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. 2022 Jul;25(7):1854-1863.
doi: 10.1017/S1368980021003256. Epub 2021 Aug 5.

Ultra-processed food intake and all-cause mortality: DRECE cohort study

Carmen Romero Ferreiro  1   2 , Cristina Martín-Arriscado Arroba  1   2 , Pilar Cancelas Navia  1   2 , David Lora Pablos  1   2   3   4 , Agustín Gómez de la Cámara  1   2   3
Affiliations

Ultra-processed food intake and all-cause mortality: DRECE cohort study

Carmen Romero Ferreiro et al. Public Health Nutr. 2022 Jul.

Abstract

Objective: To determine the association between ultra-processed food (UPF) intake and all-cause mortality in a representative sample of Spanish population.

Design: Prospective cohort design in which follow-up lasted from baseline (1991) to mortality date or 31 December 2017, whichever was first. Dietary information was collected using a validated frequency questionnaire and categorised following the NOVA classification according to the extent of food processing. The association between consumption of UPF and mortality was analysed using Cox models. Isoenergetic substitution models were constructed to compare the health effects of the NOVA groups.

Setting: Cohort from the Diet and Risk of Cardiovascular Diseases (CVD) in Spain (DRECE) study, representative of the Spanish population.

Participants: Totally, 4679 subjects between 5 and 59 years old.

Results: Average consumption of UPF was 370·8 g/d (24·4 % of energy intake). After a median follow-up of 27 years, 450 deaths occurred. Those who consumed the highest amount of UPF had higher risk of mortality. For every 10 % of the energy intake from UPF consumption, an increase of 15 % in the hazard of all-cause mortality was observed (HR 1·15; (95 % CI 1·03, 1·27); P-value = 0·012). Substitution of UPF with minimally processed foods was significantly associated with a decreased risk of mortality.

Conclusions: An increase in UPF consumption was associated with higher risk of all-cause mortality in a representative sample of the Spanish population. Moreover, the theoretical substitution of UPF with unprocessed or minimally processed foods leads to a decrease in mortality. These results support the need to promote diets based on unprocessed or minimally processed foods.

Keywords: All-cause mortality; Isoenergetic substitution; NOVA classification; Ultra-processed food.

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Figures

Fig. 1
Fig. 1
UPF consumption in Spain according to the NOVA classification. Error bars denote standard error of the mean. UPF, ultra-processed food
Fig. 2
Fig. 2
Sensitivity analyses for association between consumption of ultra-processed foods and all-cause mortality performed in model 3. a) Cox proportional hazard ratios (Wald’s 95% CI) for all-cause mortality of UPF consumption measured as percentage of total energy intake and b) Cox proportional hazard ratios (Wald’s 95% CI) for all-cause mortality of UPF consumption measured as grams/day. UPF, ultra-processed food
See this image and copyright information in PMC

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