Ultra-processed foods threaten CV health in Western countries

A population-based cohort study out of France has identified a link between the consumption of ultra-processed foods and CVD, with a higher intake of sweet and starchy snacks translating to increased risks for cardiovascular, coronary heart and cerebrovascular diseases.

The study leveraged data from the NutriNet-Santé cohort, an ongoing web-based effort that launched in 2009 with the objective of studying the associations between nutrition and health outcomes in France. First author Bernard Srour, PharmD, MPH, and co-authors said in The BMJ their study of 105,159 NutriNet-Santé participants aimed to clarify the relationship between diet and CVD risk, seeing as how 56% of CVD deaths in men and 48% in women were attributable to dietary factors in 2015.

Srour et al. wrote 25% to 60% of total daily energy intake in European countries, Canada, New Zealand and Latin American countries is derived from ultra-processed foods—foods subjected to a series of physical and chemical processes that result in sugary, salty and fatty formulations with little nutritional value. They tracked their study participants’ health outcomes alongside their diets, which were measured using repeated 24-hour dietary records designed to register patients’ normal consumption of 3,300 separate food items.

The research team collected an average of 5.7 dietary records per participant, according to the study. Foods were classified using the NOVA system, a University of Sao Paulo innovation that classifies foods and drinks based on how heavily they’re processed.

During an average 5.2 years of follow-up, Srour and colleagues recorded 1,409 first incident CVD events, including 106 MIs, 485 angioplasties, 42 acute coronary syndromes, 155 strokes and 674 transient ischemic events. At the same time, ultra-processed foods were making up more than 17% of both men’s and women’s regular dietary intake.

The authors said the main food group contributing to ultra-processed food intake was sugary products, which comprised 28% of ultra-processed foods in the form of pastries, sweetened desserts, ice cream and confectionaries. That grouping was followed closely by:

  • Ultra-processed fruits and vegetables like instant dehydrated soups and broths, veggie nuggets and fruit-based desserts (18% of total intake)
  • Beverages including sodas, sugary and artificially sweetened drinks (16% of total intake)
  • Starchy foods and breakfast cereals including pre-packaged bread, industrial dough, ready-to-eat pasta and sugary cereal (12% of total intake)
  • Processed meat and fish like chicken nuggets, fish fingers, sausages and processed ham (11% of total intake).

“Several of these nutritional compounds are known risk factors for cardiometabolic health, with a high evidence for high sodium, saturated fat, added sugars and low dietary fiber and a ‘general concordance’ for high glycemic index or load,” Srour et al. wrote. “In addition, several food groups that are mainly ultra-processed and are largely consumed in Western-type diets have been associated with increased risks of cardiometabolic outcomes with ‘high concordance’—that is, sugar-sweetened beverages and processed meats.”

The team reported participants who consumed the highest levels of ultra-processed food tended to be younger, current smokers, less educated, and have less family history of CVD. They also had higher BMIs, a higher intake of energy, lipids, carbohydrates and sodium, and a lower intake of alcohol, fruit, vegetables and dietary fiber.

As a whole, a 10% increase in ultra-processed foods in a person’s diet was linked to a 12%, 13% and 11% statistically significant increase in the rates of overall cardiovascular, coronary heart and cerebrovascular disease, respectively.

“Even if it remains unclear what specific processes, compounds or ultra-processed food subtypes play a more important role, evidence is accumulating for an association between increased overall proportion of ultra-processed food in the diet and increased risks of several chronic diseases,” Srour and co-authors wrote. “It is therefore important to inform consumers about these associations and to implement actions targeting product reformulation, taxation and communication to limit the proportion of ultra-processed foods in the diet and promote the consumption of unprocessed or minimally processed foods instead.”