Abstract P191: Changes in Ultra-Processed Food Intake During the Transition to Adulthood Are Associated With Blood Pressure in Early Adulthood Among a Filipino Birth Cohort

Abstract

Ultra-processed food (UPF) intake in adulthood is positively associated with risk of high blood pressure (BP), but little is known about the implications of UPF intake in adolescence on later BP. The objective of this study was to estimate the association between the change in UPF intake during the transition from adolescence to adulthood and BP in early adulthood. We hypothesized a positive association. Data were from the 2002, 2005, 2009, and 2018 waves of the Cebu Longitudinal Health and Nutrition Survey, a birth cohort established in 1983 in metropolitan Cebu, Philippines. Participants in the analysis sample were approximately 18 (n=2,012), 21 (n=1,853), 25 (n=1,680), and 35 (n=1,305) years old at the time of the surveys. Foods and beverages from two 24-hour recalls collected at ages 18 and 21 were classified according to NOVA. UPF intake was estimated as the percentage of daily kilocalories (kcals) from UPFs. The outcomes, systolic and diastolic BP (SBP and DBP) at ages 21, 25, and 35, were estimated as the average of three measures collected each wave. The exposure was change in UPF intake from age 18 to 21, modeled as a three-level categorical variable: 1) “decreasing” if the absolute change was <-2.5% of daily kcals, 2) “no change” if the absolute change was ≥-2.5% and ≤2.5%, and 3) “increasing” if the absolute change was >2.5%. We used multivariable linear regression models to estimate associations of SBP and DBP at ages 21, 25, and 35 with the change in UPF intake from age 18 to 21, adjusting for physical activity, smoking status, household wealth, urbanicity, UPF intake, and BP at age 18. We stratified all analyses by sex. Mean UPF intake at ages 18 and 21, respectively, was 15% and 16% of daily kcals among females and 11% and 10% among males. Mean SBP rose from 99 mmHg at age 18 to 110 mmHg at age 35 among females and from 106 to 121 mmHg among males. Compared to females with no change in UPF intake from age 18 to 21, females with decreasing UPF intake had, on average, SBP that was 2.9 mmHg lower (95% CI: -5.1, -0.7) at age 25 and DBP that was 2.6 mmHg lower (95% CI: -4.4, -0.6) at age 21 and 2.5 mmHg lower (95% CI: -4.4, -0.6) at age 25. There were no differences at age 35. For males, compared to those with no change in UPF intake from age 18 to 21, those with decreasing UPF intake had SBP and DBP that were, on average, 3.4 mmHg lower (95% CI: -6.4, -0.3) and 2.8 mmHg lower (95% CI: -5.3, -0.2) at age 35, though there were no differences earlier in adulthood. We did not observe differences in BP comparing participants with increasing UPF intake versus no change, except among females at age 25, when, contrary to our hypothesis, SBP and DBP were lower among females with increasing intake. In conclusion, we observed lower BP in early adulthood among participants with decreasing UPF intake during the transition to adulthood. Efforts to prevent hypertension in low- and middle-income countries should aim to reduce UPF intake during this transitional period.