Association Between Ultra-processed Food Consumption and Mortality Among US Adults: Prospective Cohort Study of the National Health and Nutrition Examination Survey, 2003-2018 - 19/06/25
Abstract |
Background |
Intake of ultra-processed foods (UPF) provides more than half of the daily energy US adults consume. Still, the prospective association of UPF consumption with mortality in the general US population remains understudied.
Objective |
To investigate the prospective association of UPF consumption with mortality in a nationally representative sample of US adults.
Design |
A prospective cohort analysis was conducted by linking baseline measurement from the National Health and Nutrition Examination Survey with mortality information from the National Death Index. The percentage of total energy consumed from UPF, defined by the Nova classification system, was computed based on dietary data collected using 24-hour diet recalls.
Participants/setting |
This study included 38 148 nationally representative US adults aged 20 years and older who participated in National Health and Nutrition Examination Survey between 2003-2004 and 2017-2018 and provided dietary intake data, with linkage to mortality data.
Main outcome measures |
Information on all-cause and cause-specific mortality was obtained from linkage to the National Death Index through December 31, 2019.
Statistical analysis performed |
Cox proportional hazard models estimated the multivariable-adjusted hazard ratios and 95% CIs for the association between UPF intake and mortality.
Results |
During a median follow-up of 8.0 years, 4611 deaths were confirmed, including 2064 deaths from cardiometabolic disorders and 1046 deaths from cancer. After multivariable adjustments, each 10-point increment in usual percentage of total energy from UPF was associated with a 9% higher risk of all-cause mortality (hazard ratio 1.09, 95% CI 1.04 to 1.14). The association remained significant after adjusting for the overall diet quality measured by the Health Eating Index 2015 (hazard ratio 1.06, 95% CI 1.00 to 1.11; P < .05). Among subgroups, sugar-sweetened beverages, ready-to-eat or -heat mixed dishes, ultra-processed dairy products, and ultra-processed oil/fat, condiments, and sauces were associated with an increased risk of all-cause or cause-specific mortality. Ultra-processed vegetables and legumes were associated with a reduced risk.
Conclusions |
In this nationally representative study of US adults, higher consumption of UPF was associated with a higher risk of all-cause mortality, and this association was not fully explained by overall diet quality.
Le texte complet de cet article est disponible en PDF.Keywords : Ultra-processed foods, Food processing, Mortality, Cancer, Cardiovascular disease
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| Supplementary materials: Table 3, Table 4, Table 5, Table 6 through Table 7 and Figure 1 are available at www.jandonline.org |
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| STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors. |
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| FUNDING/SUPPORT This study was supported by grant R01MD011501 from the National Institutes of Health (awarded to F. F. Zhang) and Processo grant 2018/17972-9 from the São Paulo Research Foundation (awarded to E. Martínez Steele). L. Wang was supported by American Diabetes Association’s Pathway to Stop Diabetes Award (1-24-INI-04). |
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| The National Institutes of Health and the São Paulo Research Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. |
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| AUTHOR CONTRIBUTIONS L. Wang, and F. F. Zhang conceived and designed the study. L. Wang did the statistical analysis and wrote the first draft of the manuscript. L. Wang and E. Martínez Steele acquired the data. All the authors critically revised the manuscript for important intellectual content and approved the final version. F. F. Zhang obtained funding and supervised the study. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. |
Vol 125 - N° 7
P. 875 - juillet 2025 Retour au numéro
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