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

Authors

Mahshid Dehghan, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. Electronic address: mahshid.dehghan@phri.ca.Follow
Andrew Mente, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Sumathy Rangarajan, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Viswanathan Mohan, Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
Sumathi Swaminathan, St John's Research Institute, St John's National Academy of Health Sciences, Sarjapur Road, Koramangala, Bangalore, Karnataka, India.
Alvaro Avezum, International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.Follow
Scott A. Lear, Faculty of Health Sciences, Simon Fraser University c/o Healthy Heart Program, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Annika Rosengren, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, VGR Region, Sweden.
Paul Poirier, Heart and Lung Institute, Laval University, Quebec City, QC, Canad.
Fernando Lanas, University of La Frontera, Temuco, Chile.
Patricio Lopez-Jaramillo, Masira Research Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia.
Biju Soman, Health Action by People, Thiruvananthapuram, Kerala, India.
Chuangshi Wang, Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Andrés Orlandini, Clinical Studies Latin America, Rosario, Santa Fe, Argentina.
Noushin Mohammadifard, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Khalid F. AlHabib, Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.Follow
Jephat Chifamba, University of Zimbabwe, Faculty of Medicine and Health Sciences, Unit of Physiology, Harare, Zimbabwe.Follow
Afzal Hussein Yusufali, Hatta Hospital, Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates.
Romaina Iqbal, Department of Community Health Sciences and Medicine, Aga Khan University, Pakistan.
Rasha Khatib, Advocate Aurora HealthFollow
Karen Yeates, Department of Medicine, Queen's University, Kingston, Canada.
Thandi Puoane, School of Public Health, University of the Western Cape, Bellville, South Africa.
Yuksel Altuntas, University of Health Sciences Turkey, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Endocrinology and Metabolism, Sisli, Istanbul, Turkey.Follow
Homer Uy Co, University of the Philippines College of Medicine, Manila, Philippines.Follow
Sidong Li, Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Weida Liu, Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Katarzyna Zatońska, Social Medicine Department of Wroclaw Medical University, Poland.
Rita Yusuf, Independent University, Dhaka, Bangladesh.
Noorhassim Ismail, Department of Community Health, Faculty of Medicine, University Kebangsaan, Kuala Lumpur, Malaysia.
Victoria Miller, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Salim Yusuf, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.

Recommended Citation

Dehghan M, Mente A, Rangarajan S, et al. Ultra-processed foods and mortality: analysis from the Prospective Urban and Rural Epidemiology study. Am J Clin Nutr. 2023;117(1):55-63. doi:10.1016/j.ajcnut.2022.10.014

Affiliations

Advocate Aurora Research Institute

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.

Document Type

Article

PubMed ID

36789944