Consumption of Ultra-Processed Foods and Mortality: A National Prospective Cohort in Spain
Blanco-Rojo R, Sandoval-Insausti H, López-Garcia E, Graciani A, Ordovás JM, Banegas JR, Rodríguez-Artalejo F, Guallar-Castillón P
Mayo Clinic proceedings · 167 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Cohort study (indexed by PubMed)
- 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
- Government
- U.S. Department of Agriculture
- University or hospital
- Johns Hopkins University
- University or hospital
- Harvard T.H. Chan School of Public Health
- University or hospital
- Universidad Autónoma de Madrid
- University or hospital
- Centro Nacional de Investigaciones Cardiovasculares
- Government
- Horizon 2020 Framework Programme
- Government
- Instituto de Salud Carlos III
- Government
- European Regional Development Fund
- Government
- European Social Fund
- Grants
- Instituto de Salud Carlos III (PI16/); Horizon 2020 Framework Programme (635316); European Regional Development Fund (H2020); Horizon 2020 Framework Programme (EU‐H2020); Instituto de Salud Carlos III (H2020)
Based on 9 listed funder(s).
Publication
- Published
- 2019-10-14 · Mayo Clin Proc · vol. 94 · issue 11 · pp. 2178–2188
- Publisher
- Elsevier BV
- Cited
- 218 citations · more than 100% of similar papers · 27.2× the field average
- Impact
- Top 10% most cited in its field
- References
- 61 works
- Access
- Open access (hybrid journal) · CC-BY-NC-ND
- Research areas
- Consumer Attitudes and Food Labeling · Nutrition, Genetics, and Disease · Dietary Effects on Health
- Keywords
- Medicine, Prospective cohort study, Environmental health, Cohort study, Cohort, Consumption (sociology), Internal medicine
- MeSH
- humans, neoplasms, cardiovascular diseases, diet, mortality, cause of death, risk factors, cohort studies, prospective studies, nutritive value, adult, middle aged, spain, female, male, fast foods
8 authors
From ES, US
- Ruth Blanco-RojoMadrid Institute for Advanced Studies; Universidad Autónoma de Madrid
- Helena Sandoval‐InsaustiHarvard University; Centro de Investigación Biomédica en Red; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública; Universidad Autónoma de Madrid
- Esther López‐GarcíaMadrid Institute for Advanced Studies; Centro de Investigación Biomédica en Red; Universidad Autónoma de Madrid
- Auxiliadora GracianiCentro de Investigación Biomédica en Red; Universidad Autónoma de Madrid
- José María OrdovásMadrid Institute for Advanced Studies; Tufts University; Spanish National Centre for Cardiovascular Research; Universidad Autónoma de Madrid
- José R. BanegasCentro de Investigación Biomédica en Red; Universidad Autónoma de Madrid
Abstract
Objective
To assess the prospective association between ultra-processed food consumption and all-cause mortality and to examine the effect of theoretical iso-caloric non-processed foods substitution.
Patients and methods
A population-based cohort of 11,898 individuals (mean age 46.9 years, and 50.5% women) were selected from the ENRICA study, a representative sample of the noninstitutionalized Spanish population. Dietary information was collected by a validated computer-based dietary history and categorized according to their degree of processing using NOVA classification. Total mortality was obtained from the National Death Index. Follow-up lasted from baseline (2008-2010) to mortality date or December 31th, 2016, whichever was first. The association between quartiles of consumption of ultra-processed food and mortality was analyzed by Cox models adjusted for the main confounders. Restricted cubic-splines were used to assess dose-response relationships when using iso-caloric substitutions.
Results
Average consumption of ultra-processed food was 385 g/d (24.4% of the total energy intake). After a mean follow-up of 7.7 years (93,599 person-years), 440 deaths occurred. The hazard ratio (and 95% CI) for mortality in the highest versus the lowest quartile of ultra-processed food consumption was 1.44 (95% CI, 1.01-2.07; P trend=.03) in percent of energy and 1.46 (95% CI, 1.04-2.05; P trend=.03) in grams per day per kilogram. Isocaloric substitution of ultra-processed food with unprocessed or minimally processed foods was associated with a significant nonlinear decrease in mortality.
Conclusion
A higher consumption of ultra-processed food was associated with higher mortality in the general population. Furthermore, the theoretical iso-caloric substitution ultra-processed food by unprocessed or minimally processed foods would suppose a reduction of the mortality risk. If confirmed, these findings support the necessity of the development of new nutritional policies and guides at the national and international level.
Trial registration
clinicaltrials.gov Identifier: NCT01133093.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC-ND).
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