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BMJ. 2019 May 29;365:l1451. doi: 10.1136/bmj.l1451.

Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé).

Author information

1
Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inra U1125, Cnam, University of Paris 13, Nutritional Epidemiology Research Team (EREN), Bobigny, France b.srour@eren.smbh.univ-paris13.fr.
2
Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inra U1125, Cnam, University of Paris 13, Nutritional Epidemiology Research Team (EREN), Bobigny, France.
3
MOISA, University of Montpellier, INRA, CIRAD, CIHEAM-IAMM, Montpellier SupAgro, Montpellier, France.
4
Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France.
5
Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.

Abstract

OBJECTIVE:

To assess the prospective associations between consumption of ultra-processed foods and risk of cardiovascular diseases.

DESIGN:

Population based cohort study.

SETTING:

NutriNet-Santé cohort, France 2009-18.

PARTICIPANTS:

105 159 participants aged at least 18 years. Dietary intakes were collected using repeated 24 hour dietary records (5.7 for each participant on average), designed to register participants' usual consumption of 3300 food items. These foods were categorised using the NOVA classification according to degree of processing.

MAIN OUTCOME MEASURES:

Associations between intake of ultra-processed food and overall risk of cardiovascular, coronary heart, and cerebrovascular diseases assessed by multivariable Cox proportional hazard models adjusted for known risk factors.

RESULTS:

During a median follow-up of 5.2 years, intake of ultra-processed food was associated with a higher risk of overall cardiovascular disease (1409 cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet 1.12 (95% confidence interval 1.05 to 1.20); P<0.001, 518 208 person years, incidence rates in high consumers of ultra-processed foods (fourth quarter) 277 per 100 000 person years, and in low consumers (first quarter) 242 per 100 000 person years), coronary heart disease risk (665 cases; hazard ratio 1.13 (1.02 to 1.24); P=0.02, 520 319 person years, incidence rates 124 and 109 per 100 000 person years, in the high and low consumers, respectively), and cerebrovascular disease risk (829 cases; hazard ratio 1.11 (1.01 to 1.21); P=0.02, 520 023 person years, incidence rates 163 and 144 per 100 000 person years, in high and low consumers, respectively). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (saturated fatty acids, sodium and sugar intakes, dietary fibre, or a healthy dietary pattern 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 was associated with higher risks of cardiovascular, coronary heart, and cerebrovascular diseases. These results need to be confirmed in other populations and settings, and causality remains to be established. Various factors in processing, such as nutritional composition of the final product, additives, contact materials, and neoformed contaminants might play a role in these associations, and further studies are needed to understand better the relative contributions. Meanwhile, public health authorities in several countries have recently started to promote unprocessed or minimally processed foods and to recommend limiting the consumption of ultra-processed foods.

STUDY REGISTRATION:

ClinicalTrials.gov NCT03335644.

PMID:
31142457
PMCID:
PMC6538975
DOI:
10.1136/bmj.l1451
[Indexed for MEDLINE]
Free PMC Article

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