Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé)
Srour B, Fezeu LK, Kesse-Guyot E, Allès B, Méjean C, Andrianasolo RM, Chazelas E, Deschasaux M, Hercberg S, Galan P, Monteiro CA, Julia C, Touvier M
BMJ (Clinical research ed.) · 634 citations
How it was studied
- Design
- Cohort study (classified by our AI screen)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
- Intake measured by
- Food diaries or recalls
Who paid for it
- Funding
- Independent funding
- Nonprofit
- Fondation de France
- Government
- Institut National de la Recherche Agronomique
- University or hospital
- Université Paris 13
- University or hospital
- Conservatoire National des Arts et Métiers
Based on 4 listed funder(s) and full-text disclosure statement.
Publication
- Published
- 2019-05-29 · BMJ · vol. 365 · p. l1451
- Cited
- 944 citations · more than 100% of similar papers · 94.7× the field average
- Impact
- Top 10% most cited in its field
- References
- 79 works
- Access
- Open access (hybrid journal) · CC-BY-NC
- Research areas
- Consumer Attitudes and Food Labeling · Nutritional Studies and Diet · Obesity, Physical Activity, Diet
- Keywords
- Medicine, Hazard ratio, Prospective cohort study, Cohort, Incidence (geometry), Confidence interval, Population, Cohort study, Proportional hazards model, Risk assessment, Environmental health, Internal medicine
- MeSH
- humans, cardiovascular diseases, micronutrients, diet, nutrition surveys, risk assessment, risk factors, energy intake, nutritive value, socioeconomic factors, dietary fiber, adult, aged, middle aged, france, female, male, fast foods
13 authors
From FR, BR
- Bernard Srour · correspondingInserm; Université Paris Cité; Université Sorbonne Paris Nord; Sorbonne Paris Cité; Equipe de Recherche en Epidémiologie Nutritionnelle; Centre de Recherche Épidémiologie et Statistique
- Léopold FezeuInserm; Université Paris Cité; Université Sorbonne Paris Nord; Sorbonne Paris Cité; Equipe de Recherche en Epidémiologie Nutritionnelle; Centre de Recherche Épidémiologie et Statistique
- Emmanuelle Kesse‐GuyotInserm; Université Paris Cité; Université Sorbonne Paris Nord; Sorbonne Paris Cité; Equipe de Recherche en Epidémiologie Nutritionnelle; Centre de Recherche Épidémiologie et Statistique
- Benjamin AllèsInserm; Université Paris Cité; Université Sorbonne Paris Nord; Sorbonne Paris Cité; Equipe de Recherche en Epidémiologie Nutritionnelle; Centre de Recherche Épidémiologie et Statistique
- Caroline MéjeanCentre de Coopération Internationale en Recherche Agronomique pour le Développement; Université de Montpellier; Institut Agro Montpellier; Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement; Montpellier Interdisciplinary center on Sustainable Agri-food systems: social and nutritional sciences; Centre International deHautes Etudes Agronomiques Méditerranéennes
- Roland M. AndrianasoloInserm; Université Paris Cité; Université Sorbonne Paris Nord; Sorbonne Paris Cité; Equipe de Recherche en Epidémiologie Nutritionnelle; Centre de Recherche Épidémiologie et Statistique
Abstract
Objective
To assess the prospective associations between consumption of ultra-processed foods and risk of cardiovascular diseases.
Design
Population based cohort study.
Setting
NutriNet-Santé cohort, France 2009-18.
Participants
105 159 participants aged at least 18 years. Dietary intakes were collected using repeated 24 hour dietary records (5.7 for each participant on average), designed to register participants' usual consumption of 3300 food items. These foods were categorised using the NOVA classification according to degree of processing.
Main outcome measures
Associations between intake of ultra-processed food and overall risk of cardiovascular, coronary heart, and cerebrovascular diseases assessed by multivariable Cox proportional hazard models adjusted for known risk factors.
Results
During a median follow-up of 5.2 years, intake of ultra-processed food was associated with a higher risk of overall cardiovascular disease (1409 cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet 1.12 (95% confidence interval 1.05 to 1.20); P<0.001, 518 208 person years, incidence rates in high consumers of ultra-processed foods (fourth quarter) 277 per 100 000 person years, and in low consumers (first quarter) 242 per 100 000 person years), coronary heart disease risk (665 cases; hazard ratio 1.13 (1.02 to 1.24); P=0.02, 520 319 person years, incidence rates 124 and 109 per 100 000 person years, in the high and low consumers, respectively), and cerebrovascular disease risk (829 cases; hazard ratio 1.11 (1.01 to 1.21); P=0.02, 520 023 person years, incidence rates 163 and 144 per 100 000 person years, in high and low consumers, respectively). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (saturated fatty acids, sodium and sugar intakes, dietary fibre, or a healthy dietary pattern derived by principal component analysis) and after a large range of sensitivity analyses.
Conclusions
In this large observational prospective study, higher consumption of ultra-processed foods was associated with higher risks of cardiovascular, coronary heart, and cerebrovascular diseases. These results need to be confirmed in other populations and settings, and causality remains to be established. Various factors in processing, such as nutritional composition of the final product, additives, contact materials, and neoformed contaminants might play a role in these associations, and further studies are needed to understand better the relative contributions. Meanwhile, public health authorities in several countries have recently started to promote unprocessed or minimally processed foods and to recommend limiting the consumption of ultra-processed foods.
Study registration
ClinicalTrials.gov NCT03335644.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC).
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