1Preventive Medicine Department, Medical School, University of São Paulo, São Paulo, Brazil, 2Department of Nutrition, Faculty of Public Health, University of São Paulo, São Paulo, Brazil, 3Public Health Policy Evaluation Unit, Imperial College London, London, England.
Introduction and Objective: Both ultra-processed foods (UPF) and animal-based foods have been associated with cardiovascular disease in some studies. Our study aims to examine the prospective association of two dietary factors (UPF and animal-based foods), adjusted for each other, with cardiovascular-related mortality using the UK Biobank cohort. Methods: Participants of the UK Biobank from England, Scotland, and Wales with at least two 24-h dietary recall completed between 2009 and 2012 were included. The exposure of interest was 2 dietary factors: 1) proportion of dietary energy from UPF and 2) proportion of dietary energy from animal-based foods (red meat, poultry/fish, and eggs/ dairy). The main outcome was cardiovascular-cause mortality, identified through data linkage to mortality registries. Prospective association was assessed using multivariable Cox proportional hazards models adjusted for baseline sociodemographic and lifestyle characteristics. Results: Among 126,639 participants followed for a mean of 9.2 years, there were 1,327 cardiovascular deaths. In mutually adjusted models of both dietary factors (UPF and animal-based foods), the hazard ratio for the 5th compared with the 1st quintile of the proportion of dietary energy from UPF was 1.47 (95% CI: 1.22, 1.76, comparing 41.5% with 9.4% dietary energy), whereas for animal-based food intake (meats, dairy, eggs) it was 1.10 (95% CI: 0.93, 1.32, comparing 45.3% with 16.8% dietary energy). There was no evidence of interaction (P = 0.51). Among animalbased foods, none of the subgroups was associated with CVD mortality. Conclusion: Greater consumption of UPF was associated with higher cardiovascular-cause mortality in this UK population. The total of animal-based food consumption (meat, dairy, eggs) was not associated with cardiovascular mortality, neither red meat intake. These findings suggest that the proportion of UPF in the diet may be more important with respect to cardiovascular mortality than the proportion of animal-based foods. Funding Cancer Research UK and World Cancer Research Fund.
Keywords: ultra-processed foods, animal-based dietary, cardiovascular mortality.