4.7 Article

Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study

Journal

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 77, Issue 12, Pages 1520-1531

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2021.01.047

Keywords

coronary heart disease; Framingham Heart Study; Framingham Offspring Study; NOVA; ultra-processed foods; cardiovascular disease

Funding

  1. National Heart, Lung, and Blood Institute (NHLBI)
  2. Boston University [N01-HC-25195]
  3. ARS [53-3k06-5-10, 58-1950-9-001, 58-1950-4-401, 58-1950-7-707]

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The study found that higher consumption of ultra-processed foods is associated with an increased risk of cardiovascular disease incidence and mortality, suggesting potential cardiovascular benefits of limiting ultra-processed foods.
RESULTS During follow-up (1991 to 2014/2017), the authors identified 251, 163, and 648 cases of incident hard CVD, hard CHD, and overall CVD, respectively. On average, participants consumed 7.5 servings per day of ultra-processed foods at baseline. Each additional daily serving of ultra-processed foods was associated with a 7% (95% confidence interval [CI]: 1.03 to 1.12), 9% (95% CI: 1.04 to 1.15), 5% (95% CI: 1.02 to 1.08), and 9% (95% CI: 1.02 to 1.16) increase in BACKGROUND Ultra-processed foods provide 58% of total energy in the U.S. diet, yet their association with cardiovascular disease (CVD) remains understudied. OBJECTIVES The authors investigated the associations between ultra-processed foods and CVD incidence and mortality in the prospective Framingham Offspring Cohort. METHODS The analytical sample included 3,003 adults free from CVD with valid dietary data at baseline. Data on diet, measured by food frequency questionnaire, anthropometric measures, and sociodemographic and lifestyle factors were collected quadrennially from 1991 to 2008. Data regarding CVD incidence and mortality were available until 2014 and 2017, respectively. Ultra-processed foods were defined according to the NOVA framework. The authors used Cox proportional hazards models to determine the multivariable association between ultra-processed food intake (energy adjusted servings per day) and incident hard CVD, hard coronary heart disease (CHD), overall CVD, and CVD mortality. Multivariable models were adjusted for age, sex, education, alcohol consumption, smoking, and physical activity. RESULTS During follow-up (1991 to 2014/2017), the authors identified 251, 163, and 648 cases of incident hard CVD, hard CHD, and overall CVD, respectively. On average, participants consumed 7.5 servings per day of ultra-processed foods at baseline. Each additional daily serving of ultra-processed foods was associated with a 7% (95% confidence interval [CI]: 1.03 to 1.12), 9% (95% CI: 1.04 to 1.15), 5% (95% CI: 1.02 to 1.08), and 9% (95% CI: 1.02 to 1.16) increase in the risk of hard CVD, hard CHD, overall CVD, and CVD mortality, respectively. CONCLUSIONS The current findings support that higher consumption of ultra-processed foods is associated with increased risk of CVD incidence and mortality. Although additional research in ethnically diverse populations is warranted, these findings suggest cardiovascular benefits of limiting ultra-processed foods.

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