期刊
AMERICAN JOURNAL OF CLINICAL NUTRITION
卷 113, 期 2, 页码 446-455出版社
OXFORD UNIV PRESS
DOI: 10.1093/ajcn/nqaa299
关键词
ultra-processed food; mortality; cardiovascular mortality; cerebrovascular mortality; sugar; cardiovascular disease risk factors
资金
- Italian Ministry of Health [GR-201302356060]
- HYPERCAN Study Italian Association for Cancer Research (AIRC) grant AIRC 5xMILLE [12237]
- POR FESR 2014-2020 [459 27/11/2018]
- European Commission Seventh Framework Programme FP7/2007-2013 grant [HEALTH-F2-2011-278913]
- Pfizer Foundation (Rome, Italy)
- Italian Ministry of University and Research (MIUR, Rome, Italy)-Programma Triennale di Ricerca [1588]
- Instrumentation Laboratory, Milan, Italy
- AIRC 5xMILLE (HYPERCAN Study) [12237]
- Italian Ministry of Health (PI GdG, CoPI SC) [RF-2018-12367074]
- Fondazione Umberto Veronesi Fellowship
- Fondazione Umberto Veronesi travel grant
Consumption of a high proportion of ultra-processed food (UPF) in the diet is associated with increased risk of cardiovascular disease (CVD) and all-cause mortality, partly due to its high dietary content of sugar. Additionally, some established biomarkers of CVD risk are likely to be involved in linking UPF consumption to mortality.
Background: Consumption of ultra-processed food (UPF) is gaining growing attention in relation to disease/mortality risk, but less is known on the main nutritional factors or biological mechanisms potentially underlying such associations. Objectives: We aimed to assess the association between UPF and mortality risk in a large sample of the Italian adult population and test which nutritional factors were on the pathway of this relation. Established risk factors for cardiovascular disease (CVD) were analyzed as potential biological mechanisms linking UPF to mortality. Methods: Longitudinal analysis was conducted on 22,475 men and women (mean +/- SD age: 55 +/- 12 y) recruited in the Moli-sani Study (2005-2010, Italy) and followed for 8.2 y. Food intake was assessed using a semiquantitative FFQ. UPF was defined using the NOVA classification according to degree of processing, and UPF intakes were categorized as quartiles of the ratio (%) of UPF (g/d) to total food consumed (g/d). Results: Individuals reporting the highest intake of UPF (Q4, >14.6% of total food), as opposed to the lowest (Q1, UPF < 6.6%), experienced increased risks of CVD mortality (HR: 1.58; 95% CI: 1.23, 2.03), death from ischemic heart disease (IHD)/cerebrovascular disease (HR: 152; 95% CI: 1.10, 2.09), and all-cause mortality (HR: 1.26; 95% CI: 1.09, 1.46). High sugar content explained 36.3% of the relation of UPF with IHD/cerebrovascular mortality, whereas other nutritional factors (e.g.. saturated fats) were unlikely to be on the pathway. Biomarkers of renal function accounted for 20.1% of the association of UPF with all-cause mortality, and 12.0% for that of UPF with CVD mortality. Conclusions: A high proportion of UPF in the diet was associated with increased risk of CVD and all-cause mortality, partly through its high dietary content of sugar. Some established biomarkers of CVD risk were likely to be on the pathway of such associations. These findings should serve as an incentive for limiting consumption of UPF, and encouraging natural or minimally processed foods, as several national nutritional policies recommend.
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