Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Am J Clin Nutr. 2024 Sep;120(3):499-506. doi: 10.1016/j.ajcnut.2024.07.002. Epub 2024 Jul 4.
Majority of dietary intake in United States adults comes from ultraprocessed foods (UPFs), which have been linked to several adverse health outcomes. Gallstone disease is highly prevalent and constitutes a significant burden to the United States health system but remains understudied.
This study aimed to investigate the association between UPF consumption and incident gallstone disease risk.
In this analysis, 44,149 males in the Health Professionals' Follow-up Study (HPFS: 1986-2022), 71,145 females in the Nurses' Health Study (NHS: 1986-2021), and 90,932 females in the NHS II (1991-2021) were prospectively followed. Dietary intake was quadrennially assessed with semiquantitative food frequency questionnaires and used to identify UPFs. The primary outcome was defined as cholecystectomy. Cox proportional hazards model was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).
Baseline median age was 54 y in HPFS, 53 y in NHS, and 36 y in NHS II. We identified 32,374 incident gallstone disease cases over 5,077,059 person-years. Participants in the highest UPF quintile had a higher incidence of gallstone disease than those in the lowest quintile (aHR: 1.29; 95% CI: 1.24, 1.36; P < 0.001). Incremental risk of incident gallstone disease was 2.8% per daily serving (95% CI: 2.4%, 3.2%; P < 0.001). This risk was driven by sugar-sweetened beverages and artificially sweetened beverages on UPF subgroup analyses. The proportion of risk mediated by obesity was 12.8% (95% CI: 7.7%, 20.5%; P < 0.001) in HPFS, 14.3% (95% CI: 10.4%, 19.4%; P < 0.001) in NHS, and 39.4% (95% CI: 31.2%, 48.1%; P < 0.001) in NHS II. The partial population attributable risk was estimated at 15.9% (95% CI: 13.4%, 18.3%).
UPF consumption is associated with a higher risk of gallstone disease, particularly consumption of sugar-sweetened beverages and artificially sweetened beverages. A substantial proportion of this risk is potentially mediated by obesity in younger females.
美国成年人的大部分饮食摄入都来自超加工食品（UPF），这些食品与多种不良健康后果有关。胆结石疾病的发病率很高，对美国的医疗系统构成了重大负担，但仍研究不足。
本研究旨在调查 UPF 摄入与胆结石疾病发病风险之间的关联。
在这项分析中，44149 名男性参加了健康专业人员随访研究（HPFS：1986-2022 年），71145 名女性参加了护士健康研究（NHS：1986-2021 年），90932 名女性参加了 NHS II（1991-2021 年），进行前瞻性随访。通过半定量食物频率问卷每四年评估一次饮食摄入情况，并用于识别 UPF。主要结局定义为胆囊切除术。使用 Cox 比例风险模型估计调整后的危险比（aHR）和 95%置信区间（CI）。
HPFS 中的基线中位年龄为 54 岁，NHS 为 53 岁，NHS II 为 36 岁。在 5077059 人年中，我们共发现 32374 例胆结石疾病新发病例。与最低五分位组相比，处于 UPF 五分位最高组的参与者发生胆结石疾病的风险更高（aHR：1.29；95%CI：1.24，1.36；P<0.001）。每增加一份 UPF，发生胆结石疾病的风险增加 2.8%（95%CI：2.4%，3.2%；P<0.001）。在 UPF 亚组分析中，这种风险是由含糖饮料和人工甜味饮料驱动的。在 HPFS 中，肥胖介导的风险比例为 12.8%（95%CI：7.7%，20.5%；P<0.001），在 NHS 中为 14.3%（95%CI：10.4%，19.4%；P<0.001），在 NHS II 中为 39.4%（95%CI：31.2%，48.1%；P<0.001）。肥胖介导的风险部分估计为 15.9%（95%CI：13.4%，18.3%）。
UPF 的摄入与胆结石疾病的风险增加相关，特别是含糖饮料和人工甜味饮料的摄入。这种风险的很大一部分可能是由年轻女性的肥胖所介导的。
