Abstract

Introduction: Ultra-processed food defined as food and drink products formulated through sequences of industrial processes, and generally contain non-culinary used additives. Previous studies have linked higher ultra-processed food intake with several cardiometabolic and cardiovascular diseases. However, longitudinal evidence from US populations remains scarce. Hypothesis: We hypothesized that higher intake of ultra-processed food is associated with higher risk of coronary heart disease (CHD). Methods: We selected 12,607 adults aged 44-66 years in 4 US communities from the ARIC study at baseline. Dietary intake data were collected through a validated 66-item food frequency questionnaire. Ultra-processed foods were defined using the NOVA classification and the level of intake was calculated for each participant. We conducted Cox proportional hazards models to study the association between quartiles of ultra-processed food intake and incident CHD. Nonlinearity was assessed by using restricted cubic spline regression. Results: There were 1,899 incident CHD cases documented after an median follow up of 27 years (291,285.2 person-years). Incidence rates were higher in the highest quartile of ultra-processed food intake (71.6 per 10,000 person-years; 95% CI, 65.8-78.0) compared to the lowest quartile (59.7 per 10,000 person-years; 95% CI, 54.3-65.7). Participants in the highest vs. lowest quartile were associated with a 18% higher risk of CHD (Hazard ratio 1.18 [95% CI, 1.04 - 1.34]; P-trend = 0.010) after adjusting for sociodemographic factors and health behaviors. An approximately linear relationship was observed between ultra-processed food intake and risk of CHD after 4 servings/day ( Figure ). Conclusion: In conclusion, higher ultra-processed food intake was associated with a higher risk of coronary heart disease among middle-aged US adults. Further prospective studies are needed to confirm these findings and to investigate the mechanisms by which ultra-processed food may affect health.

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