Total and subgroups consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases.

It was shown in the European Prospective Investigation into Cancer and Nutrition (EPIC) study that higher consumption of Ultra-Processed Foods (UPF) was associated with an increased risk of cancer and cardiometabolic multimorbidity. Furthermore, the relationships were different according to the subgroups of UPFs suggesting that various types of UPFs contribute differently to the risk of developing a first non-communicable disease and multimorbidity.

Aims of the study:

The objectives of the study were to investigate the relationships between total and subgroup intake of Ultra Processed Foods (UPFs) and the risk of multimorbidity defines as the co-occurrence of at least 2 chronic diseases in an individual among cancer at any site, cardiovascular diseases, and type 2 diabetes.

Study population and methods:

The authors investigated data related to seven (Denmark, Germany, Italy, Spain, Sweden, the Netherlands, and the United Kingdom) of the 10 European countries participating to the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Usual food intake in the previous 12 months was assessed at baseline using country specific food frequency questionnaire. Every 3-4 years following the enrolment, participants were contacted to obtain data on any major diseases.

To evaluate the ultra-processed food intake, the authors used the Nova food classification. Indeed, Nova classifies each food into one of the four following groups :

• The group 1) gathers unprocessed or minimally processed foods such as fresh, dry or frozen fruit or vegetables;
• The group 2 gathers processed culinary ingredients such as oils, fats; table sugar, salt.
• The group3) gathers processed foods such as cheese, simple breads, fruits in syrup;
• The group 4) gathers ultra-processed foods such as soft drinks, sweet or savoury packaged snacks, etc….

The authors only focused on the Nova group 4 of ultra-processed foods.

Results:

A total of 266 666 participants (60% women) were included in the study. The UPF consumption represented a proportion of 34% of kcal and 32% of kcal in the daily diet among men and women respectively. A total of 4461 participants developed multimorbidity of cancer and cardiometabolic diseases after a median follow up time of 11.2 years,

It was observed that:

• Higher UPF consumption( per 1 standard deviation increment [∼260 g/day]without alcoholic drinks) was associated with an increased risk of multimorbidity (HR: 1.09, 95% CI: 1.05, 1.12).
• Among the nine UPF subgroups after mutual adjustment, consumption of animal-based products, and artificially and sugar sweetened beverages showed positive associations (HR: 1.09, 95% CI:1.05–1.12; HR : 1.09, 95% CI: 1.06–1.12, respectively) in the direct transition from baseline to multimorbidity. Sauces, spreads and condiments also showed a positive association with the risk of multimorbidity (HR: 1.03, 95% CI: 1.00–1.06).But, ultra processed breads and cereals were inversely associated with risk of multimorbidity (HR: 0.97, 95%CI: 0.94–1.00). The remaining groups—sweets and desserts, savoury snacks, plant-based alternatives, ready-to-eat/heat mixed dishes and other unspecified ultra-processed foods—showed no association with the risk of multimorbidity.

 Conclusions:

A higher UPF consumption was associated with a higher risk of multimorbidity of cancer and cardiometabolic diseases. But not all UPF foods are equal. Artificially and sugar-sweetened beverages, animal-based products and sauces, spreads and condiments, but not other items, were associated with higher risk of multimorbidity suggesting that more nuanced subgroup analyses of UPFs are needed.

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