Abstract 49: Consumption of Ultra-processed Foods and Beverages is Associated With Increased Risk of Cardiovascular Mortality in the Moli-sani Study Cohort

Abstract

Introduction: Consumption of ultra-processed food and beverages (UPFB) is gaining growing attention due to its possible relation with increased risk of disease/mortality. To date, the possibility of such an association was only addressed in two European and one US population-based cohorts. Hypothesis: We assessed the hypothesis of a positive association between UPFB consumption and mortality risk in a large sample of the Italian population and tested whether some known cardiovascular disease (CVD) risk factors and nutrients could be on the pathway of this relation. We also separately analyzed UPFB presumed to be healthy ( e.g. , breakfast cereals, fruit juices) from nutrient-poor foods ( e.g., cakes, snacks). Methods: Longitudinal analysis on 22,810 men and women (mean age 55±12 y) recruited in the Moli-sani Study cohort between 2005-2010. Food intake was assessed using a semi-quantitative 188-item food frequency questionnaire. UPFB intake was defined by the NOVA classification according to degree of food processing and then categorized as number of servings/d. Hazard ratios with 95% confidence intervals (95% CI) were calculated using multivariable Cox-proportional hazard models. Results: Over a median follow up of 8.3 y, 1,235 deaths were ascertained. As opposed to lower intake (<2 servings/d), individuals reporting high intake of UPFB (>4 servings/d) experienced an increased risk of CVD mortality (HR=1.50; 95%CI 1.18-1.92) and of death for ischemic heart (IHD)/cerebrovascular disease (1.56; 1.13-2.14). An upward trend was found for all-cause mortality too (1.15; 1.00-1.34). Biomarkers of renal function (cystatin C and creatinine) or of lipid metabolisms were likely to be on the pathway between UPFB and CVD mortality. Among selected macronutrients, high content of sugar and saturated fats possibly drove the relation of UPFB with CVD mortality. High intake of ‘healthy’ UPFB was associated with an increased trend of risk comparable to that associated with ‘unhealthy’ UPFB. Conclusions: In a large Mediterranean cohort of Italian adults, high consumption of UPFB was associated with increased risk of CVD death and IHD/cerebrovascular mortality. This association was partly explained by established CVD risk factors and a high dietary content of sugar and saturated fats. UPFB presumed to be healthy appeared similarly linked to higher death risk. National dietary guidelines might consider discourage excessive consumption of ultra-processed food while recommending natural or minimally processed foods.