Ultra-Processed Food Consumption and All-Cause Mortality: The University of Navarra Follow-Up (SUN) Cohort

Abstract

Background: Ultra-processed foods (UPFs) consumption has increased in the past decade. Because of its nutritional composition, evidence suggests a potential association between UPFs consumption and higher risk of all-cause mortality. No prospective study has investigated this relationship. Methods: We evaluated the association between UPFs consumption and the risk of mortality in a dynamic, prospective Spanish cohort of university graduates, the Seguimiento Universidad de (SUN) study. We used data from 19,897 participants followed-up between December 1999 and February 2014 for a median of 10·4 years with a retention rate of 90·9%. UPFs consumption (defined as food and drink products ready to eat, drink, or heat and made predominantly or entirely from processed items extracted or refined from whole foods or synthesized in the laboratory) was assessed with the use of a validated semi-quantitative 136-item foodfrequency questionnaire (FFQ). We adjusted UPFs consumption for energy intake using the residuals method. Participants were classified according to their energy-adjusted UPFs consumption into quartiles. Cox proportional hazards models were used to estimate adjusted Hazards Ratio (HR) and 95% confidence intervals (CI) for all-cause mortality. Findings: We registered 335 deaths in 198,556 persons-years of follow-up. Participants in the highest quartile of UPFs consumption had a higher risk for all-cause mortality compared to those in the first quartile (multivariable-adjusted HR=1·62; 95% CI: 1·13-2·32) with a significant dose-response trend (p for linear trend=0·005). For each additional serving of UPFs consumption, mortality relatively increased by 9% (HR=1·09; 95% CI: 1·02-1·17). Interpretation: UPFs consumption was associated with an increased risk for all-cause mortality in a prospective cohort of Spanish middle-aged adult university graduates. Further longitudinal studies are needed to confirm our results. Funding Statement: The SUN Project has been supported by the Spanish Government-Instituto de Salud Carlos III, and the European Regional Development Fund (FEDER) (RD 06/0045, PI14/01798, PI14/01764, PI17/01795), the Navarra Regional Government, and the University of Navarra. Declaration of Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Ethics Approval Statement: The Institutional Review Board (IRB) of the University of Navarra approved the protocol and the methods used to obtain consent of participants, conforming to the principles embodied in the Declaration of Helsinki. The SUN project was registered at clinicaltrials.gov as NCT02669602.