Different Levels of Ultraprocessed Food and Beverage Consumption and Associations with Environmental Sustainability and All-cause Mortality in EPIC-NL

Reina E Vellinga; Iris van den Boomgaard; Jolanda M A Boer; Yvonne T van der Schouw; Marjolein C Harbers; W M Monique Verschuren; Pieter van 't Veer; Elisabeth H M Temme; Sander Biesbroek

doi:10.1016/j.ajcnut.2023.05.021

Different Levels of Ultraprocessed Food and Beverage Consumption and Associations with Environmental Sustainability and All-cause Mortality in EPIC-NL

Am J Clin Nutr. 2023 Jul;118(1):103-113. doi: 10.1016/j.ajcnut.2023.05.021. Epub 2023 May 18.

Authors

Reina E Vellinga¹, Iris van den Boomgaard², Jolanda M A Boer³, Yvonne T van der Schouw⁴, Marjolein C Harbers⁴, W M Monique Verschuren⁵, Pieter van 't Veer², Elisabeth H M Temme⁶, Sander Biesbroek²

Affiliations

¹ Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands. Electronic address: reina.vellinga@rivm.nl.
² Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
³ Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
⁴ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
⁵ Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
⁶ Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.

PMID: 37207984
DOI: 10.1016/j.ajcnut.2023.05.021

Abstract

Background: The adverse health effects of high ultraprocessed food and drink (UPFD) consumption are well documented. However, the environmental impact remains unclear, and the separate effects of ultraprocessed foods (UPFs) and drinks (UPDs) on all-cause mortality have not been studied previously.

Objectives: To assess the association between levels of UPFD, UPF, and UPD consumption and diet-related environmental impacts and all-cause mortality in Dutch adults.

Methods: Habitual diets were assessed by a Food Frequency Questionnaire (FFQ) from 1993-1997 in 38,261 participants of the Dutch European Prospective Investigation into Cancer and Nutrition cohort. The mean follow-up time was 18.2 y (SD = 4.1); 4,697 deaths occurred. FFQ items were categorized according to the NOVA classification. Associations between quartiles of UPFD, UPF, and UPD consumption and environmental impact indicators were analyzed using general linear models and all-cause mortality by Cox proportional hazard models. The lowest UPFD, UPF, and UPD consumption quartiles were used as comparator.

Results: The average UPFD consumption was 181 (SD = 88) g/1000 kcal. High UPF consumption was statistically significantly inversely associated with all environmental impact indicators (Q4vsQ1: -13.6% to -3.0%), whereas high UPD consumption was, except for land use, statistically significant positively associated with all environmental impact indicators (Q4vsQ1: 1.2% to 5.9%). High UPFD consumption was heterogeneously associated with environmental impacts (Q4vsQ1: -4.0% to 2.6%). After multivariable adjustment, the highest quartiles of UPFD and UPD consumption were significantly associated with all-cause mortality (HR_Q4vsQ1: 1.17, 95%CI: 1.08, 1.28 and HR_Q4vsQ1: 1.16, 95%CI: 1.07, 1.26, respectively). UPF consumption of Q2 and Q3 were associated with a borderline significant lower risk of all-cause mortality (HR_Q2vsQ1: 0.93, 95% CI: 0.85, 1.00; HR_Q3vsQ1: 0.91, 95% CI: 0.84, 0.99) whereas Q4 was not statistically significant (HR_Q4vsQ1: 1.06, 95% CI: 0.97, 1.15).

Conclusions: Reducing UPD consumption may lower environmental impact and all-cause mortality risk; however, this is not shown for UPFs. When categorizing food consumption by their degree of processing, trade-offs are observed for human and planetary health aspects.

Keywords: EPIC-NL; NOVA classification; all-cause mortality; environmental impact; planetary health; ultraprocessed drinks; ultraprocessed foods.

MeSH terms

Adult
Beverages
Diet*
Fast Foods / adverse effects
Food Handling
Food*
Humans
Prospective Studies
Risk