The estimated burden of ultra-processed foods on cardiovascular disease outcomes in Brazil: A modeling study

Eduardo Augusto Fernandes Nilson; Gerson Ferrari; Maria Laura da Costa Louzada; Renata Bertazzi Levy; Carlos Augusto Monteiro; Leandro F M Rezende

doi:10.3389/fnut.2022.1043620

The estimated burden of ultra-processed foods on cardiovascular disease outcomes in Brazil: A modeling study

Front Nutr. 2022 Nov 17:9:1043620. doi: 10.3389/fnut.2022.1043620. eCollection 2022.

Authors

Eduardo Augusto Fernandes Nilson^{1

2}, Gerson Ferrari^{3

4}, Maria Laura da Costa Louzada⁵, Renata Bertazzi Levy⁶, Carlos Augusto Monteiro¹, Leandro F M Rezende⁷

Affiliations

¹ Center for Epidemiological Research in Nutrition and Public Health, University of São Paulo, São Paulo, Brazil.
² Oswaldo Cruz Foundation-Fiocruz, Brasília, Brazil.
³ Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Santiago, Chile.
⁴ Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile.
⁵ Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil.
⁶ Department of Preventive Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
⁷ Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.

Abstract

Introduction: Ultra-processed foods (UPF) have been associated with an increased risk of cardiovascular diseases (CVD). This study aimed to estimate CVD premature deaths, incident cases, and disability adjusted life-years (DALYs) attributable to the consumption of UPF in Brazilian adults in 2019.

Methods: A validated a comparative risk assessment model was adapted to estimate the burden of major CVD outcomes (coronary heart disease and stroke) attributable to the consumption of UPF in Brazilian adults aged 30 to 69 years. The model inputs included nationally representative data of the UPF contribution to the total energy of the diet, national official demographic records, CVD outcomes (incidence, deaths and DALYs) from the Global Burden of Disease study for 2019, and relative risks from meta-analysis studies.

Results: We estimated that approximately 19,200 premature deaths (95% uncertainty intervals - UI, 7,097 to 32,353), 74,900 new cases (95% UI, 25,983 to 128,725), and 883,000 DALYs/year (95% UI, 324,279 to 1,492,593) from CVD were attributable to the consumption of UPF in Brazil, corresponding to about 22% of the premature deaths from CVD and to 33% of the total premature all-cause deaths attributable to UPF intake among Brazilian adults. Reducing UPF consumption by 10% in the adult population would avert approximately 11% of the premature CVD deaths, equivalent to 2,100 deaths/year (95% UI, 697 to 4,511). A 20% reduction in UPF intake would avert approximately 21% of the premature CVD deaths or 4,100 deaths (95% UI, 1,413 to 8,047), and a 50% reduction in UPF intake would avert about 52% of the premature CVD deaths, corresponding to 9,900 deaths/year (95% UI, 3,682 to 17,820). If UPF consumption among adults was reduced to that of the first quintile of UPF intake in the baseline scenario, approximately 81% of the premature CVD deaths would be averted, corresponding to some 15,600 deaths/year (95% UI, 5,229 to 27,519).

Conclusion: Our study estimated a high burden of premature CVD outcomes attributable to the consumption of UPF in Brazil. Our findings support food policies aimed at reducing the consumption of UPF, such as fiscal and regulatory policies, which are imperative to prevent CVD in Brazil.

Keywords: CVD; DALYs; incidence; modeling; mortality; ultra-processed foods.