Ultra-processed food intake and all-cause and cause-specific mortality in individuals with cardiovascular disease: the Moli-sani Study
Bonaccio M, Costanzo S, Di Castelnuovo A, Persichillo M, Magnacca S, De Curtis A, Cerletti C, Donati MB, de Gaetano G, Iacoviello L
European heart journal · 58 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 (classified by our AI screen)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
- Intake measured by
- Food frequency questionnaire
Who paid for it
- Funding
- Independent funding
- Government
- Italian Ministry of University and Research
Based on 1 listed funder(s).
Publication
- Published
- 2021-10-29 · Eur Heart J · vol. 43 · issue 3 · pp. 213–224
- Publisher
- Oxford University Press
- Cited
- 77 citations · more than 99% of similar papers · 10.8× the field average
- Impact
- Top 10% most cited in its field
- References
- 48 works
- Access
- Paywalled
- Research areas
- Consumer Attitudes and Food Labeling · Nutritional Studies and Diet · Food composition and properties
- Keywords
- Medicine, Disease, Cause of death, Internal medicine, Cardiology, Intensive care medicine, Environmental health
- MeSH
- humans, cardiovascular diseases, diet, cause of death, eating, aged, middle aged, female, male, fast foods
11 authors
From IT
- Marialaura Bonaccio · correspondingIstituto Neurologico Mediterraneo
- Simona CostanzoIstituto Neurologico Mediterraneo
- Augusto Filippo Di CastelnuovoClinica Mediterranea
- Mariarosaria PersichilloIstituto Neurologico Mediterraneo
- Sara MagnaccaClinica Mediterranea
- Amalia De CurtisIstituto Neurologico Mediterraneo
Abstract
Aims
To evaluate the association of ultra-processed food (UPF) intake and mortality among individuals with history of cardiovascular disease (CVD) and analyse some biological pathways possibly relating UPF intake to death.
Methods and results
Longitudinal analysis on 1171 men and women (mean age: 67 ± 10 years) with history of CVD, recruited in the Moli-sani Study (2005-10, Italy) and followed for 10.6 years (median). Food intake was assessed using a food frequency questionnaire. UPF was defined using the NOVA classification according to degree of processing and categorized as quartiles of the ratio (%) between UPF (g/day) and total food consumed (g/day). The mediating effects of 18 inflammatory, metabolic, cardiovascular, and renal biomarkers were evaluated using a logistic regression model within a counterfactual framework. In multivariable-adjusted Cox analyses, higher intake of UPF (Q4, ≥11.3% of total food), as opposed to the lowest (Q1, UPF <4.7%), was associated with higher hazards of all-cause (hazard ratio [HR]: 1.38; 95% confidence interval (CI): 1.00-1.91) and CVD mortality (HR: 1.65; 95% CI: 1.07-2.55). A linear dose-response relationship of 1% increment in UPF intake with all-cause and CVD mortality was also observed. Altered levels of cystatin C explained 18.3% and 16.6% of the relation between UPF (1% increment in the diet) with all-cause and CVD mortality, respectively.
Conclusion
A diet rich in UPF is associated with increased hazards of all-cause and CVD mortality among individuals with prior cardiovascular events, possibly through an altered renal function. Elevated UPF intake represents a major public health concern in secondary CVD prevention.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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