Ultraprocessed foods linked to risk for heart disease, stroke
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Key takeaways:
- High intake of ultraprocessed foods was linked with CVD, CHD and stroke risk.
- The link was significantly mediated when processed meats and sugar-sweetened drinks were omitted from the analysis.
High consumption of ultraprocessed food, especially processed meats and sugar-sweetened beverages, was associated with elevated risk for heart disease and stroke, researchers reported.
For the present study, consisting of participants from three large, predominantly white U.S. cohorts, ultraprocessed foods were defined as foods with ingredients to extend palatability, profitability and shelf-life and/or foods containing stabilizers, colorants, flavor enhancers, emulsifiers or sweeteners.
“In the United States, [ultraprocessed foods] represent 57.0% of the adult population’s energy intake ... [Ultraprocessed foods] encompass a heterogeneous group of products ranging from mass-produced whole-grain vitamin-fortified breads, to nutritionally devoid soft beverages associated with higher CVD,” Kenny Mendoza, MS, PhD candidate in nutritional epidemiology and a master’s student in biostatistics in the nutrition department at the Harvard T.H. Chan School of Public Health, and colleagues wrote. “To provide further evidence, we estimated the association of total and group-specific [ultraprocessed food] intakes with CVD, coronary heart disease (CHD) and stroke in three large prospective cohorts of U.S. adults. We also conducted a systematic review and meta-analysis to update the evidence of associations of total [ultraprocessed food] intake with these outcomes.”
The study was published in The Lancet Regional Health – Americas.
Ultra-processed foods and CV risk in three large cohorts
The three large prospective U.S. cohorts included 75,735 participants from the Nurses’ Health Study (mean age, 51 years; 97% white), 90,813 participants from the Nurses’ Health Study II (mean age, 37 years; 96% white) and 40,409 participants from the Health Professionals Follow-Up Study (mean age, 53.4 years; 95% white).
Cox regression models were used to determine risk for CVD, CHD — nonfatal MI and fatal CHD — and nonfatal and fatal ischemic and hemorrhagic stroke associated with quintiles of total ultraprocessed food intake and food type. Diet was assessed using validated food frequency questionnaires.
Based on the Alternative Healthy Eating Index, the lowest quintile of energy proportion from total ultraprocessed foods calorie intake was defined as 0.01% to 25.8% and the highest quintile was defined as 42.7% to 94.4%.
Over a median follow-up of 32 years, participants in the highest quintile of ultraprocessed foods intake experienced an approximately 11% greater risk for CVD, 16% greater risk for CHD and 4% greater risk for stroke compared with the lowest quintile (HR for CVD = 1.11; 95% CI, 1.06-1.16; HR = 1.16; 95% CI, 1.09-1.24; HR for stroke = 1.04; 95% CI, 0.96-1.12)
Removal of sugar-sweetened beverages and processed meats from the analysis significantly attenuated risk for CVD and CHD and was associated with an 8% risk reduction for stroke.
In addition, higher intake of bread and cereals was associated with lower risk for stroke and cold cereals were associated with lower risk for CVD and CHD. Increased intake of refined bread was only associated with lower stroke risk and increased hard liquor intake — whiskey, vodka, brandy or rum — was associated with lower risk for CHD, according to the study.
Ultra-processed food and CVD meta-analysis
The researchers then used Medline and Embase databases to conduct a meta-analysis of 22 prospective multinational studies that evaluated the association between ultraprocessed foods and CVD risk. Across studies, ultraprocessed food intake was measured as either servings per day, diet weight percentage or percentage energy contribution.
In the pooled analysis, individuals with the highest ultraprocessed food intake was associated with a 17% greater CVD risk, 23% greater CHD risk and 9% greater stroke risk compared with those with the lowest intake.
However, the researchers reported reduced quality of evidence from their meta-analysis due to short follow-up duration, insufficient studies on ultraprocessed food and stroke risk, between-study heterogeneity of 40% or more and small measures of association.
“Data from three U.S. cohorts and the existing evidence suggest an adverse role of the consumption of total [ultraprocessed food] as part of a dietary pattern in the risk of CVD, CHD and stroke,” the researchers wrote. “Deconstructing the [ultraprocessed food] classification provided more evidence to support the notion that the role of both food processing and nutritional quality in cardiovascular health shall be considered for individual [ultraprocessed food] groups.
“Specifically, our findings suggest soft drinks and processed meats should be discouraged, given their consistent adverse association with CVD CHD, and stroke,” they wrote. “Reducing the content of sodium, saturated fats, added sugars, and cosmetic additives non-essential for human health in whole-grain bread, cold cereals and some savory snacks may enhance the otherwise nutritional value of these products in the U.S.”
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