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. 2025 Jan 8:50:101208.
doi: 10.1016/j.lanepe.2024.101208. eCollection 2025 Mar.

Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countries

Esther M González-Gil  1 , Michèle Matta  2 , Fernanda Morales Berstein  3   4 , Manon Cairat  5 , Geneviève Nicolas  1 , Jessica Blanco  1 , Nathalie Kliemann  6 , Renata Bertazzi Levy  7 , Fernanda Rauber  7   8 , Inarie Jacobs  1 , Aline Al Nahas  1 , Emine Koc Cakmak  9 , Eszter P Vamos  10 , Kiara Chang  10 , Sahar G Yammine  11 , Christopher Millett  10   12 , Mathilde Touvier  11 , Maria Gabriela Matias Pinho  13   14 , Konstantinos K Tsilidis  15   16 , Alicia K Heath  15 , Christina M Lill  17   18 , Valeria Pala  19 , Conchi Moreno-Iribas  20   21   22 , Maria Santucci De Magistris  23 , Christina C Dahm  24 , Niels Bock  24 , Anja Olsen  24   25 , Anne Tjønneland  25   26 , Yvonne T van der Schouw  27 , Pilar Amiano  21   28   29 , Franziska Jannasch  30 , Matthias B Schulze  30   31 , Francesca Romana Mancini  5 , Chloé Marques  5 , Claire Cadeau  5 , Catalina Bonet  32   33 , Daniel Redondo-Sánchez  21   34   35 , Kristin Benjaminsen Borch  36 , Magritt Brustad  36   37 , Guri Skeie  1   36 , Jesús Humberto-Gómez  21   38 , Alessandra Macciotta  39   40 , Pietro Ferrari  1 , Laure Dossus  1 , Marc J Gunter  1   15 , Inge Huybrechts  1
Affiliations

Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countries

Esther M González-Gil et al. Lancet Reg Health Eur. .

Abstract

Background: Ultra-processed food (UPF) consumption has been linked with higher risk of mortality. This multi-centre study investigated associations between food intake by degree of processing, using the Nova classification, and all-cause and cause-specific mortality.

Methods: This study analyzed data from the European Prospective Investigation into Cancer and Nutrition. All-cause mortality and cause-specific mortality due to cancer, circulatory diseases, digestive diseases, Parkinson's disease, and Alzheimer's disease served as endpoints. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazards regression models. Substitution analyses were also performed.

Findings: Overall, 428,728 (71.7% female) participants were included in the analysis and 40,016 deaths were documented after 15.9 years of follow-up. UPFs (in percentage grams per day [g/d]) were positively associated with all-cause mortality (HRs per 1-SD: 1.04; 95% CI: 1.02,1.05), as well as mortality from circulatory diseases (1.09; 95% CI: 1.07,1.12), cerebrovascular disease (1.11; 95% CI: 1.05,1.17), ischemic heart disease (1.10; 95% CI: 1.06,1.15), digestive diseases (1.12; 95% CI: 1.05,1.20), and Parkinson's disease (1.23; 95% CI: 1.06,1.42). No associations were found between UPFs and mortality from cancer or Alzheimer's disease. Replacing processed and UPFs with unprocessed/minimally processed foods was associated with lower mortality risk.

Interpretation: In this pan-European analysis, higher UPF consumption was associated with greater mortality from circulatory diseases, digestive diseases, and Parkinson's disease. The results support growing evidence that higher consumption of UPFs and lower consumption of unprocessed foods may have a negative impact on health.

Funding: l'Institut National du Cancer, and World Cancer Research Fund International.

Keywords: EPIC study; Mortality; Nova classification; Ultra-processed foods; Unprocessed/minimally processed foods.

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Conflict of interest statement

FMB was supported by a Wellcome Trust PhD studentship in Molecular, Genetic and Lifecourse Epidemiology (224982/Z/22/Z). RB, FR, KC, and IH were supported by the World Cancer Research Fund International (IIG_FULL_2020_033). CML was supported by the Heisenberg program of the Deutsche Forschungsgemeinschaft. NB funded by the Aarhus University Research Foundation (AUFF) via the Graduate School of Health at Aarhus University.

Figures

Fig. 1
Fig. 1
Flowchart of the study sample.
Fig. 2
Fig. 2
Associations of consumption of unprocessed/minimally processed foods (Nova 1), culinary ingredients (Nova 2), processed foods (Nova 3) and ultra-processed foods (Nova 4) per 1SD increment of percentage of grams per day and all-Cause and cause specific mortality. Cox regression stratified by age (1-year categories), sex, centre and controlled by smoking intensity, smoking status, educational level, marital status, physical activity, total energy intake, alcohol intake, body mass index and MedScore. Total of subjects included in the analysis 428,728. HR: hazard ratio; LCI: lower confidence interval; UCI: upper confidence interval.
Fig. 2
Fig. 2
Associations of consumption of unprocessed/minimally processed foods (Nova 1), culinary ingredients (Nova 2), processed foods (Nova 3) and ultra-processed foods (Nova 4) per 1SD increment of percentage of grams per day and all-Cause and cause specific mortality. Cox regression stratified by age (1-year categories), sex, centre and controlled by smoking intensity, smoking status, educational level, marital status, physical activity, total energy intake, alcohol intake, body mass index and MedScore. Total of subjects included in the analysis 428,728. HR: hazard ratio; LCI: lower confidence interval; UCI: upper confidence interval.
See this image and copyright information in PMC

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