Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche Epidémiologie et Statistique, Sorbonne Paris Cité, Bobigny, France.
Département de Santé Publique, Hôpital Avicenne (AP-HP), Bobigny, France.
JAMA Intern Med. 2019 Apr 1;179(4):490-498. doi: 10.1001/jamainternmed.2018.7289.
Growing evidence indicates that higher intake of ultraprocessed foods is associated with higher incidence of noncommunicable diseases. However, to date, the association between ultraprocessed foods consumption and mortality risk has never been investigated.
To assess the association between ultraprocessed foods consumption and all-cause mortality risk.
DESIGN, SETTING, AND PARTICIPANTS: This observational prospective cohort study selected adults, 45 years or older, from the French NutriNet-Santé Study, an ongoing cohort study that launched on May 11, 2009, and performed a follow-up through December 15, 2017 (a median of 7.1 years). Participants were selected if they completed at least 1 set of 3 web-based 24-hour dietary records during their first 2 years of follow-up. Self-reported data were collected at baseline, including sociodemographic, lifestyle, physical activity, weight and height, and anthropometrics.
The ultraprocessed foods group (from the NOVA food classification system), characterized as ready-to-eat or -heat formulations made mostly from ingredients usually combined with additives. Proportion (in weight) of ultraprocessed foods in the diet was computed for each participant.
The association between proportion of ultraprocessed foods and overall mortality was the main outcome. Mean dietary intakes from all of the 24-hour dietary records available during the first 2 years of follow-up were calculated and considered as the baseline usual food-and-drink intakes. Mortality was assessed using CépiDC, the French national registry of specific mortality causes. Hazard ratios (HRs) and 95% CIs were determined for all-cause mortality, using multivariable Cox proportional hazards regression models, with age as the underlying time metric.
A total of 44 551 participants were included, of whom 32 549 (73.1%) were women, with a mean (SD) age at baseline of 56.7 (7.5) years. Ultraprocessed foods accounted for a mean (SD) proportion of 14.4% (7.6%) of the weight of total food consumed, corresponding to a mean (SD) proportion of 29.1% (10.9%) of total energy intake. Ultraprocessed foods consumption was associated with younger age (45-64 years, mean [SE] proportion of food in weight, 14.50% [0.04%]; P < .001), lower income (<€1200/mo, 15.58% [0.11%]; P < .001), lower educational level (no diploma or primary school, 15.50% [0.16%]; P < .001), living alone (15.02% [0.07%]; P < .001), higher body mass index (calculated as weight in kilograms divided by height in meters squared; ≥30, 15.98% [0.11%]; P < .001), and lower physical activity level (15.56% [0.08%]; P < .001). A total of 602 deaths (1.4%) occurred during follow-up. After adjustment for a range of confounding factors, an increase in the proportion of ultraprocessed foods consumed was associated with a higher risk of all-cause mortality (HR per 10% increment, 1.14; 95% CI, 1.04-1.27; P = .008).
An increase in ultraprocessed foods consumption appears to be associated with an overall higher mortality risk among this adult population; further prospective studies are needed to confirm these findings and to disentangle the various mechanisms by which ultraprocessed foods may affect health.
越来越多的证据表明，超加工食品的摄入量较高与非传染性疾病的发病率较高有关。然而，迄今为止，超加工食品消费与死亡率风险之间的关联从未被研究过。
评估超加工食品消费与全因死亡率风险之间的关系。
设计、地点和参与者：这项观察性前瞻性队列研究从法国 NutriNet-Santé 研究中选择了成年人，年龄在 45 岁及以上，该研究于 2009 年 5 月 11 日启动，至 2017 年 12 月 15 日进行了随访（中位随访时间为 7.1 年）。如果参与者在头 2 年的随访中至少完成了 1 套 3 次基于网络的 24 小时饮食记录，则选择他们参加。基线时收集了包括社会人口统计学、生活方式、身体活动、体重和身高以及人体测量学在内的自我报告数据。
超加工食品组（来自 NOVA 食品分类系统），特征是由通常与添加剂混合的成分制成的即食或即热配方。为每个参与者计算了饮食中超加工食品的比例（重量）。
主要结果是超加工食品比例与总死亡率之间的关系。在头 2 年的随访期间，使用所有 24 小时饮食记录计算了平均饮食摄入量，并将其视为基线常规食物和饮料摄入量。使用 CépiDC（法国特定死因登记处）评估死亡率。使用多变量 Cox 比例风险回归模型，以年龄为基础时间指标，确定全因死亡率的风险比（HR）和 95%置信区间。
共纳入 44551 名参与者，其中 32549 名（73.1%）为女性，基线时的平均（SD）年龄为 56.7（7.5）岁。超加工食品占所消耗食物总重量的平均（SD）比例为 14.4%（7.6%），占总能量摄入的平均（SD）比例为 29.1%（10.9%）。超加工食品的消费与较年轻的年龄（45-64 岁，食物重量的平均比例为 14.50%[0.04%]；P < .001）、较低的收入（<€1200/月，15.58%[0.11%]；P < .001）、较低的教育水平（无文凭或小学，15.50%[0.16%]；P < .001）、独居（15.02%[0.07%]；P < .001）、更高的体重指数（体重以千克为单位除以身高以米为单位的平方；≥30，15.98%[0.11%]；P < .001）和较低的身体活动水平（15.56%[0.08%]；P < .001）相关。随访期间共发生 602 例死亡（1.4%）。在调整了一系列混杂因素后，超加工食品消费比例的增加与全因死亡率的风险增加相关（每增加 10%的 HR，1.14；95%CI，1.04-1.27；P = .008）。
在该成年人群中，超加工食品消费的增加似乎与总体死亡率风险升高有关；需要进一步的前瞻性研究来证实这些发现，并阐明超加工食品可能影响健康的各种机制。
