Article Text
Abstract
Background Global dietary patterns have significantly shifted towards an increased consumption of ultra-processed foods (UPFs), which tend to have a poorer nutritional profile, and include a variey of non-food substances such as emulsifiers and artificial flavours. This trend raises concerns due to the potential impact of UPFs on cardiometabolic diseases, however, large scale prospective studies tracking UPF consumption at multiple time points remain limited. This study investigates the prospective association between UPF consumption and the risk of cronoary heart disease (CHD) and its secondary endpoints. It also examins nutrient profiles and consumption trend from 1991 to 2002 among midlife adults in the United Kingdom.
Methods Midlife adults from Whitehall II were prospectively followed from 1991 to 2013. The intake of UPFs was assessed through self-reported Food frequency questionnaires (FFQ), which captured 127 food items consumed. These were categorized according to the degree of processing by the NOVA classification, and their contribution to the overall food intake by weight was estimated. UPFs were measured during three phases: 1991/1994 (phase 3), 1997/1999 (phase 5), and 2002/2004 (phase 7). The incidence of CHD and its secondary endpoints, such as total angina and myocardial infarction, were evaluated from 1991/1993 to 2015/2016 via medical examinations and review of hospital records. Cox proportional hazards regression models were employed to evaluate the prospective association between UPF consumption (in quintiles) at each of phase 3, 5 and 7, with CHD outcomes, adjusting for socio-demographics, total energy intake and lifestyle factors.
Results 5494 participants (mean age,50.0±6.1) were included.Higher consumption of UPF was associated with higher intake of sugar, fat, and sodium. In multivariable cox models, at phase 3, the highest [33.1%±6.6 total food intake in grams/day] versus lowest [mean 9.6%±2.3] quintile of UPF intake was associated with higher CHD incidence [HR:1.30; 95% Confidence Interval (CI): 1.01-1.72; p=0.04]. At phase 7 (2002/2004), the highest [40.0% ± 7.6] versus lowest [mean 9.3%±2.9] quintile of UPF intake was associated with higher CHD incidence [HR:1.50; 95% CI: 1.10-2.24; p=0.047]. No significant associations were found at phase 5 (1997/1999) UPF intake across quintiles and any incident of CHD or secondary endpoints.
Conclusion In UK midlife adults, higher UPF intake tended to be prospectively associated with increased CHD risk. Acknowledging sample size and NOVA classification limitations, further research is needed for validation and exploring additional factors. These findings may support minimizing UPFs within a healthy diet and highlight the need for public awareness and policy interventions targeting UPF consumption.