Consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study

Reynalda Cordova; Vivian Viallon; Emma Fontvieille; Laia Peruchet-Noray; Anna Jansana; Karl-Heinz Wagner; Cecilie Kyrø; Anne Tjønneland; Verena Katzke; Rashmita Bajracharya; Matthias B Schulze; Giovanna Masala; Sabina Sieri; Salvatore Panico; Fulvio Ricceri; Rosario Tumino; Jolanda M A Boer; W M Monique Verschuren; Yvonne T van der Schouw; Paula Jakszyn; Daniel Redondo-Sánchez; Pilar Amiano; José María Huerta; Marcela Guevara; Yan Borné; Emily Sonestedt; Konstantinos K Tsilidis; Christopher Millett; Alicia K Heath; Elom K Aglago; Dagfinn Aune; Marc J Gunter; Pietro Ferrari; Inge Huybrechts; Heinz Freisling

doi:10.1016/j.lanepe.2023.100771

Consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study

Lancet Reg Health Eur. 2023 Nov 14:35:100771. doi: 10.1016/j.lanepe.2023.100771. eCollection 2023 Dec.

Authors

Reynalda Cordova^{1

2}, Vivian Viallon¹, Emma Fontvieille¹, Laia Peruchet-Noray¹, Anna Jansana¹, Karl-Heinz Wagner², Cecilie Kyrø³, Anne Tjønneland^{3

4}, Verena Katzke⁵, Rashmita Bajracharya⁵, Matthias B Schulze^{6

7}, Giovanna Masala⁸, Sabina Sieri⁹, Salvatore Panico¹⁰, Fulvio Ricceri¹¹, Rosario Tumino¹², Jolanda M A Boer¹³, W M Monique Verschuren^{13

14}, Yvonne T van der Schouw¹⁴, Paula Jakszyn^{15

16}, Daniel Redondo-Sánchez^{17

18

19}, Pilar Amiano^{19

20

21}, José María Huerta^{19

22}, Marcela Guevara^{19

23

24}, Yan Borné²⁵, Emily Sonestedt²⁵, Konstantinos K Tsilidis^{26

27}, Christopher Millett^{28

29}, Alicia K Heath²⁷, Elom K Aglago²⁷, Dagfinn Aune^{27

30

31}, Marc J Gunter^{1

27}, Pietro Ferrari¹, Inge Huybrechts¹, Heinz Freisling¹

Affiliations

¹ International Agency for Research on Cancer (IARC-WHO), Lyon, France.
² Department of Nutritional Sciences, University of Vienna, Vienna, Austria.
³ Danish Cancer Institute Center, Copenhagen, Denmark.
⁴ Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
⁵ Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
⁶ Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
⁷ Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
⁸ Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
⁹ Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
¹⁰ Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
¹¹ Department of Clinical and Biological Sciences, Centre for Biostatistics, Epidemiology, and Public Health, University of Turin, Italy.
¹² Hyblean Association for Epidemiological Research, AIRE ONLUS Ragusa, Italy.
¹³ Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
¹⁴ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
¹⁵ Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
¹⁶ Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain.
¹⁷ Escuela Andaluza de Salud Pública (EASP), Granada 18011, Spain.
¹⁸ Instituto de Investigación Biosanitaria ibs. Granada, Granada 18012, Spain.
¹⁹ Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
²⁰ Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain.
²¹ Bio Gipuzkoa Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain.
²² Department of Epidemiology, Murcia Regional Health Council-IMIB, Murcia, Spain.
²³ Instituto de Salud Pública y Laboral de Navarra, Pamplona 31003, Spain.
²⁴ Navarra Institute for Health Research (IdiSNA), Pamplona 31008, Spain.
²⁵ Nutritional Epidemiology, Department of Clinical Sciences Malmö, The Faculty of Medicine, Lund University, Malmö, Sweden.
²⁶ Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
²⁷ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
²⁸ Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom.
²⁹ NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal.
³⁰ Department of Nutrition, Oslo New University College, Oslo, Norway.
³¹ Department of Research, The Cancer Registry of Norway, Oslo, Norway.

Abstract

Background: It is currently unknown whether ultra-processed foods (UPFs) consumption is associated with a higher incidence of multimorbidity. We examined the relationship of total and subgroup consumption of UPFs with the risk of multimorbidity defined as the co-occurrence of at least two chronic diseases in an individual among first cancer at any site, cardiovascular disease, and type 2 diabetes.

Methods: This was a prospective cohort study including 266,666 participants (60% women) free of cancer, cardiovascular disease, and type 2 diabetes at recruitment from seven European countries in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Foods and drinks consumed over the previous 12 months were assessed at baseline by food-frequency questionnaires and classified according to their degree of processing using Nova classification. We used multistate modelling based on Cox regression to estimate cause-specific hazard ratios (HR) and their 95% confidence intervals (CI) for associations of total and subgroups of UPFs with the risk of multimorbidity of cancer and cardiometabolic diseases.

Findings: After a median of 11.2 years of follow-up, 4461 participants (39% women) developed multimorbidity of cancer and cardiometabolic diseases. Higher UPF consumption (per 1 standard deviation increment, ∼260 g/day without alcoholic drinks) was associated with an increased risk of multimorbidity of cancer and cardiometabolic diseases (HR: 1.09, 95% CI: 1.05, 1.12). Among UPF subgroups, associations were most notable for animal-based products (HR: 1.09, 95% CI: 1.05, 1.12), and artificially and sugar-sweetened beverages (HR: 1.09, 95% CI: 1.06, 1.12). Other subgroups such as ultra-processed breads and cereals (HR: 0.97, 95% CI: 0.94, 1.00) or plant-based alternatives (HR: 0.97, 95% CI: 0.91, 1.02) were not associated with risk.

Interpretation: Our findings suggest that higher consumption of UPFs increases the risk of cancer and cardiometabolic multimorbidity.

Funding: Austrian Academy of Sciences, Fondation de France, Cancer Research UK, World Cancer Research Fund International, and the Institut National du Cancer.

Keywords: Cancer; Cardiovascular diseases; Diabetes; Diet; Multimorbidity; Ultra-processed foods.

Grants and funding

001/WHO_/World Health Organization/International