Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study
Keywords: 
Ultra-processed foods
Consumption
Cause mortality
NOVA classification
Issue Date: 
2019
Publisher: 
BMJ
ISSN: 
0959-8138
Note: 
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/ by-nc/4.0/.
Citation: 
Rico-Campà, A. (Anais); Martinez-Gonzalez, M. A. (Miguel Ángel); Álvarez-Álvarez, I. (Ismael); et al. "Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study". BMJ. 365, 2019, l1949
Abstract
OBJECTIVE To evaluate the association between consumption of ultra-processed foods and all cause mortality. DESIGN Prospective cohort study. SETTING Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018. PARTICIPANTS 19899 participants (12113 women and 7786 men) aged 20-91 years followed-up every two years between December 1999 and February 2014 for food and drink consumption, classified according to the degree of processing by the NOVA classification, and evaluated through a validated 136 item food frequency questionnaire. MAIN OUTCOME MEASURE Association between consumption of energy adjusted ultra-processed foods categorised into quarters (low, low-medium, medium-high, and high consumption) and all cause mortality, using multivariable Cox proportional hazard models. RESULTS 335 deaths occurred during 200432 persons years of follow-up. Participants in the highest quarter (high consumption) of ultra-processed foods consumption had a higher hazard for all cause mortality compared with those in the lowest quarter (multivariable adjusted hazard ratio 1.62, 95% confidence interval 1.13 to 2.33) with a significant dose-response relation (P for linear trend=0.005). For each additional serving of ultra-processed foods, all cause mortality relatively increased by 18% (adjusted hazard ratio 1.18, 95% confidence interval 1.05 to 1.33). CONCLUSIONS A higher consumption of ultra-processed foods (>4 servings daily) was independently associated with a 62% relatively increased hazard for all cause mortality. For each additional serving of ultraprocessed food, all cause mortality increased by 18%.

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