Written by Chrystal Moulton, Staff Writer. Results from the analysis showed a positive association between consumption of 1 standard deviation/day = 260g UPF/day and multimorbidity (at least 2 chronic diseases among cancer, type 2 diabetes, or cardiovascular disease) [HR= 1.09, p<0.05].
The EPIC study, the European Prospective Investigation into Cancer and Nutrition, is a prospective study assessing the association between diet, environmental risk factors, lifestyle, and genetics with the risk of developing cancer and other diseases. The recruitment period was from 1992 to 2000. A total of 520,000 individuals from Norway, Italy, France, Germany, Sweden, Greece, Denmark, Spain, the Netherlands, and the UK was recruited to this prospective study. From the data collected in the EPIC study, researchers in the current trial investigated the association between ultra-processed foods (UPF) and the incidence of multimorbidity where multimorbidity is defined as the occurrence of at least 2 chronic diseases (either cancer, type 2 diabetes, or cardiovascular disease).
Since cancer, type 2 diabetes, and cardiovascular disease were the targeted morbidities in this analysis, data from Greece, Norway, and France were excluded from the analysis [as information on those diseases were not collected at those sites]. Additionally, participants who already had cancer, type 2 diabetes, or cardiovascular disease or were missing any data (nutritional or lifestyle data) at baseline were excluded. Thus, the current analysis included 266,666 individuals. Country specific food-frequency questionnaires were conducted at baseline. The food-frequency questionnaires assessed food intake over 12months prior to registration into the study. After enrolling, individuals were contacted every 3-4 years to ascertain information on chronic disease development. 11,000 food items were included in the EPIC food database to which the Nova food classification system was applied. Based on the Nova food classification system, food items were classified into 4 categories: unprocessed/minimally processed food, processed culinary ingredients, processed food, and ultra-processed foods. For this analysis, researchers focused on the ultra-processed food (UPF) classification. Researchers also accounted for the change in food processing over time and adjusted the ultra-processed food (UPF) consumption accordingly. Weight and height were assessed at baseline. Adherence to healthy diet and physical activity were assessed using the Mediterranean Diet Score and four-level categorical Cambridge index, respectively. Sociodemographic and lifestyle data was also collected at baseline. BMI was calculated using height and weight measurements. Incidence of cancer, type 2 diabetes, and cardiovascular disease was obtained through follow-up (every 3-4 years), registries, next of kin, medical/health insurance records, or death certificates. Using this information, researchers calculated the risk or incidence of cancer, type 2 diabetes, or cardiovascular disease with intake of ultra-processed food (UPF) [1 standard deviation/day = 260g UPF/day].
Results from the analysis showed a positive association between consumption of 1 standard deviation/day = 260g UPF/day and multimorbidity (at least 2 chronic diseases among cancer, type 2 diabetes, or cardiovascular disease) [HR= 1.09, p<0.05]. Even after adjusting for BMI, the positive association between UPF consumption and multimorbidity was maintained (HR=1.06, p<0.05). Also, consumption of UPF was positively associated with development of cancer (HR=1.01, p<0.05), cardiovascular disease (HR=1.06, p<.0.05), and type 2 diabetes (HR=1.11, p<0.05). This relationship was maintained even after adjusting for BMI. The transition from initial development of cancer, type 2 diabetes, or cardiovascular disease to development of an additional chronic disease among the 3 (cancer, type 2 diabetes, or cardiovascular disease) was positively associated with consumption of UPF:
- Cancer to multimorbidity- HR= 1.05 (CI: 0.99-1.11), p<0.05
- CVD to multimorbidity- HR=1.02 (CI: 0.97-1.08), p<0.05
- T2D to multimorbidity- HR=1.02 (CI 0.98-1.06), p<0.05
This association was maintained after adjusting for BMI. Further analysis of UPF subgroups showed that consumption of artificially sweetened and sugar sweetened drinks as well as consumption of animal products was positively associated with the direct transition from no chronic disease at baseline and cancer-cardiometabolic multimorbidity (HR=1.09, p<0.05). Plant based alternatives and ultra-processed breads and cereals were negatively associated with cancer- cardiometabolic multimorbidity (HR=0.97, p<0.05). Spreads, sauces, and condiments were positively associated with cancer- cardiometabolic multimorbidity (HR=1.03, p<0.05).
Overall, data from the EPIC study showed that individuals were more likely to develop both cancer and cardiometabolic disease with high consumption of UPF. Also, consumption of UPF increases the risk of initially developing cancer, CVD, or type 2 diabetes. Additional studies will be needed to verify these findings.
Source: Cordova, Reynalda, Vivian Viallon, Emma Fontvieille, Laia Peruchet-Noray, Anna Jansana, Karl-Heinz Wagner, Cecilie Kyrø et al. “Consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study.” The Lancet Regional Health–Europe (2023).
© 2023 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND IGO license (http://creativecommons.org/licenses/by-nc-nd/3.0/igo/)
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Posted December 13, 2023.
Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.
Reference:
- Cordova, Reynalda, et al. “Consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study.” The Lancet Regional Health–Europe (2023).
