumathy, Mohan, Viswanathan, Swaminathan, Sumathi, Avezum, Alvaro, Lear, Scott A, Rosengren, Annika, Poirier, Paul, Lanas, Fernando, Lopez-Jaramillo, Patricio, Soman, Biju, Wang, Chuangshi, Orlandini, Andrés, Mohammadifard, Noushin, AlHabib, Khalid F, Chifamba, Jephat, Yusufali, Afzal Hussein, Iqbal, Romaina, Khatib, Rasha, Yeates, Karen, Puoane, Thandi, Altuntas, Yuksel, Co, Homer Uy, Li, Sidong, Liu, Weida, Zatońska, Katarzyna, Yusuf, Rita, Ismail, Noorhassim, Miller, Victoria, Yusuf, Salim
• Format: Text
• Language: unknown
• Published: Advocate Aurora Health Institutional Repository 2023
• Subjects: NOVA classification; cardiovascular disease; minimally processed foods; mortality; ultra-processed foods; Advocate Aurora Research Institute; Population Health and Public Health; Aurora Research Institute
• Online Access: https://institutionalrepository.aah.org/allother/452; https://doi.org/10.1016/j.ajcnut.2022.10.014; https://libkey.io/libraries/1712/10.1016/j.ajcnut.2022.10.014

Background: Higher intake of ultra-processed foods (UPFs) has been associated with increased risk of CVD and mortality in observational studies from Western countries but data from non-Western countries are limited. Objectives: We aimed to assess the association between consumption of UPFs and risk of mortality and major CVD in a cohort from multiple world regions. Design: This analysis includes 138,076 participants without a history of CVD between the ages of 35 and 70 y living on 5 continents, with a median follow-up of 10.2 y. We used country-specific validated food-frequency questionnaires to determine individuals' food intake. We classified foods and beverages based on the NOVA classification into UPFs. The primary outcome was total mortality (CV and non-CV mortality) and secondary outcomes were incident major cardiovascular events. We calculated hazard ratios using multivariable Cox frailty models and evaluated the association of UPFs with total mortality, CV mortality, non-CV mortality, and major CVD events. Results: In this study, 9227 deaths and 7934 major cardiovascular events were recorded during the follow-up period. We found a diet high in UPFs (≥2 servings/d compared with 0 intake) was associated with higher risk of mortality (HR: 1.28; 95% CI: 1.15, 1.42; P-trend < 0.001), CV mortality (HR: 1.17; 95% CI: 0.98, 1.41; P-trend = 0.04), and non-CV mortality (HR: 1.32; 95% CI 1.17, 1.50; P-trend < 0.001). We did not find a significant association between UPF intake and risk of major CVD. Conclusions: A diet with a high intake of UPFs was associated with a higher risk of mortality in a diverse multinational study. Globally, limiting the consumption of UPFs should be encouraged.