1. In this large prospective cohort study done in France, higher consumption of ultraprocessed food was linked with higher mortality.
2. Ultraprocessed food consumption was also linked with male gender, lower income, lower education level, higher BMI, and lower physical activity level. However, the association with higher all-cause mortality remained after correcting for these factors.
Evidence Rating Level: 2 (Good)
Study Rundown: Ultraprocessed foods are typically ready-to-eat or heat-to-eat food products with multiple ingredients requiring industrial processes and additives for preparation. High consumption of these products has already been linked in the existing literature with dyslipidemia, obesity, hypertension, and cancer. In this large, prospective cohort study conducted in France between 2009 and 2017 involving almost 45 000 patients, higher intake of ultraprocessed foods was associated with elevated all-cause mortality. Although ultraprocessed food consumption was associated with male gender, lower income, lower education level, higher BMI, and lower physical activity level, the above effect on all-cause mortality was sustained even after correcting for these and other demographic variables.
The large sample size, robust statistical analysis and follow up time (median 7.1 years) were strengths of this study. Although a randomized trial would be helpful, it is unlikely to ever be done for this clinical question. This study supports more detailed nutritional history taking as well as counselling for patients, as well as population based health strategies to reduce intake of ultraprocessed foods.
In-Depth [prospective cohort]: This was an observational prospective cohort study of adults 45 years or older in France, with patients recruited between May 2009 and December 2017 (median follow up 7.1 years). Total sample size was 44,551 (73.1% female, mean age 56.7). Participants were selected from the NutriNet-Santé Study and completed at least one of three possible 24-hour dietary records online every six months. Additional questionnaires were collected to obtain information regarding sociodemographic data, anthropometrics, physical activity, and health status. The 24-hour dietary records were validated through comparison interviews with dieticians. Foods were classified using the NOVA food classification system which categorizes foods into four groups based on nature, extent, and purpose of processing. This study focused on the most highly processed group (Group 1 foods). Primary outcome was all-cause mortality. Variable of interest was proportion in weight (%) of Group 1 foods. Cox proportional hazard regression models were used to compare Group 1 foods and overall mortality, with multiple models. The most restrictive of these models adjusted for known or potential risk factors or confounding factors including gender, income, education level, marital status, residence type, BMI, smoking status, alcohol intake, physical activity, energy intake, and family history of cancer/cardiovascular disease. Higher intake of Group 1 foods was associated with younger age, lower income, lower education level, living alone, lower physical activity, and higher BMI. There were 602 deaths during follow up (1.4% of sample size). Using Model 3, the hazard ratio for all-cause mortality per 10% increment in Group 1 food intake by weight was 1.14 (95% CI 1.04-.27, p=0.008). A sensitivity analysis adjusting for cardiovascular disease, type 2 diabetes, hypertension, dyslipidemia, and prevalent cancers did not significantly affect the results.
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