Exposure to ultra-processed food and risk of cardiovascular mortality: a prospective cohort study

Abstract

AIMS: There has been a global shift from nutrient-dense diets to an ultra-processed food pattern, which is linked to adverse health outcomes, including cardiovascular mortality. However, there is limited evidence in an Australian setting. Furthermore, many people in Australia have emigrated from countries with heart-healthy diets. This study explored the association between ultra-processed food exposure and cardiovascular mortality in an Australian cohort. METHODS AND RESULTS: Data were derived from the Melbourne Collaborative Cohort Study. Food frequency questionnaire data collected at baseline were used to estimate ultra-processed food exposure according to the Nova classification system. Cardiovascular deaths were identified using data linkage between baseline (1990-94) and 31 March 2019. Fine and Gray competing risk models were fitted to assess the association between energy-adjusted ultra-processed food exposure and cardiovascular mortality, accounting for other types of mortality as competing risks. We included 39 544 participants (mean age 55.1 years at baseline, 60% female). During the follow-up period, which spanned 919 379 person-years and a median follow-up of 25.1 years, 4229 cardiovascular deaths occurred. After adjusting for sociodemographic, lifestyle, and health-related factors, participants with the highest relative intake of ultra-processed food had 19% higher risk of cardiovascular mortality (hazard ratiohigh (quartile 4) vs. low (quartile 1) category = 1.19, 95% confidence intervals: 1.09-1.29, P-value for trend < 0.001). CONCLUSION: Aligning with findings from the USA and Europe, higher exposure to the ultra-processed food pattern was prospectively associated with a higher risk of cardiovascular mortality.

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