Ultra-processed foods and mortality: analysis from the Prospective Urban and Rural Epidemiology study

Dehghan M 1 , Mente A 2 , Rangarajan S 2 , Mohan V 3 , Swaminathan S 4 , Avezum A 5 Show all authors , Lear SA 6 , Rosengren A 7 , Poirier P 8 , Lanas F 9 , Lopez-Jaramillo P 10 , Soman B 11 , Wang C 12 , Orlandini A 13 , Mohammadifard N 14 , AlHabib KF 15 , Chifamba J 16 , Yusufali AH 17 , Iqbal R 18 , Khatib R 19 , Yeates K 20 , Puoane T 21 , Altuntas Y 22 , Co HU 23 , Li S 12 , Liu W 12 , Zatońska K 24 , Yusuf R 25 , Ismail N 26 , Miller V 2 , Yusuf S 2 , Prospective Urban Rural Epidemiology (PURE) study investigators

Affiliations 

  • 1 Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. Electronic address: mahshid.dehghan@phri.ca
  • 2 Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  • 3 Dr. Mohan's Diabetes Specialities Centre, Chennai, India
  • 4 St John's Research Institute, St John's National Academy of Health Sciences, Sarjapur Road, Koramangala, Bangalore, Karnataka, India
  • 5 International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
  • 6 Faculty of Health Sciences, Simon Fraser University c/o Healthy Heart Program, St. Paul's Hospital, Vancouver, British Columbia, Canada
  • 7 Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, VGR Region, Sweden
  • 8 Heart and Lung Institute, Laval University, Quebec City, QC, Canad
  • 9 University of La Frontera, Temuco, Chile
  • 10 Masira Research Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia
  • 11 Health Action by People, Thiruvananthapuram, Kerala, India
  • 12 Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
  • 13 Clinical Studies Latin America, Rosario, Santa Fe, Argentina
  • 14 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  • 15 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 16 University of Zimbabwe, Faculty of Medicine and Health Sciences, Unit of Physiology, Harare, Zimbabwe
  • 17 Hatta Hospital, Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
  • 18 Department of Community Health Sciences and Medicine, Aga Khan University, Pakistan
  • 19 Institute for Community and Public Health, Birzeit University, Birzeit, Palestine & Advocate Research Institute, Advocate Health Care, IL, USA
  • 20 Department of Medicine, Queen's University, Kingston, Canada
  • 21 School of Public Health, University of the Western Cape, Bellville, South Africa
  • 22 University of Health Sciences Turkey, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Endocrinology and Metabolism, Sisli, Istanbul, Turkey
  • 23 University of the Philippines College of Medicine, Manila, Philippines
  • 24 Social Medicine Department of Wroclaw Medical University, Poland
  • 25 Independent University, Dhaka, Bangladesh
  • 26 Department of Community Health, Faculty of Medicine, University Kebangsaan, Kuala Lumpur, Malaysia
Am J Clin Nutr, 2023 Jan;117(1):55-63.
PMID: 36789944 DOI: 10.1016/j.ajcnut.2022.10.014

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications