Ultra-processed food consumption and risk of cardiovascular events: a systematic review and dose-response meta-analysis

Abstract

Background: Ultra-processed food (UPF) consumption continues to increase worldwide. However, evidences from meta-analyses are limited regarding the effects on cardiovascular events (CVEs).

Methods: A meta-analysis was performed to assess the dose-response relationship of UPF consumption and CVEs risk (including the morbidity and mortality of cardiovascular causes, and myocardial infarction, stroke, transient ischemic attack, coronary intervention). Databases (PubMed, EMBASE, Cochrane Library, and Web of Science) were searched for observational studies published in English language up to October 24, 2023. Generalized least squares regression and restricted cubic splines were used to estimate the linear/nonlinear relationship. PROSPERO CRD 42023391122.

Findings: Twenty studies with 1,101,073 participants and 58,201 CVEs cases with a median follow-up of 12.2 years were included. A positive linear relationship between UPF intake and CVEs risk was identified. In addition, positive correlation between coronary heart disease and UPF consumption in terms of daily serving and daily energy proportion. No significant association of UPF consumption with the risk of cerebrovascular disease was observed. Briefly, 10% increase of UPF by daily weight proportion was associated with a 1.9% increase of CVEs risk (RR = 1.019; 95% CI, 1.007-1.031; P = 0.002), an additional daily serving corresponding to 2.2% CVEs risk increase (RR = 1.022; 95% CI, 1.013-1.031; P < 0.001), and 10% increase by daily energy proportion corresponding to 1.6% CVEs risk increase (RR = 1.016; 95% CI, 1.002-1.030; P = 0.022).

Interpretation: UPF consumption were associated with a higher risk of CVEs in the positive linear relationship. Our findings highlight the importance of minimizing UPF consumption for cardiovascular health and might be help to pursue public health policies in control of UPF consumption.

Funding: This work was supported by the Key Research and Development Program of Shaanxi Province (2023-ZDLSF-22), the Innovative Talent Support Program of Shaanxi Province (2022KJXX-106), and the Key Research and Development Program of Shaanxi Province (2023-YBSF-424).

Keywords: Cardiovascular events; Coronary heart disease; Dose–response; Meta-analysis; Risk; Ultra-processed food.

Fig. 1

Study selection process of ultra-processed food consumption and risk of cardiovascular events.

Fig. 2

Forest plot of the association between the highest level of ultra-processed food consumption by daily weight proportion and risk of cardiovascular events compared to the lowest level (A); Forest plot of the association between the second highest level of ultra-processed food consumption by daily weight proportion and risk of cardiovascular events compared to the lowest level (B); Forest plot of the association between the third highest level of UPF consumption by daily weight proportion and risk of cardiovascular events compared to the lowest level (C); Dose–response association between ultra-processed food consumption by daily weight proportion and risk of cardiovascular events (D). Abbreviations: RR, relative risk; CI, confidence interval; CVD, cardiovascular disease; CHD, coronary heart disease; UPF, ultra-processed food; CVEs, cardiovascular events.

Fig. 3

Forest plot of the association between the highest level of ultra-processed food consumption by daily servings and risk of coronary heart disease compared to the lowest level (A); Forest plot of the association between the second highest level of ultra-processed food consumption by daily servings and risk of coronary heart disease compared to the lowest level (B); Forest plot of the association between the third highest level of ultra-processed food consumption by daily servings and risk of coronary heart disease compared to the lowest level (C); Forest plot of the association between the highest level of ultra-processed food consumption by daily energy proportion and risk of coronary heart disease compared to the lowest level (D); Forest plot of the association between the second highest level of ultra-processed food consumption by daily energy proportion and risk of coronary heart disease compared to the lowest level (E); Forest plot of the association between the third highest level of ultra-processed food consumption by daily energy proportion and risk of coronary heart disease compared to the lowest level (F); Dose–response association between ultra-processed food consumption by daily servings and risk of coronary heart disease (G); Dose–response association between ultra-processed food consumption by daily energy proportion and risk of coronary heart disease (H). −/−^∗: not reported in the original article. Abbreviations: CHD, coronary heart disease; RR, relative risk; CI, confidence interval; UPF, ultra-processed food.