Abstract

Aims

To evaluate the association of ultra-processed food (UPF) intake and mortality among individuals with history of cardiovascular disease (CVD) and analyse some biological pathways possibly relating UPF intake to death.

Methods and results

Longitudinal analysis on 1171 men and women (mean age: 67 ± 10 years) with history of CVD, recruited in the Moli-sani Study (2005–10, Italy) and followed for 10.6 years (median). Food intake was assessed using a food frequency questionnaire. UPF was defined using the NOVA classification according to degree of processing and categorized as quartiles of the ratio (%) between UPF (g/day) and total food consumed (g/day). The mediating effects of 18 inflammatory, metabolic, cardiovascular, and renal biomarkers were evaluated using a logistic regression model within a counterfactual framework. In multivariable-adjusted Cox analyses, higher intake of UPF (Q4, ≥11.3% of total food), as opposed to the lowest (Q1, UPF <4.7%), was associated with higher hazards of all-cause (hazard ratio [HR]: 1.38; 95% confidence interval (CI): 1.00–1.91) and CVD mortality (HR: 1.65; 95% CI: 1.07–2.55). A linear dose–response relationship of 1% increment in UPF intake with all-cause and CVD mortality was also observed. Altered levels of cystatin C explained 18.3% and 16.6% of the relation between UPF (1% increment in the diet) with all-cause and CVD mortality, respectively.

Conclusion

A diet rich in UPF is associated with increased hazards of all-cause and CVD mortality among individuals with prior cardiovascular events, possibly through an altered renal function. Elevated UPF intake represents a major public health concern in secondary CVD prevention.

中文翻译：

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心血管疾病患者的超加工食品摄入和全因和特定原因死亡率：Moli-sani 研究

摘要

目标

评估超加工食品 (UPF) 摄入量与心血管疾病 (CVD) 病史个体死亡率的关系，并分析一些可能将 UPF 摄入量与死亡相关的生物学途径。

方法和结果

对 1171 名有 CVD 病史的男性和女性（平均年龄：67 ± 10 岁）进行纵向分析，招募于 Moli-sani 研究（2005-10，意大利）并随访 10.6 年（中位数）。使用食物频率问卷评估食物摄入量。UPF 是根据加工程度使用 NOVA 分类定义的，并归类为 UPF（克/天）与总食物消耗量（克/天）之间的比率 (%) 的四分位数。在反事实框架内使用逻辑回归模型评估了 18 种炎症、代谢、心血管和肾脏生物标志物的中介作用。在多变量调整的 Cox 分析中，与最低的（Q1，UPF <4.7%）相比，较高的 UPF 摄入量（Q4，≥11.3%）与较高的全因危害（风险比 [HR ]：1.38；95% 置信区间 (CI)：1.00–1。91) 和 CVD 死亡率 (HR: 1.65; 95% CI: 1.07–2.55)。还观察到 UPF 摄入量增加 1% 与全因死亡率和 CVD 死亡率呈线性剂量反应关系。胱抑素 C 水平的改变分别解释了 UPF（饮食中增加 1%）与全因死亡率和 CVD 死亡率之间关系的 18.3% 和 16.6%。

结论

富含 UPF 的饮食与先前发生心血管事件的个体的全因和 CVD 死亡率风险增加有关，可能是通过改变肾功能。升高的 UPF 摄入量代表了二级 CVD 预防中的主要公共卫生问题。