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. 2019 May 29:365:l1949.
doi: 10.1136/bmj.l1949.

Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study

Anaïs Rico-Campà  1   2 , Miguel A Martínez-González  1   2   3   4 , Ismael Alvarez-Alvarez  1 , Raquel de Deus Mendonça  1   5 , Carmen de la Fuente-Arrillaga  1   2   3 , Clara Gómez-Donoso  1 , Maira Bes-Rastrollo  6   2   3
Affiliations

Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study

Anaïs Rico-Campà et al. BMJ. .

Abstract

Objective: To evaluate the association between consumption of ultra-processed foods and all cause mortality.

Design: Prospective cohort study.

Setting: Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018.

Participants: 19 899 participants (12 113 women and 7786 men) aged 20-91 years followed-up every two years between December 1999 and February 2014 for food and drink consumption, classified according to the degree of processing by the NOVA classification, and evaluated through a validated 136 item food frequency questionnaire.

Main outcome measure: Association between consumption of energy adjusted ultra-processed foods categorised into quarters (low, low-medium, medium-high, and high consumption) and all cause mortality, using multivariable Cox proportional hazard models.

Results: 335 deaths occurred during 200 432 persons years of follow-up. Participants in the highest quarter (high consumption) of ultra-processed foods consumption had a higher hazard for all cause mortality compared with those in the lowest quarter (multivariable adjusted hazard ratio 1.62, 95% confidence interval 1.13 to 2.33) with a significant dose-response relation (P for linear trend=0.005). For each additional serving of ultra-processed foods, all cause mortality relatively increased by 18% (adjusted hazard ratio 1.18, 95% confidence interval 1.05 to 1.33).

Conclusions: A higher consumption of ultra-processed foods (>4 servings daily) was independently associated with a 62% relatively increased hazard for all cause mortality. For each additional serving of ultra-processed food, all cause mortality increased by 18%.

Study registration: ClinicalTrials.gov NCT02669602.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Flowchart of study participants. SUN=Seguimiento Universidad de Navarra
Fig 2
Fig 2
Kaplan-Meier incidence for consumption of ultra-processed foods, adjusted through inverse probability weighting. See table 3 footnote † for adjustment factors
Fig 3
Fig 3
Subgroup and sensitivity analyses for association between consumption of ultra-processed foods and all cause mortality (highest versus lowest quarter of consumption). See table 3 footnote † for adjustment factors. CVD=cardiovascular disease
Fig 4
Fig 4
Restricted cubic splines analysis of association between consumption of ultra-processed foods and all cause mortality. Dotted lines represent 95% confidence intervals
See this image and copyright information in PMC

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