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      Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study

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          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

          19 899 participants (12 113 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 200 432 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 ultra-processed food, all cause mortality increased by 18%.

          Study registration

          ClinicalTrials.gov NCT02669602.

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          Most cited references19

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          Web Site and R Package for Computing E-values

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            Consumption of ultra-processed food products and its effects on children's lipid profiles: a longitudinal study.

            Cardiovascular disease development is related to known risk factors (such as diet and blood lipids) that begin in childhood. Among dietary factors, the consumption of ultra-processing products has received attention. This study investigated whether children's consumption of processed and ultra-processing products at preschool age predicted an increase in lipid concentrations from preschool to school age.
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              Red and processed meat consumption and mortality: dose-response meta-analysis of prospective cohort studies.

              To examine and quantify the potential dose-response relationship between red and processed meat consumption and risk of all-cause, cardiovascular and cancer mortality.
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                Author and article information

                Contributors
                Role: researcher
                Role: professor
                Role: postdoctoral researcher
                Role: postdoctoral researcher
                Role: research dietitian
                Role: doctoral student
                http://orcid.org//0000-0002-9139-4206Role: professor
                Journal
                BMJ
                BMJ
                BMJ-UK
                bmj
                The BMJ
                BMJ Publishing Group Ltd.
                0959-8138
                1756-1833
                2019
                29 May 2019
                : 365
                : l1949
                Affiliations
                [1 ]Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
                [2 ]Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
                [3 ]IDISNA, Navarra Institute for Health Research, Pamplona, Spain
                [4 ]Harvard TH Chan School of Public Health, Boston, MA, USA
                [5 ]Department of Nutrition, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
                Author notes
                Correspondence to: M Bes-Rastrollo mbes@ 123456unav.es
                Article
                rica047977
                10.1136/bmj.l1949
                6538973
                31142450
                0f43065b-7ea4-4d79-a09d-3881edc3f16d
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                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/.

                History
                : 23 April 2019
                Categories
                Research

                Medicine
                Medicine

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