Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countriesResearch in context
Summary: Background: Ultra-processed food (UPF) consumption has been linked with higher risk of mortality. This multi-centre study investigated associations between food intake by degree of processing, using the Nova classification, and all-cause and cause-specific mortality. Methods: This study an...
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2025-03-01
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| author | Esther M. González-Gil Michèle Matta Fernanda Morales Berstein Manon Cairat Geneviève Nicolas Jessica Blanco Nathalie Kliemann Renata Bertazzi Levy Fernanda Rauber Inarie Jacobs Aline Al Nahas Emine Koc Cakmak Eszter P. Vamos Kiara Chang Sahar G. Yammine Christopher Millett Mathilde Touvier Maria Gabriela Matias Pinho Konstantinos K. Tsilidis Alicia K. Heath Christina M. Lill Valeria Pala Conchi Moreno-Iribas Maria Santucci De Magistris Christina C. Dahm Niels Bock Anja Olsen Anne Tjønneland Yvonne T. van der Schouw Pilar Amiano Franziska Jannasch Matthias B. Schulze Francesca Romana Mancini Chloé Marques Claire Cadeau Catalina Bonet Daniel Redondo-Sánchez Kristin Benjaminsen Borch Magritt Brustad Guri Skeie Jesús Humberto-Gómez Alessandra Macciotta Pietro Ferrari Laure Dossus Marc J. Gunter Inge Huybrechts |
| author_facet | Esther M. González-Gil Michèle Matta Fernanda Morales Berstein Manon Cairat Geneviève Nicolas Jessica Blanco Nathalie Kliemann Renata Bertazzi Levy Fernanda Rauber Inarie Jacobs Aline Al Nahas Emine Koc Cakmak Eszter P. Vamos Kiara Chang Sahar G. Yammine Christopher Millett Mathilde Touvier Maria Gabriela Matias Pinho Konstantinos K. Tsilidis Alicia K. Heath Christina M. Lill Valeria Pala Conchi Moreno-Iribas Maria Santucci De Magistris Christina C. Dahm Niels Bock Anja Olsen Anne Tjønneland Yvonne T. van der Schouw Pilar Amiano Franziska Jannasch Matthias B. Schulze Francesca Romana Mancini Chloé Marques Claire Cadeau Catalina Bonet Daniel Redondo-Sánchez Kristin Benjaminsen Borch Magritt Brustad Guri Skeie Jesús Humberto-Gómez Alessandra Macciotta Pietro Ferrari Laure Dossus Marc J. Gunter Inge Huybrechts |
| author_sort | Esther M. González-Gil |
| collection | DOAJ |
| description | Summary: Background: Ultra-processed food (UPF) consumption has been linked with higher risk of mortality. This multi-centre study investigated associations between food intake by degree of processing, using the Nova classification, and all-cause and cause-specific mortality. Methods: This study analyzed data from the European Prospective Investigation into Cancer and Nutrition. All-cause mortality and cause-specific mortality due to cancer, circulatory diseases, digestive diseases, Parkinson’s disease, and Alzheimer’s disease served as endpoints. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazards regression models. Substitution analyses were also performed. Findings: Overall, 428,728 (71.7% female) participants were included in the analysis and 40,016 deaths were documented after 15.9 years of follow-up. UPFs (in percentage grams per day [g/d]) were positively associated with all-cause mortality (HRs per 1-SD: 1.04; 95% CI: 1.02,1.05), as well as mortality from circulatory diseases (1.09; 95% CI: 1.07,1.12), cerebrovascular disease (1.11; 95% CI: 1.05,1.17), ischemic heart disease (1.10; 95% CI: 1.06,1.15), digestive diseases (1.12; 95% CI: 1.05,1.20), and Parkinson’s disease (1.23; 95% CI: 1.06,1.42). No associations were found between UPFs and mortality from cancer or Alzheimer’s disease. Replacing processed and UPFs with unprocessed/minimally processed foods was associated with lower mortality risk. Interpretation: In this pan-European analysis, higher UPF consumption was associated with greater mortality from circulatory diseases, digestive diseases, and Parkinson’s disease. The results support growing evidence that higher consumption of UPFs and lower consumption of unprocessed foods may have a negative impact on health. Funding: l’Institut National du Cancer, and World Cancer Research Fund International. |
| format | Article |
| id | doaj-art-e32aca818bb841e7a77b342f35f9975d |
| institution | Kabale University |
| issn | 2666-7762 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
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| series | The Lancet Regional Health. Europe |
| spelling | doaj-art-e32aca818bb841e7a77b342f35f9975d2025-01-09T06:14:49ZengElsevierThe Lancet Regional Health. Europe2666-77622025-03-0150101208Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countriesResearch in contextEsther M. González-Gil0Michèle Matta1Fernanda Morales Berstein2Manon Cairat3Geneviève Nicolas4Jessica Blanco5Nathalie Kliemann6Renata Bertazzi Levy7Fernanda Rauber8Inarie Jacobs9Aline Al Nahas10Emine Koc Cakmak11Eszter P. Vamos12Kiara Chang13Sahar G. Yammine14Christopher Millett15Mathilde Touvier16Maria Gabriela Matias Pinho17Konstantinos K. Tsilidis18Alicia K. Heath19Christina M. Lill20Valeria Pala21Conchi Moreno-Iribas22Maria Santucci De Magistris23Christina C. Dahm24Niels Bock25Anja Olsen26Anne Tjønneland27Yvonne T. van der Schouw28Pilar Amiano29Franziska Jannasch30Matthias B. Schulze31Francesca Romana Mancini32Chloé Marques33Claire Cadeau34Catalina Bonet35Daniel Redondo-Sánchez36Kristin Benjaminsen Borch37Magritt Brustad38Guri Skeie39Jesús Humberto-Gómez40Alessandra Macciotta41Pietro Ferrari42Laure Dossus43Marc J. Gunter44Inge Huybrechts45Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France; Corresponding author. Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, France.Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, FranceMRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UKUniversité Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif 94805, FranceNutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, FranceNutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, FranceCancer Research Centre (CEPON), Santa Catarina, BrazilDepartment of Preventive Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, BrazilDepartment of Preventive Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Centre for Epidemiological Studies in Nutrition and Health, School of Public Health, University of São Paulo, BrazilNutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, FranceNutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, FranceDepartment of Epidemiology and Biostatistics, School of Public Health, MRC Centre for Environment and Health, Imperial College London, London, United KingdomPublic Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UKPublic Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UKUniversité Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny F-93017, FrancePublic Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), NOVA University Lisbon, Lisbon, PortugalUniversité Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny F-93017, FranceCopernicus Institute of Sustainable Development, Department Environmental Sciences, Utrecht University, Utrecht, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the NetherlandsCancer Epidemiology and Prevention Research Unit, School of Public Health, Imperial College London, London, UK; Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, GreeceCancer Epidemiology and Prevention Research Unit, School of Public Health, Imperial College London, London, UKAgeing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK; Institute of Epidemiology and Sociology, University of Münster, Münster, GermanyEpidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori- Milan, ItalyInstituto de Salud Pública y Laboral de Navarra, Pamplona 31003, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona 31008, SpainAzienda Ospedaliera Universitaria (AOU) Federico II, Naples, ItalyDepartment of Public Health, Aarhus University, Aarhus, DenmarkDepartment of Public Health, Aarhus University, Aarhus, DenmarkDepartment of Public Health, Aarhus University, Aarhus, Denmark; Danish Cancer Institute, Copenhagen, DenmarkDanish Cancer Institute, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, DenmarkJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the NetherlandsCentro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain; Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain; BioGipuzkoa (BioDonostia) Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, SpainDepartment of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, GermanyDepartment of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, Nuthetal, GermanyUniversité Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif 94805, FranceUniversité Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif 94805, FranceUniversité Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif 94805, FranceUnit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, L'Hospitalet de Llobregat, Spain; Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, SpainCentro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain; Escuela Andaluza de Salud Pública (EASP), Granada 18011, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada 18012, SpainDepartment of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, NorwayDepartment of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway; The Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, NorwayNutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France; Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, NorwayCentro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain; Department of Epidemiology, Murcia Regional Health Council-IMIB, Murcia, SpainDepartment of Clinical and Biological Sciences, University of Turin, Orbassano, TO, Italy; Department of Translational Medicine, University of Piemonte Orientale, Novara, ItalyNutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, FranceNutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, FranceNutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France; Cancer Epidemiology and Prevention Research Unit, School of Public Health, Imperial College London, London, UKNutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, FranceSummary: Background: Ultra-processed food (UPF) consumption has been linked with higher risk of mortality. This multi-centre study investigated associations between food intake by degree of processing, using the Nova classification, and all-cause and cause-specific mortality. Methods: This study analyzed data from the European Prospective Investigation into Cancer and Nutrition. All-cause mortality and cause-specific mortality due to cancer, circulatory diseases, digestive diseases, Parkinson’s disease, and Alzheimer’s disease served as endpoints. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazards regression models. Substitution analyses were also performed. Findings: Overall, 428,728 (71.7% female) participants were included in the analysis and 40,016 deaths were documented after 15.9 years of follow-up. UPFs (in percentage grams per day [g/d]) were positively associated with all-cause mortality (HRs per 1-SD: 1.04; 95% CI: 1.02,1.05), as well as mortality from circulatory diseases (1.09; 95% CI: 1.07,1.12), cerebrovascular disease (1.11; 95% CI: 1.05,1.17), ischemic heart disease (1.10; 95% CI: 1.06,1.15), digestive diseases (1.12; 95% CI: 1.05,1.20), and Parkinson’s disease (1.23; 95% CI: 1.06,1.42). No associations were found between UPFs and mortality from cancer or Alzheimer’s disease. Replacing processed and UPFs with unprocessed/minimally processed foods was associated with lower mortality risk. Interpretation: In this pan-European analysis, higher UPF consumption was associated with greater mortality from circulatory diseases, digestive diseases, and Parkinson’s disease. The results support growing evidence that higher consumption of UPFs and lower consumption of unprocessed foods may have a negative impact on health. Funding: l’Institut National du Cancer, and World Cancer Research Fund International.http://www.sciencedirect.com/science/article/pii/S2666776224003776Nova classificationUnprocessed/minimally processed foodsUltra-processed foodsMortalityEPIC study |
| spellingShingle | Esther M. González-Gil Michèle Matta Fernanda Morales Berstein Manon Cairat Geneviève Nicolas Jessica Blanco Nathalie Kliemann Renata Bertazzi Levy Fernanda Rauber Inarie Jacobs Aline Al Nahas Emine Koc Cakmak Eszter P. Vamos Kiara Chang Sahar G. Yammine Christopher Millett Mathilde Touvier Maria Gabriela Matias Pinho Konstantinos K. Tsilidis Alicia K. Heath Christina M. Lill Valeria Pala Conchi Moreno-Iribas Maria Santucci De Magistris Christina C. Dahm Niels Bock Anja Olsen Anne Tjønneland Yvonne T. van der Schouw Pilar Amiano Franziska Jannasch Matthias B. Schulze Francesca Romana Mancini Chloé Marques Claire Cadeau Catalina Bonet Daniel Redondo-Sánchez Kristin Benjaminsen Borch Magritt Brustad Guri Skeie Jesús Humberto-Gómez Alessandra Macciotta Pietro Ferrari Laure Dossus Marc J. Gunter Inge Huybrechts Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countriesResearch in context The Lancet Regional Health. Europe Nova classification Unprocessed/minimally processed foods Ultra-processed foods Mortality EPIC study |
| title | Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countriesResearch in context |
| title_full | Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countriesResearch in context |
| title_fullStr | Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countriesResearch in context |
| title_full_unstemmed | Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countriesResearch in context |
| title_short | Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countriesResearch in context |
| title_sort | associations between degree of food processing and all cause and cause specific mortality a multicentre prospective cohort analysis in 9 european countriesresearch in context |
| topic | Nova classification Unprocessed/minimally processed foods Ultra-processed foods Mortality EPIC study |
| url | http://www.sciencedirect.com/science/article/pii/S2666776224003776 |
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