Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé) - PubMed (original) (raw)

Observational Study

doi: 10.1136/bmj.l1451.

Léopold K Fezeu 2, Emmanuelle Kesse-Guyot 2, Benjamin Allès 2, Caroline Méjean 3, Roland M Andrianasolo 2, Eloi Chazelas 2, Mélanie Deschasaux 2, Serge Hercberg 2 4, Pilar Galan 2, Carlos A Monteiro 5, Chantal Julia 2 4, Mathilde Touvier 2

Affiliations

Observational Study

Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé)

Bernard Srour et al. BMJ. 2019.

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.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi\_disclosure.pdf and declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1

Fig 1

Flowchart for study sample, NutriNet-Santé cohort, France, 2009-18

Fig 2

Fig 2

Relative contribution (%) of each food group to consumption of ultra-processed food in diet

Fig 3

Fig 3

Spline plot for linearity assumption of association between proportion of ultra-processed food in diet and risks of overall cardiovascular, coronary heart, and cerebrovascular diseases. Restricted cubic spline SAS macro developed by Desquilbet and Mariotti

Similar articles

Cited by

References

    1. World Health Organization. Cardiovascular diseases (CVDs) fact sheet. WHO. [cited 2018 Jun 1]. www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
    1. Mozaffarian D. Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review. Circulation 2016;133:187-225. 10.1161/CIRCULATIONAHA.115.018585 - DOI - PMC - PubMed
    1. Wilkins E, Wilson L, Wickramasinghe K, et al. European Cardiovascular Disease Statistics 2017. European Heart Network, Brussels. [cited 2018 Jun 1]. www.ehnheart.org/cvd-statistics/cvd-statistics-2017.html
    1. Perk J, De Backer G, Gohlke H, et al. European Association for Cardiovascular Prevention & Rehabilitation (EACPR) ESC Committee for Practice Guidelines (CPG) European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012;33:1635-701. 10.1093/eurheartj/ehs092 - DOI - PubMed
    1. Eckel RH, Jakicic JM, Ard JD, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;129(Suppl 2):S76-99. 10.1161/01.cir.0000437740.48606.d1 - DOI - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources