Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies
Mendoza K, Smith-Warner SA, Rossato SL, Khandpur N, Manson JE, Qi L, Rimm EB, Mukamal KJ, Willett WC, Wang M, Hu FB, Mattei J, Sun Q
Lancet regional health. Americas · 92 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
- Not stated
Who paid for it
- Funding
- Possibly industry funded
- Government
- Consejo Nacional de Ciencia y Tecnología
- Nonprofit
- Fundación México en Harvard
- Government
- National Institutes of Health
- Government
- Pan American Health Organization
- Authors
- At least one author declares a financial tie to industry
- Grants
- National Institutes of Health (U01-CA167552); National Institutes of Health (R01‐HL‐088521); National Institutes of Health (R01-CA67262); National Institutes of Health (HL-035464); National Institutes of Health (HL060712); National Institutes of Health (R01 CA49449); National Institutes of Health (P01 CA 87969); National Institutes of Health (U01 HL-145386); National Institutes of Health (R01 HL034594); National Institutes of Health (CA-49449); National Institutes of Health (R01HL035464); National Institutes of Health (U01-CA176726); National Institutes of Health (HL034594); National Institutes of Health (CA176726); National Institutes of Health (R01DK120870); National Institutes of Health (R01 HL060712); National Institutes of Health (UM1‐CA‐186107); National Institutes of Health (CA-167552); National Institutes of Health (CA186107); National Institutes of Health (CA67262); National Institutes of Health (CA 87969); National Institutes of Health (HL088521); National Institutes of Health (DK120870)
Based on 4 listed funder(s) and full-text disclosure statement.
Publication
- Published
- 2024-09-01 · Lancet Reg Health Am · vol. 37 · p. 100859
- Publisher
- Elsevier BV
- Cited
- 92 citations · more than 99% of similar papers · 11.6× the field average
- Impact
- Top 10% most cited in its field
- References
- 115 works
- Access
- Open access (journal) · CC-BY-NC-ND
- Research areas
- Consumer Attitudes and Food Labeling · Nutrition, Genetics, and Disease · Global Public Health Policies and Epidemiology
- Keywords
- Medicine, Prospective cohort study, Hazard ratio, Funnel plot, Meta-analysis, Cohort study, Publication bias, Internal medicine, Stroke (engine), Nurses' Health Study, Cohort, Confidence interval
13 authors
From US, BR, NL
- Kenny Mendoza-HerreraHarvard University
- Stephanie A. Smith‐WarnerHarvard University
- Sinara Laurini RossatoHarvard University; Universidade Federal de Uberlândia
- Neha KhandpurWageningen University & Research
- JoAnn E. MansonBrigham and Women's Hospital; Harvard University
- Lu QiTulane University
Abstract
Background
Prospective associations between total and groups of ultra-processed foods (UPF) and cardiovascular disease (CVD) remained to be characterised. Our aim was to assess the association of total and group-specific UPF intakes with CVD, coronary heart disease (CHD), and stroke in three large prospective cohorts of US adults. Additionally, we conducted a systematic review and meta-analyses on the existing evidence on the associations of total UPF intake with these outcomes.
Methods
UPF intake was assessed through food frequency questionnaires in the Nurses' Health Study (NHS; n = 75,735), Nurses' Health Study II (NHSII; n = 90,813), and Health Professionals Follow-Up Study (HPFS; n = 40,409). Cox regression estimated cohort-specific associations of total and group-specific UPF intake with risk of CVD (cases = 16,800), CHD (cases = 10,401), and stroke (cases = 6758), subsequently pooled through fixed-effect models. Random-effects meta-analyses pooled existing prospective findings on the UPF-CVD association identified on Medline and Embase up to April 5, 2024, without language restrictions. Risk of bias was assessed with the Newcastle-Ottawa Scale, funnel plots, and Egger's tests, and meta-evidence was evaluated using NutriGrade.
Findings
The baseline mean (SD) age was 50.8 years (7.2) for the NHS, 36.7 years (4.6) for the NHSII, and 53.4 years (9.6) for the HPFS. The proportion of participants of White race was 97.7% in the NHS, 96.4% in the NHSII, and 94.9% in the HPFS. Among the three cohorts, multivariable-adjusted hazard ratios [HRs (95% CIs)] for CVD, CHD, and stroke for the highest (vs. lowest) total UPF intake quintile were 1.11 (1.06-1.16), 1.16 (1.09-1.24), and 1.04 (0.96-1.12), respectively. UPF groups demonstrated divergent associations. Sugar-/artificially-sweetened drinks and processed meats were associated with higher CVD risk, whereas inverse associations were observed for bread/cold cereals, yoghurt/dairy desserts, and savoury snacks. Meta-analysing 22 prospective studies showed that total UPF intake at the highest category (vs. lowest) was associated with 17% (11%-24%), 23% (12%-34%), and 9% (3%-15%) higher CVD, CHD, and stroke risk. Meta-evidence quality was high for CHD, moderate for CVD, and low for stroke.
Interpretation
Total UPF intake was adversely associated with CVD and CHD risk in US adults, corroborated by prospective studies from multiple countries, also suggesting a small excess stroke risk. Nutritional advice for cardiovascular health should consider differential consequences of group-specific UPF. Replication is needed in racially/ethnically-diverse populations.
Funding
National Institutes of Health (NIH) grants supported the NHS, NHSII, and HPFS.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC-ND).
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