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

26 Pages Posted: 30 Sep 2018

See all articles by Anaïs Rico-Campà

Anaïs Rico-Campà

University of Navarra - Department of Preventive Medicine and Public Health

Miguel A. Martínez-González

University of Navarra - Department of Preventive Medicine and Public Health; Carlos III Institute of Health - Center for Biomedical Research in Network-Physiopathology of Obesity and Nutrition (CIBEROBN); IdiSNA, Navarra Institute for Health Research; Harvard University - T.H. Chan School of Public Health

Ismael Alvarez-Alvarez

University of Navarra - Department of Preventive Medicine and Public Health

Raquel de Deus Mendonça

University of Navarra - Department of Preventive Medicine and Public Health; Federal University of Minas Gerais (UFMG) - School of Nursing

Carmen de la Fuente-Arrillaga

University of Navarra - Department of Preventive Medicine and Public Health; Carlos III Institute of Health - Center for Biomedical Research in Network-Physiopathology of Obesity and Nutrition (CIBEROBN); IdiSNA, Navarra Institute for Health Research

Clara Gómez-Donoso

University of Navarra - Department of Preventive Medicine and Public Health

Maira Bes-Rastrollo

University of Navarra - Department of Preventive Medicine and Public Health; Carlos III Institute of Health - Center for Biomedical Research in Network-Physiopathology of Obesity and Nutrition (CIBEROBN); IdiSNA, Navarra Institute for Health Research

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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 Navarra" (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.   

Suggested Citation

Rico-Campà, Anaïs and Martínez-González, Miguel A. and Alvarez-Alvarez, Ismael and de Deus Mendonça, Raquel and de la Fuente-Arrillaga, Carmen and Gómez-Donoso, Clara and Bes-Rastrollo, Maira, Ultra-Processed Food Consumption and All-Cause Mortality: The University of Navarra Follow-Up (SUN) Cohort (September 14, 2018). Available at SSRN: https://ssrn.com/abstract=3250931

Anaïs Rico-Campà

University of Navarra - Department of Preventive Medicine and Public Health

c/ Irunlarrea, 1
Pamplona, 31008
Spain

Miguel A. Martínez-González

University of Navarra - Department of Preventive Medicine and Public Health

c/ Irunlarrea, 1
Pamplona, 31008
Spain

Carlos III Institute of Health - Center for Biomedical Research in Network-Physiopathology of Obesity and Nutrition (CIBEROBN)

C/ Monforte de Lemos 3-5
Pabellón 11. Planta 0
Madrid, 28029
Spain

IdiSNA, Navarra Institute for Health Research

C/Irunlarrea, 3
Pamplona, 31008
Spain

Harvard University - T.H. Chan School of Public Health

677 Huntington Avenue
Boston, MA MA 02115
United States

Ismael Alvarez-Alvarez

University of Navarra - Department of Preventive Medicine and Public Health

c/ Irunlarrea, 1
Pamplona, 31008
Spain

Raquel De Deus Mendonça

University of Navarra - Department of Preventive Medicine and Public Health

c/ Irunlarrea, 1
Pamplona, 31008
Spain

Federal University of Minas Gerais (UFMG) - School of Nursing

Av. Alfredo Balena, 190 - Sala 120
Belo Horizonte
Brazil

Carmen De la Fuente-Arrillaga

University of Navarra - Department of Preventive Medicine and Public Health

c/ Irunlarrea, 1
Pamplona, 31008
Spain

Carlos III Institute of Health - Center for Biomedical Research in Network-Physiopathology of Obesity and Nutrition (CIBEROBN)

C/ Monforte de Lemos 3-5
Pabellón 11. Planta 0
Madrid, 28029
Spain

IdiSNA, Navarra Institute for Health Research

C/Irunlarrea, 3
Pamplona, 31008
Spain

Clara Gómez-Donoso

University of Navarra - Department of Preventive Medicine and Public Health

c/ Irunlarrea, 1
Pamplona, 31008
Spain

Maira Bes-Rastrollo (Contact Author)

University of Navarra - Department of Preventive Medicine and Public Health ( email )

c/ Irunlarrea, 1
Pamplona, 31008
Spain

Carlos III Institute of Health - Center for Biomedical Research in Network-Physiopathology of Obesity and Nutrition (CIBEROBN) ( email )

C/ Monforte de Lemos 3-5
Pabellón 11. Planta 0
Madrid, 28029
Spain

IdiSNA, Navarra Institute for Health Research ( email )

C/Irunlarrea, 3
Pamplona, 31008
Spain

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