Ultra-Processed Food Consumption and Adult Mortality Risk: A Systematic Review and Dose-Response Meta-Analysis of 207,291 Participants

Abstract

We performed a systematic review and dose-response meta-analysis of observational studies assessing the association between UPF consumption and adult mortality risk. A systematic search was conducted using ISI Web of Science, PubMed/MEDLINE, and Scopus electronic databases from inception to August 2021. Data were extracted from seven cohort studies (totaling 207,291 adults from four countries). Using a random-effects model, hazard ratios (HR) of pooled outcomes were estimated. Our results showed that UPF consumption was related to an enhanced risk of all-cause mortality (HR = 1.21; 95% CI: 1.13, 1.30; I² = 21.9%; p < 0.001), cardiovascular diseases (CVDs)-cause mortality (HR = 1.50; 95% CI: 1.37, 1.63; I² = 0.0%; p < 0.001), and heart-cause mortality (HR = 1.66; 95% CI: 1.50, 1.85; I² = 0.0%; p = 0.022), but not cancer-cause mortality. Furthermore, our findings revealed that each 10% increase in UPF consumption in daily calorie intake was associated with a 15% higher risk of all-cause mortality (OR = 1.15; 95% CI: 1.09, 1.21; I² = 0.0%; p < 0.001). The dose-response analysis revealed a positive linear association between UPF consumption and all-cause mortality (P_nonlinearity = 0.879, P_{dose-response} = p < 0.001), CVDs-cause mortality (P_nonlinearity = 0.868, P_{dose-response} = p < 0.001), and heart-cause mortality (P_nonlinearity = 0.774, P_{dose-response} = p < 0.001). It seems that higher consumption of UPF is significantly associated with an enhanced risk of adult mortality. Despite this, further experimental studies are necessary to draw a more definite conclusion.

Keywords: dose–response; meta-analysis; mortality risk; systematic review; ultra-processed food.

Figure 1

Flowchart of the process of the study selection.

Figure 2

Forest plots demonstrating OR and 95% CI of pooled results from the random effects models to evaluate the relationship between ultra-processed food consumption and risk of mortality: (A) all-cause, (B) CVD-cause, (C) heart-cause, and (D) cancer-cause. The study-specific HR and 95 % CI are represented by black squares and horizontal lines, respectively; the area of the grey square is proportional to the specific-study weight to the overall meta-analysis. The center of the open diamond and the vertical dashed line represent the pooled HR, and its width represents the pooled 95 % CI.

Figure 2

Forest plots demonstrating OR and 95% CI of pooled results from the random effects models to evaluate the relationship between ultra-processed food consumption and risk of mortality: (A) all-cause, (B) CVD-cause, (C) heart-cause, and (D) cancer-cause. The study-specific HR and 95 % CI are represented by black squares and horizontal lines, respectively; the area of the grey square is proportional to the specific-study weight to the overall meta-analysis. The center of the open diamond and the vertical dashed line represent the pooled HR, and its width represents the pooled 95 % CI.

Figure 3

Forest plots showing the linear dose–response meta-analysis of mortality risk for 10% change in ultra-processed food consumption in daily intake. The study-specific HR and 95 % CI are represented by black squares and horizontal lines, respectively; the area of the grey square is proportional to the specific-study weight to the overall meta-analysis. The center of the open diamond and the vertical dashed line represent the pooled HR, and its width represents the pooled 95 % CI.

Figure 4

Dose–response association between ultra-processed food consumption and risk of mortality: (A) all-cause, (B) CVD-cause, (C) heart-cause, and (D) cancer-cause. It has been revised.

Figure 4

Dose–response association between ultra-processed food consumption and risk of mortality: (A) all-cause, (B) CVD-cause, (C) heart-cause, and (D) cancer-cause. It has been revised.

Figure 5

Forest plots showing sensitivity analysis results.

Figure 6

Funnel plot for evaluation publication bias.