by Veronica Hackethal, MD
People who consume higher levels of ultra-processed foods may be at
increased risk for death, according to a study (Association
Between Ultra-processed Food Consumption and Risk of Mortality Among
Middle-aged Adults in France) published online February
11 in JAMA Internal Medicine.
"Findings from this
prospective study of a large French cohort suggest for the first
time, to our knowledge, that an increased proportion of
ultra-processed foods in the diet is associated with a higher
risk of overall mortality," write Laura Schnabel, MD, from the
Sorbonne Paris Cité, Bobigny, France, and colleagues.
include mass-produced, ready-to-eat foods such as,
Such foods usually
contain "empty calories" and have a high caloric content with little
They are low in fiber and
high in carbohydrates, saturated fats, and salt. Usually, they
contain food additives and contaminants that may be harmful to
health, including some that may be carcinogenic, according to the
People often select ultra-processed foods because of,
Such foods are also
highly marketed and are often prominently displayed in supermarkets.
Yet such convenience may come at a cost.
Accumulating evidence has
linked ultra-processed foods to increased risk for chronic diseases,
Whether this leads to an
increased risk for death has never been investigated before.
Therefore, the researchers conducted an observational prospective
They analyzed data from
44,551 adults aged 45 years and older who were participants in the
French NutriNet-Santé Study, an
ongoing, nationwide, web-based nutritional study that was launched
in May 2009.
The researchers conducted
a follow-up through December 15, 2017. Of the participants, 73.1%
were women, and the mean age was 57 years.
The researchers collected information on food intake using a series
of three web-based 24-hour dietary recall questionnaires, which were
completed every 6 months.
about foods typically consumed by the respondents at breakfast,
lunch, and dinner, as well as snacks.
The questionnaire also
provided validated photos so that participants could self-report
Respondents reported that, on average, 14.4% of the total weight of
the food they consumed came from ultra-processed foods. In other
words, ultra-processed foods accounted for 29.1% of their total
daily caloric intake.
During the course of the 7-year study, 602 participants died (1.4%
of the study group).
For every 10% increase in the proportion of ultra-processed foods in
the diet, the risk for all-cause death increased by 14%:
hazard ratio per
10% increment, 1.14
P = .008
Notably, these analyses
adjusted for many potential confounders that could have affected
family history of cancer/cardiovascular disease
number of 24-hour
dietary records completed
season of dietary
nutritional quality of the diet
The authors emphasize
that adjusting for an overall
healthy diet (as estimated by
adherence to French national recommendations) weakened the
association between ultra-processed foods and death but did not
That suggests that an
overall healthy diet may play a role in the association, but other
factors may also be involved.
They went on to explain that additives, as well as the
high salt, high sugar and low fiber content of ultra-processed
foods, could contribute to increased risk for chronic diseases.
Those, in turn, could
ultimately lead to the increased risk for mortality found in this
"Further studies are
needed to confirm those results in different populations and to
disentangle the various mechanisms by which ultra-processed
foods may affect health, including both their nutritional
features and their food processing-related characteristics,"
They mention several
limitations to the study.
Notably, participation in
the study was voluntary and may have attracted participants who were
more health conscious than the general population.
If so, the results may
underestimate the link between ultra-processed foods and death.
Also, follow-up may have been too short to capture some deaths
resulting from chronic diseases, which develop over decades.
Nevertheless, the authors conclude:
foods consumption has largely increased during the past several
decades and may drive a growing burden of non-communicable