Ruth Blanco-Rojo1, Helena Sandoval-Insausti2, Esther López-Garcia3, Auxiliadora Graciani4, Jose M Ordovás5, Jose R Banegas4, Fernando Rodríguez-Artalejo3, Pilar Guallar-Castillón6. 1. Instituto Madrileño De Estudios Avanzados-alimentacion-Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid + Centro Superior de Investigaciones Científicas, Madrid, Spain. 2. Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Centro de Investigación Biomedica en Red of Epidemiology and Public Health, Madrid, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA. 3. Instituto Madrileño De Estudios Avanzados-alimentacion-Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid + Centro Superior de Investigaciones Científicas, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Centro de Investigación Biomedica en Red of Epidemiology and Public Health, Madrid, Spain. 4. Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Centro de Investigación Biomedica en Red of Epidemiology and Public Health, Madrid, Spain. 5. Instituto Madrileño De Estudios Avanzados-alimentacion-Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid + Centro Superior de Investigaciones Científicas, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA. 6. Instituto Madrileño De Estudios Avanzados-alimentacion-Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid + Centro Superior de Investigaciones Científicas, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Centro de Investigación Biomedica en Red of Epidemiology and Public Health, Madrid, Spain; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD. Electronic address: mpilar.guallar@uam.es.
Abstract
OBJECTIVE: To assess the prospective association between ultra-processed food consumption and all-cause mortality and to examine the effect of theoretical iso-caloric 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 iso-caloric 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 iso-caloric 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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01133093.
OBJECTIVE: To assess the prospective association between ultra-processed food consumption and all-cause mortality and to examine the effect of theoretical iso-caloric 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 iso-caloric 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 iso-caloric 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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01133093.
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