Consumption of ultra-processed foods and the risk of overweight and obesity, and weight trajectories in the French cohort NutriNet-Santé

AbstractIntroductionPrevious epidemiological studies have found associations between the consumption of ultra-processed foods and the risk of obesity-related outcomes, such as post-menopausal breast cancer, cardiovascular diseases, hypertension and mortality. However, only one Spanish prospective study has explored the associations between the consumption of ultra-processed foods and the risk of overweight and obesity. The aim of this study is to investigate the associations between ultra-processed food consumption and the risk of overweight and obesity, as well as the associations between ultra-processed food consumption and weight trajectories, in middle-aged adults included in the French large scale NutriNet-Santé cohort.MethodsOverall, 110260 participants aged at least 18 years from the French NutriNet-Santé cohort (2009–2019) were included. Dietary intakes were collected using repeated 24 hour dietary records, merged with a food composition database of 3300 different products. These were categorized according to their degree of processing by the NOVA classification. Associations between ultra-processed food intake and risks of overweight and obesity were assessed using multivariable Cox proportional hazard models. Associations between ultra-processed food intake and weight trajectories were assessed using multivariable linear mixed models for repeated measures with random slope and intercept. Models were adjusted for known risk factors (sociodemographic, lifestyle, and nutritional factors).ResultsUltra-processed food intake was associated with a higher risk of overweight (n = 7063 incident cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet = 1.11 (95% confidence interval 1.08 to 1.14); P < 0.0001, median follow-up: 4.1y, 260304 person-years) and obesity (n = 3066 incident cases; HR = 1.09 (95% confidence interval 1.05 to 1.13); P < 0.0001, median follow-up: 8.0y 365344 person-years). Higher consumers of ultra-processed foods (4th quartile) were more likely to present an increase in body mass index over time (change of BMI/time-unit in Q4 vs Q1 = 0.04, P < 0.0001). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (fruits and vegetables and sugary drinks consumption, intakes of saturated fatty acids, sodium, sugar, dietary fiber or Healthy/Western patterns derived by principal component analysis) and after a large range of sensitivity analyses.ConclusionIn this large observational prospective study, higher consumption of ultra-processed foods in the diet was associated with a higher risk of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting ultra-processed food consumption.

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Ultra-processed food consumption and risk of obesity: a prospective cohort study of UK Biobank

European Journal of Nutrition ◽

10.1007/s00394-020-02367-1 ◽

2020 ◽

Cited By ~ 3

Author(s):

Fernanda Rauber ◽

Kiara Chang ◽

Eszter P. Vamos ◽

Maria Laura da Costa Louzada ◽

Carlos Augusto Monteiro ◽

...

Keyword(s):

Food Consumption ◽

Abdominal Obesity ◽

Repeated Measures ◽

Population Policy ◽

Processed Foods ◽

Processed Food ◽

Uk Biobank ◽

The Uk ◽

Incident Cases

Abstract Objective The objective of this study was to examine the associations between ultra-processed food consumption and risk of obesity among UK adults. Methods Participants aged 40–69 years at recruitment in the UK Biobank (2006–2019) with dietary intakes collected using 24-h recall and repeated measures of adiposity––body mass index (BMI), waist circumference (WC) and percentage of body fat (% BF)––were included (N = 22,659; median follow-up: 5 years). Ultra-processed foods were identified using the NOVA classification and their consumption was expressed as a percentage of total energy intake. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HR) of several indicators of obesity according to ultra-processed food consumption. Models were adjusted for sociodemographic and lifestyle characteristics. Results 947 incident cases of overall obesity (BMI ≥ 30 kg/m2) and 1900 incident cases of abdominal obesity (men: WC ≥ 102 cm, women: WC ≥ 88 cm) were identified during follow-up. Participants in the highest quartile of ultra-processed food consumption had significantly higher risk of developing overall obesity (HR 1.79; 95% CI 1.06─3.03) and abdominal obesity (HR 1.30; 95% CI 1.14─1.48). They had higher risk of experiencing a ≥ 5% increase in BMI (HR 1.31; 95% CI 1.20─1.43), WC (HR 1.35; 95% CI 1.25─1.45) and %BF (HR 1.14; 95% CI 1.03─1.25), than those in the lowest quartile of consumption. Conclusions Our findings provide evidence that higher consumption of ultra-processed food is strongly associated with a higher risk of multiple indicators of obesity in the UK adult population. Policy makers should consider actions that promote consumption of fresh or minimally processed foods and reduce consumption of ultra-processed foods.

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Ultra-processed Food Consumption and Incident Frailty: A Prospective Cohort Study of Older Adults (P01-012-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz028.p01-012-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Helena Sandoval-Insausti ◽

Ruth Blanco-Rojo ◽

Auxiliadora Graciani ◽

Esther Lopez-Garcia ◽

Belén Moreno-Franco ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Food Intake ◽

Food Consumption ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Community Dwelling ◽

Alcoholic Beverages ◽

Processed Foods ◽

Processed Food

Abstract Objectives Ultra-processed food intake has been associated with chronic conditions. The aim of this study was to assess the relationship between ultra-processed food intake and incident frailty in community-dwelling older adults. Methods Prospective cohort study with 1822 individuals aged ≥60 who were recruited during 2008–2010 in Spain. At baseline, food consumption was obtained using a validated computerized face-to-face dietary history. Ultra-processed foods were identified according to the nature and extent of their industrial processing (NOVA classification). In 2012, incident frailty was ascertained based on Fried's criteria. Statistical analyses were performed with logistic regression and adjusted for the main potential confounders. Results After a mean follow-up of 3.5 years, 132 cases of frailty were identified. The odds ratios (95% confidence interval) for frailty across increasing quartiles of the percentage of total energy intake from ultra-processed foods were: 1.00, 1.52 (0.78–2.96), 2.98 (1.62–5.50), and 3.67 (2.00–6.73); p for linear trend: <0.001. Results were similar when food consumption was expressed as gram per day/body weight. Regarding ultra-processed food groups, the highest versus the lowest tertiles of consumption of yogurts and fermented milks, cakes and pastries, as well as non-alcoholic beverages (instant coffee and cocoa, packaged juices, and other non-alcoholic drinks, excluding soft drinks) were also significantly related to incident frailty. Conclusions Consumption of ultra-processed foods is strongly associated with frailty risk in older adults. Funding Sources Data collection was funded by the following grants: FIS PI16/1512; PI16/1460; PI16/609; PI17/1709 (State Secretary of R + D and FEDER/FSE), the ATHLOS project (EU H2020-Project ID: 635316), the SALAMANDER project (PCIN-2016-145), and the CIBERESP, Instituto de Salud Carlos III, Madrid, Spain.

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Consumption of ultra-processed food products, diet quality and nutritional status among Mexican children

Proceedings of The Nutrition Society ◽

10.1017/s0029665120006126 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Alejandra Donaji Benítez-Arciniega ◽

Ivonne Vizcarra-Bordi ◽

Roxana Valdés-Ramos ◽

Leidi Rocío Mercado-García ◽

Carmen Liliana Ceballos-Juárez ◽

...

Keyword(s):

Nutritional Status ◽

Food Consumption ◽

Diet Quality ◽

Food System ◽

Positive Association ◽

Overweight And Obesity ◽

Nutritional Deficiencies ◽

Processed Meat ◽

Processed Foods ◽

Processed Food

AbstractUltra-processed food consumption has increased in recent years. The evidence suggests a positive association between consumption of ultra-processed food consumption and low diet-quality and malnutrition, characterized by nutritional deficiencies and high prevalence of obesity and overweight. In México the combined prevalence of overweight and obesity in schoolchildren is 33.2%, and ultra-processed food consumption varies from 40.4% to 81.5% depending on the product. The objective of this study was to describe the association between ultra-processed food consumption, diet-quality and nutritional status in Mexican schoolchildren. We analyzed dietetic and anthropometric data from 364 children (6–12 years) of two communities in the center of México. Four 3d-recalls (three days records followed up for ten months including weekdays and weekends) were used for data collection. Consumed foods were classified according to the level of processing using the NOVA classification. Portions of each food, dietary energy, macro and micronutrients intakes were calculated in accordance with the Mexican equivalent food system, nutrition labelling of each product and software Nutrimind® 15.0. Nutritional status was evaluated according to BMI categories; diet-quality was assessed calculating a dietary score. All data were adjusted by energy. In our study, 32% of foods consumed by schoolchildren were ultra-processed, 49% were minimally processed or unprocessed. 30% of the energy intake derived from ultra-processed foods (95% CI 29.2–33.2%). Major ultra-processed foods in habitual diet were bakery, pastries (23%), sugar-sweetened beverages (dairy and non-dairy) (22%), processed meat (18%), pizzas and pastas (9%), and canned vegetables (4%). Children in the highest quartile of ultra-processed foods consumption, presented lower diet-quality than those in the lowest quartile. In this group of children, 38.0% presented combined overweight or obesity, although there were no statistically significant differences between nutritional status and ultra-processed food consumption. Regular ultra-processed food consumption is associated with a lower diet quality in healthy schoolchildren. It is necessary to implement strategies to reduce intake of these products to avoid possible risks to health in early ages.

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Ultra-processed foods, incident overweight and obesity, and longitudinal changes in weight and waist circumference: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Public Health Nutrition ◽

10.1017/s1368980019002854 ◽

2019 ◽

Vol 23 (6) ◽

pp. 1076-1086 ◽

Cited By ~ 18

Author(s):

Scheine Leite Canhada ◽

Vivian Cristine Luft ◽

Luana Giatti ◽

Bruce Bartholow Duncan ◽

Dora Chor ◽

...

Keyword(s):

Longitudinal Study ◽

Waist Circumference ◽

Overweight And Obesity ◽

Processed Foods ◽

Adult Health ◽

Processed Food ◽

Central Adiposity ◽

Robust Variance ◽

Large Weight

AbstractObjective:To evaluate the association of ultra-processed food (UPF) consumption with gains in weight and waist circumference, and incident overweight/obesity, in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort.Design:We applied FFQ at baseline and categorized energy intake by degree of processing using the NOVA classification. Height, weight and waist circumference were measured at baseline and after a mean 3·8-year follow-up. We assessed associations, through Poisson regression with robust variance, of UPF consumption with large weight gain (1·68 kg/year) and large waist gain (2·42 cm/year), both being defined as ≥90th percentile in the cohort, and with incident overweight/obesity.Setting:Brazil.Participants:Civil servants of Brazilian public academic institutions in six cities (n 11 827), aged 35–74 years at baseline (2008–2010).Results:UPF provided a mean 24·6 (sd 9·6) % of ingested energy. After adjustment for smoking, physical activity, adiposity and other factors, fourth (>30·8 %) v. first (<17·8 %) quartile of UPF consumption was associated (relative risk (95 % CI)) with 27 and 33 % greater risk of large weight and waist gains (1·27 (1·07, 1·50) and 1·33 (1·12, 1·58)), respectively. Similarly, those in the fourth consumption quartile presented 20 % greater risk (1·20 (1·03, 1·40)) of incident overweight/obesity and 2 % greater risk (1·02; (0·85, 1·21)) of incident obesity. Approximately 15 % of cases of large weight and waist gains and of incident overweight/obesity could be attributed to consumption of >17·8 % of energy as UPF.Conclusions:Greater UPF consumption predicts large gains in overall and central adiposity and may contribute to the inexorable rise in obesity seen worldwide.

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Ultra-processed Food Consumption and Incident Frailty: A Prospective Cohort Study of Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glz140 ◽

2019 ◽

Vol 75 (6) ◽

pp. 1126-1133 ◽

Cited By ~ 11

Author(s):

Helena Sandoval-Insausti ◽

Ruth Blanco-Rojo ◽

Auxiliadora Graciani ◽

Esther López-García ◽

Belén Moreno-Franco ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Food Intake ◽

Food Consumption ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Community Dwelling ◽

Processed Foods ◽

Processed Food ◽

Age Related

Abstract Background Ultra-processed food intake has been associated with chronic conditions and mortality. The aim of this study was to assess the relationship between ultra-processed food intake and incident frailty in community-dwelling older adults. Methods Prospective cohort study with 1,822 individuals aged at least 60 years who were recruited during 2008–2010 in Spain. At baseline, food consumption was obtained using a validated computerized face-to-face dietary history. Ultra-processed foods were identified according to the nature and extent of their industrial processing (NOVA classification). In 2012, incident frailty was ascertained based on Fried’s criteria. Statistical analyses were performed with logistic regression and adjusted for the main potential confounders. Results After a mean follow-up of 3.5 years, 132 cases of frailty were identified. The fully adjusted risks of frailty across increasing quartiles of the percentage of total energy intake from ultra-processed foods were the following: 0.04 (0.02–0.05), 0.05 (0.03–0.07), 0.09 (0.07–0.12), and 0.11 (0.08–0.14). Results were similar when food consumption was expressed as gram per day/body weight. Regarding ultra-processed food groups, the highest versus the lowest tertiles of consumption of yogurts and fermented milks, cakes and pastries, as well as nonalcoholic beverages (instant coffee and cocoa, packaged juices, and other nonalcoholic drinks, excluding soft drinks) were also significantly related to incident frailty. Conclusions Consumption of ultra-processed foods is strongly associated with frailty risk in older adults. Substituting unprocessed or minimally processed foods for ultra-processed foods would play an important role in the prevention of age-related frailty. Trial registration NCT02804672.

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Food consumption according to the degree of processing, dietary diversity and socio-demographic factors among pregnant women in Rio de Janeiro, Brazil: The Rio Birth Cohort Study of Environmental Exposure and Childhood Development (PIPA project)

Nutrition and Health ◽

10.1177/0260106020960881 ◽

2020 ◽

pp. 026010602096088

Author(s):

Nathalia Ferrazzo Naspolini ◽

Priscila Pereira Machado ◽

Carmen Ildes Rodrigues Fróes-Asmus ◽

Volney de M Câmara ◽

Josino Costa Moreira ◽

...

Keyword(s):

Confidence Interval ◽

Pregnant Women ◽

Food Consumption ◽

Food Processing ◽

Odds Ratio ◽

Dietary Diversity ◽

Demographic Factors ◽

Processed Foods ◽

Processed Food ◽

Socio Demographic Factors

Background: Relevant evidence has addressed the negative impact of food processing on health. However, maternal ultra-processed food consumption is poorly investigated. Aim: To analyze food consumption according to the degree of food processing, dietary diversity, and associated socio-demographic factors during pregnancy. Methods: Cross-sectional data was taken from a birth cohort in Rio de Janeiro, Brazil, with 142 pregnant women. We assessed diet using a qualitative food frequency questionnaire and classified food items according to the NOVA classification system as non-ultra-processed-foods and ultra-processed-foods. Non-ultra-processed-food and ultra-processed-food scores were calculated, reflecting weekly intake of more than one subgroup. Dietary diversity of the non-ultra-processed-food diet fraction was described according to the Food and Agriculture Organization guidelines. The association between food consumption and socio-demographic factors were investigated using logistic regression models. Results: Over 60% of the pregnant women reported consumption of at least three non-ultra-processed-food groups. However, only 25% had adequate dietary diversity. The level of education (Complete high school: odds ratio, 5.36; 95% confidence interval, 1.73–16.65) was associated with regular intake of “meat and eggs.” Among the ultra-processed-food score, 27% of the participants described a weekly consumption of at least two ultra-processed-food subgroups. White women (odds ratio, 2.63; 95% confidence interval, 1.05–6.63) had a higher chance of reporting “packaged ready meals” consumption. Conclusions: This study shows a high weekly consumption of ultra-processed-food subgroups and low dietary diversity of the non-ultra-processed-food fraction of the diet of pregnant women in Brazil. Our results elucidate the influence of socio-demographic characteristics on diet quality during pregnancy.

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Consumption of ultra-processed foods and the risk of overweight, obesity, and weight trajectories

European Journal of Public Health ◽

10.1093/eurpub/ckz185.415 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

B Srour ◽

M Beslay ◽

B Allès ◽

E Chazelas ◽

M Deschasaux ◽

...

Keyword(s):

Repeated Measures ◽

Saturated Fatty Acids ◽

Food Additives ◽

Overweight And Obesity ◽

Sensitivity Analyses ◽

Processed Foods ◽

Sugary Drinks ◽

Increased Risk ◽

Weight Trajectories ◽

Incident Cases

Abstract Previous epidemiological studies found associations between the consumption of ultra-processed foods (UPF) and the risk of obesity-related outcomes. The aim of this study is to investigate the associations between UPF consumption and the risk of overweight and obesity, and weight trajectories, in in the French large scale NutriNet-Santé cohort. Methods Overall, 110260 participants aged at least 18 years from the French NutriNet-Santé cohort (2009-2019) were included. Dietary intakes were collected using repeated 24h dietary records, merged with a food composition database of 3300 different products, categorized according to their degree of processing by the NOVA classification. Associations between UPF intake and risks of overweight and obesity were assessed using Cox proportional hazard models. Associations between UPF intake and weight trajectories were assessed using linear mixed models for repeated measures with random slope and intercept. Results UPF intake was associated with a higher risk of overweight (n = 7063 incident cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet = 1.11 (1.08-1.14); P < 0.0001) and obesity (n = 3066 incident cases; HR = 1.09 (1.05-1.13); P < 0.0001). Higher consumers of UPF (4th quartile) were more likely to present an increase in body mass index over time (β = 0.04, P < 0.0001). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (fruits and vegetables and sugary drinks consumption, intakes of saturated fatty acids, sodium, sugar, dietary fiber or Healthy/Western patterns) and after a large range of sensitivity analyses. Conclusions In this large observational prospective study, higher consumption of UPF was associated with a higher risk of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting UPF consumption. Key messages The consumption of ultra-processed food is associated with an increased risk of overweight and obesity. As the French Public Helath agency recommends, their consumption should be limited. Nutritional composition, food additives, contact materials, or neoformed contaminants might play a role in these associations and further studies are needed to understand their relative contribution.

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Ultra-processed food intake and risk of type 2 diabetes in a French cohort of middle-aged adults

European Journal of Public Health ◽

10.1093/eurpub/ckz185.388 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Cited By ~ 2

Author(s):

B Srour ◽

L K Fezeu ◽

E Kesse-Guyot ◽

B Allès ◽

E Chazelas ◽

...

Keyword(s):

Type 2 Diabetes ◽

Food Intake ◽

Saturated Fatty Acids ◽

Sensitivity Analyses ◽

Processed Foods ◽

Processed Food ◽

Sugary Drinks ◽

Increased Risk ◽

Incident Cases

Abstract Objective The consumption of ultra-processed foods has been increasing during the last decades, and has been previously associated with increased risks of mortality and several chronic diseases. The objective of this study is to assess for the first time the prospective associations between consumption of ultra-processed foods and the risk of type 2 diabetes (T2D). Methods 104707 participants aged at least 18 years (median age 41.5 years) from the French NutriNet-Santé cohort (2009-2019). Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants’ usual consumption for 3300 different food items, categorized according to their degree of processing by the NOVA classification. Associations between ultra-processed food intake and risk of T2D were assessed using multi-adjusted Cox proportional hazard models. Results Ultra-processed sugary products, fruits and vegetables, and beverages were the highest contributors of the ultra-processed category (respectively 27.9, 18.5 and 15.6%). Ultra-processed food intake was associated with a higher risk of T2D (n = 821 incident cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet = 1.15 (1.06-1.25); P = 0.0009, 582252 person-years). These results remained statistically significant after adjustment for other metabolic comorbidities, for several markers of the nutritional quality of the diet (red meat and sugary drinks consumption, intakes of saturated fatty acids, sodium, sugar, dietary fiber or Healthy/Western patterns derived by principal component analysis) and after a large range of sensitivity analyses. Conclusions In this large observational prospective study, higher consumption of ultra-processed foods in the diet was associated with a higher risk of T2D. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting ultra-processed food consumption. Key messages The consumption of ultra-processed food is associated with an increased risk of type 2 diabetes. As the French Public Helath agency recommends, their consumption should be limited. Nutritional composition, food additives, contact materials, or neoformed contaminants might play a role in these associations and further studies are needed to understand their relative contribution.

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Ultra-processed food intake and risk of type 2 diabetes in a French cohort of middle-aged adults

Proceedings of The Nutrition Society ◽

10.1017/s0029665120004826 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Bernard Srour ◽

Léopold K. Fezeu ◽

Emmanuelle Kesse-Guyot ◽

Benjamin Allès ◽

Caroline Méjean ◽

...

Keyword(s):

Type 2 Diabetes ◽

Food Intake ◽

Saturated Fatty Acids ◽

Food Additives ◽

Sensitivity Analyses ◽

Processed Foods ◽

Processed Food ◽

Sugary Drinks ◽

Incident Cases

AbstractIntroduction:The consumption of ultra-processed foods has been increasing during the last decades, and has been previously associated with increased risks of mortality and several chronic diseases such as cancer, cardiovascular diseases, hypertension, and dyslipidemia. The objective of this study is to assess the prospective associations between consumption of ultra-processed foods and the risk of type 2 diabetes (T2D).Methods:Overall, 104707 participants aged at least 18 years (median age 41.5 years) from the French NutriNet-Santé cohort (2009–2019) were included. Dietary intakes were collected using repeated 24 hour dietary records (5.7/subject in average), designed to register participants' usual consumption for 3300 different food items. These were categorized according to their degree of processing by the NOVA classification. Associations between ultra-processed food intake and risk of type 2 diabetes were assessed using multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history and nutritional factors).Results:Ultra-processed sugary products, fruits and vegetables, and beverages were the highest contributors of the ultra-processed category (respectively 27.9, 18.5 and 15.6%). Ultra-processed food intake was associated with a higher risk of T2D (n = 821 incident cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet = 1.15 (95% confidence interval 1.06 to 1.25); P = 0.0009, median follow-up: 6.0y, 582252 person-years). These results remained statistically significant after adjustment for other metabolic comorbidities, for several markers of the nutritional quality of the diet (red meat and sugary drinks consumption, intakes of saturated fatty acids, sodium, sugar, dietary fiber or Healthy/Western patterns derived by principal component analysis) and after a large range of sensitivity analyses.Conclusions:In this large observational prospective study, higher consumption of ultra-processed foods in the diet was associated with a higher risk of type 2 diabetes. These results need to be confirmed in other populations and settings, and causality remains to be established. Various dimensions of processing such as nutritional composition of the final product, food additives, contact materials, and neoformed contaminants might play a role in these associations and further studies are needed to better understand their relative contribution. Meanwhile, public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting ultra-processed food consumption.Study Registration: Clinicaltrials.gov NCT03335644.

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Ultra-processed food intake and all-cause mortality: DRECE cohort study

Public Health Nutrition ◽

10.1017/s1368980021003256 ◽

2021 ◽

pp. 1-28

Author(s):

Carmen Romero Ferreiro ◽

Cristina Martín-Arriscado Arroba ◽

Pilar Cancelas Navia ◽

David Lora Pablos ◽

Agustín Gómez de la Cámara

Keyword(s):

Food Intake ◽

Energy Intake ◽

Representative Sample ◽

Spanish Population ◽

Processed Foods ◽

Processed Food ◽

Minimally Processed ◽

Risk Of Mortality ◽

All Cause Mortality

Abstract Objective: To determine the association between ultra-processed food intake and all-cause mortality in a representative sample of Spanish population. Design: Prospective cohort design in which follow-up lasted from baseline (1991) to mortality date or December 31st, 2017, whichever was first. Dietary information was collected using a validated frequency questionnaire and categorized following the NOVA classification according to the extent of food processing. The association between consumption of ultra-processed food and mortality was analysed using Cox models. Isocaloric substitution models were constructed to compare the health effects of the NOVA groups. Setting: Cohort from the DRECE study, representative of the Spanish population Participants: 4679 subjects between 5 and 59 years old Results: Average consumption of ultra-processed food was 370.8 grams/day (24.4% of energy intake). After a median follow-up of 27 years, 450 deaths occurred. Those who consumed the highest amount of ultra-processed foods had higher risk of mortality. For every 10% of the energy intake from ultra-processed foods consumption, an increase of 15% in the hazard of all-cause mortality was observed (HR, 1.15; 95%CI, 1.03-1.27; p-value= 0.012). Substitution of ultra-processed foods with minimally processed foods was significantly associated with a decreased risk of mortality. Conclusions: An increase in ultra-processed foods consumption was associated with higher risk of all-cause mortality in a representative sample of the Spanish population. Moreover, the theoretical substitution of ultra-processed food with unprocessed or minimally processed foods leads to a decrease in mortality. These results support the need to promote diets based on unprocessed or minimally processed foods.

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