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Open Access 26-12-2023 | Hypertension | Original Contribution

Ultra-processed foods and incident cardiovascular disease and hypertension in middle-aged women

Authors: Anushriya Pant, Sarah Gribbin, Priscila Machado, Allison Hodge, Jason H. Wasfy, Lisa Moran, Simone Marschner, Clara K. Chow, Sarah Zaman

Published in: European Journal of Nutrition | Issue 3/2024

Abstract

Purpose

Ultra-processed food (UPF) intake has increased in recent decades, yet limited knowledge of long-term effects on cardiovascular health persists and sex-specific data is scant. We determined the association of UPF intake with incident cardiovascular disease (CVD) and/or hypertension in a population-based cohort of women.

Methods

In the Australian Longitudinal Study on Women’s Health, women aged 50–55 years were prospectively followed (2001–2016). UPFs were identified using NOVA classification and contribution of these foods to total dietary intake by weight was estimated. Primary endpoint was incident CVD (self-reported heart disease/stroke). Secondary endpoints were self-reported hypertension, all-cause mortality, type 2 diabetes mellitus, and/or obesity. Logistic regression models assessed associations between UPF intake and incident CVD, adjusting for socio-demographic, medical comorbidities, and dietary variables.

Results

We included 10,006 women (mean age 52.5 ± 1.5; mean UPF intake 26.6 ± 10.2% of total dietary intake), with 1038 (10.8%) incident CVD, 471 (4.7%) deaths, and 4204 (43.8%) hypertension cases over 15 years of follow-up. In multivariable-adjusted models, the highest [mean 42.0% total dietary intake] versus the lowest [mean 14.2% total dietary intake] quintile of UPF intake was associated with higher incident hypertension [odds ratio (OR) 1.39, 95% confidence interval (CI) 1.10–1.74; p = 0.005] with a linear trend (p_trend = 0.02), but not incident CVD [OR 1.22, 95% CI 0.92–1.61; p = 0.16] or all-cause mortality (OR 0.80, 95% CI 0.54–1.20; p = 0.28). Similar results were found after multiple imputations for missing values.

Conclusion

In women, higher UPF intake was associated with increased hypertension, but not incident CVD. These findings may support minimising UPFs within a healthy diet for women.

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Vogel B, Acevedo M, Appelman Y, Bairey Merz CN, Chieffo A, Figtree GA, Guerrero M, Kunadian V, Lam CSP, Maas AHEM, Mihailidou AS, Olszanecka A, Poole JE, Saldarriaga C, Saw J, Zühlke L, Mehran R (2021) The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. The Lancet 397(10292):2385–2438. https://doi.org/10.1016/S0140-6736(21)00684-XCrossRef

Zhou B, Perel P, Mensah GA, Ezzati M (2021) Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol 18(11):785–802. https://doi.org/10.1038/s41569-021-00559-8CrossRefPubMedPubMedCentral

Monteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada ML, Rauber F, Khandpur N, Cediel G, Neri D, Martinez-Steele E, Baraldi LG, Jaime PC (2019) Ultra-processed foods: what they are and how to identify them. Public Health Nutr 22(5):936–941. https://doi.org/10.1017/s1368980018003762CrossRefPubMedPubMedCentral

Steele EM, Batis C, Cediel G, Louzada M, Khandpur N, Machado P, Moubarac JC, Rauber F, Jedlicki MR, Levy RB, Monteiro CA (2021) The burden of excessive saturated fatty acid intake attributed to ultra-processed food consumption: a study conducted with nationally representative cross-sectional studies from eight countries. J Nutr Sci 10:e43. https://doi.org/10.1017/jns.2021.30CrossRefPubMedPubMedCentral

Machado PP, Steele EM, Levy RB, Sui Z, Rangan A, Woods J, Gill T, Scrinis G, Monteiro CA (2019) Ultra-processed foods and recommended intake levels of nutrients linked to non-communicable diseases in Australia: evidence from a nationally representative cross-sectional study. BMJ Open 9(8):e029544. https://doi.org/10.1136/bmjopen-2019-029544CrossRefPubMedPubMedCentral

Martini D, Godos J, Bonaccio M, Vitaglione P, Grosso G (2021) Ultra-Processed Foods and Nutritional Dietary Profile: A Meta-Analysis of Nationally Representative Samples. Nutrients. https://doi.org/10.3390/nu13103390CrossRefPubMedPubMedCentral

Juul F, Vaidean G, Parekh N (2021) Ultra-processed foods and cardiovascular diseases: potential mechanisms of action. Adv Nutr 12(5):1673–1680. https://doi.org/10.1093/advances/nmab049CrossRefPubMedPubMedCentral

Srour B, Fezeu LK, Kesse-Guyot E, Allès B, Debras C, Druesne-Pecollo N, Chazelas E, Deschasaux M, Hercberg S, Galan P, Monteiro CA, Julia C, Touvier M (2020) Ultraprocessed food consumption and risk of type 2 diabetes among participants of the NutriNet-Santé Prospective Cohort. JAMA Intern Med 180(2):283–291. https://doi.org/10.1001/jamainternmed.2019.5942CrossRefPubMed

Shim SY, Kim HC, Shim JS (2022) Consumption of ultra-processed food and blood pressure in Korean adults. Korean Circ J 52(1):60–70. https://doi.org/10.4070/kcj.2021.0228CrossRefPubMed

10.

Juul F, Martinez-Steele E, Parekh N, Monteiro CA, Chang VW (2018) Ultra-processed food consumption and excess weight among US adults. Br J Nutr 120(1):90–100. https://doi.org/10.1017/s0007114518001046CrossRefPubMed

11.

Chen X, Chu J, Hu W, Sun N, He Q, Liu S, Feng Z, Li T, Han Q, Shen Y (2022) Associations of ultra-processed food consumption with cardiovascular disease and all-cause mortality: UK Biobank. Eur J Pub Health 32(5):779–785. https://doi.org/10.1093/eurpub/ckac104CrossRef

12.

Juul F, Vaidean G, Lin Y, Deierlein AL, Parekh N (2021) Ultra-processed foods and incident cardiovascular disease in the Framingham offspring study. J Am Coll Cardiol 77(12):1520–1531. https://doi.org/10.1016/j.jacc.2021.01.047CrossRefPubMed

13.

Du S, Kim H, Rebholz CM (2021) Higher ultra-processed food consumption is associated with increased risk of incident coronary artery disease in the atherosclerosis risk in communities study. J Nutr 151(12):3746–3754. https://doi.org/10.1093/jn/nxab285CrossRefPubMedPubMedCentral

14.

Li H, Li S, Yang H, Zhang Y, Ma Y, Hou Y, Zhang X, Sun L, Borné Y, Wang Y (2023) Association of ultra-processed food intake with cardiovascular and respiratory disease multimorbidity: a prospective cohort study. Mol Nutr Food Res 67(11):2200628. https://doi.org/10.1002/mnfr.202200628CrossRef

15.

Srour B, Kordahi MC, Bonazzi E, Deschasaux-Tanguy M, Touvier M, Chassaing B (2022) Ultra-processed foods and human health: from epidemiological evidence to mechanistic insights. Lancet Gastroenterol Hepatol 7(12):1128–1140. https://doi.org/10.1016/S2468-1253(22)00169-8CrossRefPubMed

16.

Suksatan W, Moradi S, Naeini F, Bagheri R, Mohammadi H, Talebi S, Mehrabani S, Hojjati Kermani MA, Suzuki K (2021) Ultra-processed food consumption and adult mortality risk: a systematic review and dose-response meta-analysis of 207,291 participants. Nutrients. https://doi.org/10.3390/nu14010174CrossRefPubMedPubMedCentral

17.

Srour B, Fezeu LK, Kesse-Guyot E, Allès B, Méjean C, Andrianasolo RM, Chazelas E, Deschasaux M, Hercberg S, Galan P, Monteiro CA, Julia C, Touvier M (2019) Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé). BMJ 365:l1451. https://doi.org/10.1136/bmj.l1451CrossRefPubMedPubMedCentral

18.

Rico-Campà A, Martínez-González MA, Alvarez-Alvarez I, Mendonça RdD, de la Fuente-Arrillaga C, Gómez-Donoso C, Bes-Rastrollo M (2019) Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ 365:l1949. https://doi.org/10.1136/bmj.l1949CrossRefPubMedPubMedCentral

19.

Romero Ferreiro C, Martín-Arriscado Arroba C, Cancelas Navia P, Lora Pablos D, Gómez de la Cámara A (2022) Ultra-processed food intake and all-cause mortality: DRECE cohort study. Public Health Nutr 25(7):1854–1863. https://doi.org/10.1017/S1368980021003256CrossRef

20.

Kityo A, Lee S-A (2023) The intake of ultra-processed foods, all-cause, cancer and cardiovascular mortality in the Korean Genome and Epidemiology Study-Health Examinees (KoGES-HEXA) cohort. PLoS ONE 18(5):e0285314. https://doi.org/10.1371/journal.pone.0285314CrossRefPubMedPubMedCentral

21.

Pant A, Gribbin S, McIntyre D, Trivedi R, Marschner S, Laranjo L, Mamas MA, Flood V, Chow CK, Zaman S (2023) Primary prevention of cardiovascular disease in women with a Mediterranean diet: systematic review and meta-analysis. Heart. https://doi.org/10.1136/heartjnl-2022-321930CrossRefPubMed

22.

Gribbin S, Enticott J, Hodge AM, Moran L, Thong E, Joham A, Zaman S (2022) Association of carbohydrate and saturated fat intake with cardiovascular disease and mortality in Australian women. Heart 108(12):932–939. https://doi.org/10.1136/heartjnl-2021-319654CrossRefPubMed

23.

Brown WJ, Bryson L, Byles JE, Dobson AJ, Lee C, Mishra G, Schofield M (1998) Women’s Health Australia: recruitment for a national longitudinal cohort study. Women Health 28(1):23–40. https://doi.org/10.1300/j013v28n01_03CrossRefPubMed

24.

Banna JC, McCrory MA, Fialkowski MK, Boushey C (2017) Examining plausibility of self-reported energy intake data: considerations for method selection. Front Nutr. https://doi.org/10.3389/fnut.2017.00045CrossRefPubMedPubMedCentral

25.

Ireland P, Jolley D, Giles G, O’Dea K, Powles J, Rutishauser I, Wahlqvist ML, Williams J (1994) Development of the Melbourne FFQ: a food frequency questionnaire for use in an Australian prospective study involving an ethnically diverse cohort. Asia Pac J Clin Nutr 3(1):19–31PubMed

26.

Hodge A, Patterson AJ, Brown WJ, Ireland P, Giles G (2000) The Anti Cancer Council of Victoria FFQ: relative validity of nutrient intakes compared with weighed food records in young to middle-aged women in a study of iron supplementation. Aust N Z J Public Health 24(6):576–583. https://doi.org/10.1111/j.1467-842x.2000.tb00520.xCrossRefPubMed

27.

Lane MM, Lotfaliany M, Hodge AM, O’Neil A, Travica N, Jacka FN, Rocks T, Machado P, Forbes M, Ashtree DN, Marx W (2023) High ultra-processed food consumption is associated with elevated psychological distress as an indicator of depression in adults from the Melbourne Collaborative Cohort Study. J Affect Disord 335:57–66. https://doi.org/10.1016/j.jad.2023.04.124CrossRefPubMed

28.

Foster-Powell K, Holt SH, Brand-Miller JC (2002) International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr 76(1):5–56. https://doi.org/10.1093/ajcn/76.1.5CrossRefPubMed

29.

Australian Institute of Health Welfare (2022) Overweight and obesity. AIHW. https://www.aihw.gov.au/reports/australias-health/overweight-and-obesity

30.

Brown WJ, Pavey T (2016) Physical activity in mid-age and older women: lessons from the Australian longitudinal study on women’s health. Kinesiol Rev 5(1):87–97. https://doi.org/10.1123/kr.2015-0057CrossRef

31.

Brown WJ, Bauman A, Bull F, Burton NW (2013) Development of evidence-based physical activity recommendations for adults (18–64 years). Report prepared for the Australian Government Department of Health. Australian Department of Health, Canberra, Australia

32.

Wang M, Du X, Huang W, Xu Y (2022) Ultra-processed foods consumption increases the risk of hypertension in adults: a systematic review and meta-analysis. Am J Hypertens 35(10):892–901. https://doi.org/10.1093/ajh/hpac069CrossRefPubMed

33.

Scaranni P, Cardoso LO, Chor D, Melo ECP, Matos SMA, Giatti L, Barreto SM, da Fonseca MJM (2021) Ultra-processed foods, changes in blood pressure and incidence of hypertension: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Public Health Nutr 24(11):3352–3360. https://doi.org/10.1017/s136898002100094xCrossRefPubMedPubMedCentral

34.

Mendonça RdD, Lopes ACS, Pimenta AM, Gea A, Martinez-Gonzalez MA, Bes-Rastrollo M (2016) Ultra-processed food consumption and the incidence of hypertension in a mediterranean cohort: the Seguimiento Universidad de Navarra Project. Am J Hypertens 30(4):358–366. https://doi.org/10.1093/ajh/hpw137CrossRef

35.

Gu Q, Burt VL, Paulose-Ram R, Dillon CF (2008) Gender differences in hypertension treatment, drug utilization patterns, and blood pressure control among US adults with hypertension: data from the National Health and Nutrition Examination Survey 1999–2004. Am J Hypertens 21(7):789–798. https://doi.org/10.1038/ajh.2008.185CrossRefPubMed

36.

Blanco-Rojo R, Sandoval-Insausti H, López-Garcia E, Graciani A, Ordovás JM, Banegas JR, Rodríguez-Artalejo F, Guallar-Castillón P (2019) Consumption of ultra-processed foods and mortality: a national prospective cohort in Spain. Mayo Clin Proc 94(11):2178–2188. https://doi.org/10.1016/j.mayocp.2019.03.035CrossRefPubMed

37.

Schnabel L, Kesse-Guyot E, Allès B, Touvier M, Srour B, Hercberg S, Buscail C, Julia C (2019) Association between ultraprocessed food consumption and risk of mortality among middle-aged adults in France. JAMA Intern Med 179(4):490–498. https://doi.org/10.1001/jamainternmed.2018.7289CrossRefPubMedPubMedCentral

38.

Yuan L, Hu H, Li T, Zhang J, Feng Y, Yang X, Li Y, Wu Y, Li X, Huang H, Hu F, Chen C, Zhang M, Zhao Y, Hu D (2023) Dose–response meta-analysis of ultra-processed food with the risk of cardiovascular events and all-cause mortality: evidence from prospective cohort studies. Food Funct 14(6):2586–2596. https://doi.org/10.1039/D2FO02628GCrossRefPubMed

39.

Mendonça RdD, Pimenta AM, Gea A, de la Fuente-Arrillaga C, Martinez-Gonzalez MA, Lopes ACS, Bes-Rastrollo M (2016) Ultraprocessed food consumption and risk of overweight and obesity: the University of Navarra Follow-Up (SUN) cohort study. Am J Clin Nutr 104(5):1433–1440. https://doi.org/10.3945/ajcn.116.135004CrossRefPubMed

40.

Canhada SL, Luft VC, Giatti L, Duncan BB, Chor D, Fonseca M, Matos SMA, Molina M, Barreto SM, Levy RB, Schmidt MI (2020) Ultra-processed foods, incident overweight and obesity, and longitudinal changes in weight and waist circumference: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Public Health Nutr 23(6):1076–1086. https://doi.org/10.1017/s1368980019002854CrossRefPubMed

41.

Levy RB, Rauber F, Chang K, Louzada MLdC, Monteiro CA, Millett C, Vamos EP (2021) Ultra-processed food consumption and type 2 diabetes incidence: a prospective cohort study. Clin Nutr 40(5):3608–3614. https://doi.org/10.1016/j.clnu.2020.12.018CrossRefPubMed

42.

Llavero-Valero M, Escalada-San Martín J, Martínez-González MA, Basterra-Gortari FJ, de la Fuente-Arrillaga C, Bes-Rastrollo M (2021) Ultra-processed foods and type-2 diabetes risk in the SUN project: a prospective cohort study. Clin Nutr 40(5):2817–2824. https://doi.org/10.1016/j.clnu.2021.03.039CrossRefPubMed

43.

Delpino FM, Figueiredo LM, Bielemann RM, da Silva BGC, dos Santos FS, Mintem GC, Flores TR, Arcêncio RA, Nunes BP (2021) Ultra-processed food and risk of type 2 diabetes: a systematic review and meta-analysis of longitudinal studies. Int J Epidemiol 51(4):1120–1141. https://doi.org/10.1093/ije/dyab247CrossRef

44.

Moradi S, Entezari MH, Mohammadi H, Jayedi A, Lazaridi A-V, MaH K, Miraghajani M (2022) Ultra-processed food consumption and adult obesity risk: a systematic review and dose-response meta-analysis. Crit Rev Food Sci Nutr 63(2):249–260. https://doi.org/10.1080/10408398.2021.1946005CrossRef

45.

Albrektsen G, Heuch I, Løchen M-L, Thelle DS, Wilsgaard T, Njølstad I, Bønaa KH (2016) Lifelong gender gap in risk of incident myocardial infarction: the Tromsø study. JAMA Intern Med 176(11):1673–1679. https://doi.org/10.1001/jamainternmed.2016.5451CrossRef

46.

Baraldi LG, Martinez Steele E, Canella DS, Monteiro CA (2018) Consumption of ultra-processed foods and associated sociodemographic factors in the USA between 2007 and 2012: evidence from a nationally representative cross-sectional study. BMJ Open 8(3):e020574. https://doi.org/10.1136/bmjopen-2017-020574CrossRefPubMedCentral

47.

Braesco V, Souchon I, Sauvant P, Haurogné T, Maillot M, Féart C, Darmon N (2022) Reprint of: ultra-processed foods: how functional is the NOVA system? Cahiers de Nutrition et de Diététique 57(3):210–221. https://doi.org/10.1038/s41430-022-01099-1CrossRef

48.

Costa Louzada ML, Martins AP, Canella DS, Baraldi LG, Levy RB, Claro RM, Moubarac JC, Cannon G, Monteiro CA (2015) Ultra-processed foods and the nutritional dietary profile in Brazil. Rev Saude Publica 49:38. https://doi.org/10.1590/s0034-8910.2015049006132CrossRefPubMed

49.

He FJ, Tan M, Ma Y, MacGregor GA (2020) Salt reduction to prevent hypertension and cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol 75(6):632–647. https://doi.org/10.1016/j.jacc.2019.11.055CrossRefPubMed

50.

Zinöcker MK, Lindseth IA (2018) The western diet-microbiome-host interaction and its role in metabolic disease. Nutrients. https://doi.org/10.3390/nu10030365CrossRefPubMedPubMedCentral

51.

Boulangé CL, Neves AL, Chilloux J, Nicholson JK, Dumas ME (2016) Impact of the gut microbiota on inflammation, obesity, and metabolic disease. Genome Med 8(1):42. https://doi.org/10.1186/s13073-016-0303-2CrossRefPubMedPubMedCentral

52.

Rauber F, Campagnolo PD, Hoffman DJ, Vitolo MR (2015) Consumption of ultra-processed food products and its effects on children’s lipid profiles: a longitudinal study. Nutr Metab Cardiovasc Dis 25(1):116–122. https://doi.org/10.1016/j.numecd.2014.08.001CrossRefPubMed

53.

National Agency for Health Safety F, Environment and Work (ANSES), Données de Consommations et Habitudes Alimentaires de L’étude Inca 3. https://www.data.gouv.fr/fr/datasets/donnees-de-consommations-et-habitudes-alimentaires-de-letude-inca-3/. Accessed 22 Sep 2023

54.

Magalhães V, Severo M, Correia D, Torres D, Costa de Miranda R, Rauber F, Levy R, Rodrigues S, Lopes C (2021) Associated factors to the consumption of ultra-processed foods and its relation with dietary sources in Portugal. J Nutr Sci 10:e89. https://doi.org/10.1017/jns.2021.61CrossRefPubMedPubMedCentral

55.

Martínez Steele E, Baraldi LG, Louzada ML, Moubarac JC, Mozaffarian D, Monteiro CA (2016) Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open 6(3):e009892. https://doi.org/10.1136/bmjopen-2015-009892CrossRefPubMedPubMedCentral

56.

Adams J, White M (2015) Characterisation of UK diets according to degree of food processing and associations with socio-demographics and obesity: cross-sectional analysis of UK National Diet and Nutrition Survey (2008–12). Int J Behav Nutr Phys Act 12:160. https://doi.org/10.1186/s12966-015-0317-yCrossRefPubMedPubMedCentral

Title: Ultra-processed foods and incident cardiovascular disease and hypertension in middle-aged women
Authors: Anushriya Pant
Sarah Gribbin
Priscila Machado
Allison Hodge
Jason H. Wasfy
Lisa Moran
Simone Marschner
Clara K. Chow
Sarah Zaman
Publication date: 26-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Hypertension
Hypertension
Published in: European Journal of Nutrition / Issue 3/2024
Print ISSN: 1436-6207
Electronic ISSN: 1436-6215
DOI: https://doi.org/10.1007/s00394-023-03297-4

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