Bonaccio Marialaura, Costanzo Simona, Di Castelnuovo Augusto, Persichillo Mariarosaria, Magnacca Sara, De Curtis Amalia, Cerletti Chiara, Donati Maria Benedetta, de Gaetano Giovanni, Iacoviello Licia
Department of Epidemiology and Prevention, IRCCS NEUROMED, Via dell'Elettronica, 86077 Pozzilli, IS, Italy.
Mediterranea Cardiocentro, Via Orazio, Napoli 80122, Italy.
Eur Heart J. 2022 Jan 25;43(3):213-224. doi: 10.1093/eurheartj/ehab783.
To evaluate the association of ultra-processed food (UPF) intake and mortality among individuals with history of cardiovascular disease (CVD) and analyse some biological pathways possibly relating UPF intake to death.
Longitudinal analysis on 1171 men and women (mean age: 67 ± 10 years) with history of CVD, recruited in the Moli-sani Study (2005-10, Italy) and followed for 10.6 years (median). Food intake was assessed using a food frequency questionnaire. UPF was defined using the NOVA classification according to degree of processing and categorized as quartiles of the ratio (%) between UPF (g/day) and total food consumed (g/day). The mediating effects of 18 inflammatory, metabolic, cardiovascular, and renal biomarkers were evaluated using a logistic regression model within a counterfactual framework. In multivariable-adjusted Cox analyses, higher intake of UPF (Q4, ≥11.3% of total food), as opposed to the lowest (Q1, UPF <4.7%), was associated with higher hazards of all-cause (hazard ratio [HR]: 1.38; 95% confidence interval (CI): 1.00-1.91) and CVD mortality (HR: 1.65; 95% CI: 1.07-2.55). A linear dose-response relationship of 1% increment in UPF intake with all-cause and CVD mortality was also observed. Altered levels of cystatin C explained 18.3% and 16.6% of the relation between UPF (1% increment in the diet) with all-cause and CVD mortality, respectively.
A diet rich in UPF is associated with increased hazards of all-cause and CVD mortality among individuals with prior cardiovascular events, possibly through an altered renal function. Elevated UPF intake represents a major public health concern in secondary CVD prevention.
评估心血管疾病（CVD）病史个体的超加工食品（UPF）摄入量与死亡率之间的关联，并分析一些可能将UPF摄入量与死亡联系起来的生物学途径。
对莫利萨尼研究（2005 - 2010年，意大利）中招募的1171名有CVD病史的男性和女性（平均年龄：67±10岁）进行纵向分析，随访10.6年（中位数）。使用食物频率问卷评估食物摄入量。根据加工程度，UPF采用NOVA分类法定义，并按UPF（克/天）与总食物摄入量（克/天）之比（%）的四分位数进行分类。在反事实框架内，使用逻辑回归模型评估18种炎症、代谢、心血管和肾脏生物标志物的中介作用。在多变量调整的Cox分析中，与最低摄入量（Q1，UPF<4.7%）相比，较高的UPF摄入量（Q4，≥总食物的11.3%）与全因死亡（风险比[HR]：1.38；95%置信区间[CI]：1.00 - 1.91）和CVD死亡（HR：1.65；95%CI：1.07 - 2.55）的较高风险相关。还观察到UPF摄入量每增加1%与全因和CVD死亡率呈线性剂量反应关系。胱抑素C水平的改变分别解释了UPF（饮食中增加1%）与全因和CVD死亡率之间关系的18.3%和16.6%。
富含UPF的饮食与既往有心血管事件的个体全因和CVD死亡风险增加相关，可能是通过改变肾功能。UPF摄入量升高是二级CVD预防中的一个主要公共卫生问题。
