Title : The intake of ultra-processed foods, all-cause, cancer and cardiovascular mortality in the health examinees (HEXA) cohort
Abstract:
The relationship between ultra-processed food (UPF) intake and mortality is unknown despite the rise in the intake of UPF in Asian countries. This study examined the association of UPF intake with all-cause, cancer and cardiovascular disease (CVD) mortality.
Methods: Participants were 113,576 adults who responded to a 106-item food frequency questionnaire at recruitment of the 2004-2013 Health Examinees (HEXA) study, a prospective cohort study in Korea. UPF were defined using the NOVA classification and evaluated as quartiles of the proportion of UPF in the diet (% total food weight). Multivariable cox-regression and restricted cubic spline models were used to examine the association of UPF intake with all-cause and cause specific mortality.
Findings: 3456 deaths were recorded during a median follow-up of 10.6 (interquartile range, 9.5-11.9) years. There was no evidence of association of total UPF intake with all-cause, cancer or CVD mortality comparing the highest with the lowest quartiles of UPF intake (all-cause mortality, men: hazard ratio [HR] 1.08, 95% confidence interval [CI] 0.95-1.22; women: HR 0.95, 95% CI 0.81-1.11; cancer mortality, men: HR 1.02, 95% confidence interval [CI] 0.84-1.22; women: HR 1.02, 95% CI 0.83-1.26; CVD mortality, men: HR 0.88, 95% CI 0.64-1.22; women: HR 0.80, 95% CI 0.53-1.19). However, the risk of all-cause mortality increased in both men and women with high consumption of ultra-processed red meat and fish (men, HR 1.26, 95% CI 1.11-1.43); women, HR 1.22 95% CI 1.05-1.43); and in men with high consumption of ultra-processed milk (HR 1.13, 95% CI 1.01-1.26); and soymilk drink (HR 1.12, 95% CI 1.00-1.25).
Conclusion: We found no evidence of association between total UPF intake with all-cause, cancer and CVD mortality, but ultra-processed red meat and fish in both sexes, and milk and soymilk drinks in men were positively associated with all-cause mortality.
Audience Take Away:
Consumption of whole or minimally processed foods in place of ultra-processed meat, milk and soy beverages may be of interest to the Korean population-but further evidence is required to substantiate this claim. Faculty members should form consortia of cohorts from Asian countries, and conduct pooled analyses on the impact of UPF consumption on multiple health outcomes to solve the limitations of low UPF intake and fewer cases in individual cohorts. The findings of this study further raise the question of why total UPF intake is not associated with mortality in Korea-inconsistent with existing literature from
