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. 2021 Mar 30;77(12):1520-1531.
doi: 10.1016/j.jacc.2021.01.047.

Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study

Filippa Juul  1 , Georgeta Vaidean  2 , Yong Lin  3 , Andrea L Deierlein  4 , Niyati Parekh  5
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Free article

Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study

Filippa Juul et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Ultra-processed foods provide 58% of total energy in the U.S. diet, yet their association with cardiovascular disease (CVD) remains understudied.

Objectives: The authors investigated the associations between ultra-processed foods and CVD incidence and mortality in the prospective Framingham Offspring Cohort.

Methods: The analytical sample included 3,003 adults free from CVD with valid dietary data at baseline. Data on diet, measured by food frequency questionnaire, anthropometric measures, and sociodemographic and lifestyle factors were collected quadrennially from 1991 to 2008. Data regarding CVD incidence and mortality were available until 2014 and 2017, respectively. Ultra-processed foods were defined according to the NOVA framework. The authors used Cox proportional hazards models to determine the multivariable association between ultra-processed food intake (energy-adjusted servings per day) and incident hard CVD, hard coronary heart disease (CHD), overall CVD, and CVD mortality. Multivariable models were adjusted for age, sex, education, alcohol consumption, smoking, and physical activity.

Results: During follow-up (1991 to 2014/2017), the authors identified 251, 163, and 648 cases of incident hard CVD, hard CHD, and overall CVD, respectively. On average, participants consumed 7.5 servings per day of ultra-processed foods at baseline. Each additional daily serving of ultra-processed foods was associated with a 7% (95% confidence interval [CI]: 1.03 to 1.12), 9% (95% CI: 1.04 to 1.15), 5% (95% CI: 1.02 to 1.08), and 9% (95% CI: 1.02 to 1.16) increase in the risk of hard CVD, hard CHD, overall CVD, and CVD mortality, respectively.

Conclusions: The current findings support that higher consumption of ultra-processed foods is associated with increased risk of CVD incidence and mortality. Although additional research in ethnically diverse populations is warranted, these findings suggest cardiovascular benefits of limiting ultra-processed foods.

Keywords: Framingham Heart Study; Framingham Offspring Study; NOVA; cardiovascular disease; coronary heart disease; ultra-processed foods.

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Conflict of interest statement

Funding Support and Author Disclosures The current analyses were unfunded. The Framingham Heart Study is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with Boston University (Contract No. N01-HC-25195). Funding support for the Framingham Food Frequency Questionnaire datasets was provided by ARS Contract #53-3k06-5-10, ARS Agreement #'s 58-1950-9-001, 58-1950-4-401, and 58-1950-7-707. This manuscript was not prepared in collaboration with investigators of the Framingham Heart Study and does not necessarily reflect the opinions or views of the Framingham Heart Study, Boston University, or NHLBI. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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