Consumption of ultra-processed foods and mortality: a national prospective cohort in Spain

Authors: BLANCO-ROJO, RUTH - Autonomous University Of Madrid; SANDOVAL-INSAUSTI, HELENA - Centro De Investigacion Biomedica En Red (CIBER)-Epidemiología Y Salud Pública; LOPEZ-GARCIA, ESTHER - Centro De Investigacion Biomedica En Red (CIBER)-Epidemiología Y Salud Pública; GRACIANI, AUXILIADORA - Centro De Investigacion Biomedica En Red (CIBER)-Epidemiología Y Salud Pública; ORDOVAS, JOSE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; BANEGAS, JOSE - Centro De Investigacion Biomedica En Red (CIBER)-Epidemiología Y Salud Pública; RODRIGUEZ-ARTALEJO, FERNANDO - Consejo Superior De Investigaciones Cientificas (CSIC); GUALLAR-CASTILLON, PILAR - Centro De Investigacion Biomedica En Red (CIBER)-Epidemiología Y Salud Pública

Submitted to: Mayo Clinic Proceedings
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/28/2019
Publication Date: 11/1/2019
Citation: Blanco-Rojo, R., Sandoval-Insausti, H., Lopez-Garcia, E., Graciani, A., Ordovas, J.M., Banegas, J.R., Rodriguez-Artalejo, F., Guallar-Castillon, P. 2019. Consumption of ultra-processed foods and mortality: a national prospective cohort in Spain. Mayo Clinic Proceedings. 94(11):2178-2188. https://doi.org/10.1016/j.mayocp.2019.03.035.
DOI: https://doi.org/10.1016/j.mayocp.2019.03.035

Interpretive Summary: Ultra-processed foods (UPF) are typically high energy-dense products, high in sugar, unhealthy fats, and salt, and low in dietary fiber, protein, vitamins, and minerals. UPF already make up more than half of the total dietary energy consumed in high-income countries and up to one-third of energy in middle-income countries. Observational studies have shown that increases in the dietary share of UPF result in deterioration of the nutritional quality of the overall diet and increased obesity, metabolic syndrome, and other chronic diseases. In this study, we determined the prospective association between UPF consumption and all-cause mortality. For this purpose, we used a population-based cohort of 11,898 individuals (mean age 47 years, 50% women) from the ENRICA study. Our results show that the average consumption of UPF was 385 g/d (24.4% of energy). After a mean follow-up of 7.7 years (93,599 person-years), 440 deaths occurred. The hazard for mortality, comparing the highest versus the lowest quartile of UPF consumption, was around 1.45. Isocaloric substitution of UPF with minimally processed food was associated with a significant decrease in mortality. These results support the notion that higher consumption of UPF was associated with higher mortality in the general population.

Technical Abstract: Objective: To assess the prospective association between ultra-processed food consumption and all cause mortality and to examine the effect of theoretical isocaloric 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 isocaloric 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 isocaloric 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.