Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy.
Mediterranea Cardiocentro, Naples, Italy.
Am J Clin Nutr. 2021 Feb 2;113(2):446-455. doi: 10.1093/ajcn/nqaa299.
Consumption of ultra-processed food (UPF) is gaining growing attention in relation to disease/mortality risk, but less is known on the main nutritional factors or biological mechanisms potentially underlying such associations.
We aimed to assess the association between UPF and mortality risk in a large sample of the Italian adult population and test which nutritional factors were on the pathway of this relation. Established risk factors for cardiovascular disease (CVD) were analyzed as potential biological mechanisms linking UPF to mortality.
Longitudinal analysis was conducted on 22,475 men and women (mean ± SD age: 55 ± 12 y) recruited in the Moli-sani Study (2005-2010, Italy) and followed for 8.2 y. Food intake was assessed using a semiquantitative FFQ. UPF was defined using the NOVA classification according to degree of processing, and UPF intakes were categorized as quartiles of the ratio (%) of UPF (g/d) to total food consumed (g/d).
Individuals reporting the highest intake of UPF (Q4, >14.6% of total food), as opposed to the lowest (Q1, UPF < 6.6%), experienced increased risks of CVD mortality (HR: 1.58; 95% CI: 1.23, 2.03), death from ischemic heart disease (IHD)/cerebrovascular disease (HR: 1.52; 95% CI: 1.10, 2.09), and all-cause mortality (HR: 1.26; 95% CI: 1.09, 1.46). High sugar content explained 36.3% of the relation of UPF with IHD/cerebrovascular mortality, whereas other nutritional factors (e.g., saturated fats) were unlikely to be on the pathway. Biomarkers of renal function accounted for 20.1% of the association of UPF with all-cause mortality, and 12.0% for that of UPF with CVD mortality.
A high proportion of UPF in the diet was associated with increased risk of CVD and all-cause mortality, partly through its high dietary content of sugar. Some established biomarkers of CVD risk were likely to be on the pathway of such associations. These findings should serve as an incentive for limiting consumption of UPF, and encouraging natural or minimally processed foods, as several national nutritional policies recommend.
超加工食品（UPF）的消费与疾病/死亡率风险的关系日益受到关注，但对于潜在关联的主要营养因素或生物学机制知之甚少。
我们旨在评估意大利成年人群体中大量样本中 UPF 与死亡率风险之间的关联，并检验该关联的路径中的营养因素。心血管疾病（CVD）的既定危险因素被分析为将 UPF 与死亡率联系起来的潜在生物学机制。
对 22475 名男性和女性（平均年龄±标准差：55±12 岁）进行纵向分析，这些人于 2005-2010 年在莫利萨尼研究（意大利）中招募，并随访 8.2 年。采用半定量 FFQ 评估食物摄入量。根据加工程度，使用 NOVA 分类法定义 UPF，将 UPF 摄入量分为 UPF （g/d）与总食物摄入量（g/d）的比例（%）的四分位数（Q）。
与 UPF 摄入量最低（Q1，UPF<6.6%）的人相比，报告 UPF 摄入量最高（Q4，>14.6%的总食物）的个体患 CVD 死亡率（HR：1.58；95%CI：1.23，2.03）、缺血性心脏病（IHD）/脑血管疾病（HR：1.52；95%CI：1.10，2.09）和全因死亡率（HR：1.26；95%CI：1.09，1.46）的风险增加。高糖含量解释了 UPF 与 IHD/脑血管病死亡率之间关系的 36.3%，而其他营养因素（例如饱和脂肪）不太可能是该关系的途径。肾功能生物标志物解释了 UPF 与全因死亡率之间关联的 20.1%，解释了 UPF 与 CVD 死亡率之间关联的 12.0%。
饮食中 UPF 比例较高与 CVD 和全因死亡率风险增加有关，部分原因是其高糖含量。一些既定的 CVD 风险生物标志物可能是这些关联的途径。这些发现应该鼓励限制 UPF 的消费，并鼓励天然或最低限度加工的食物，因为一些国家的营养政策建议这样做。
