Effect of ultraprocessed food intake on cardiometabolic risk is mediated by diet quality: a cross-sectional study.

Jennifer Griffin, Anwar Albaloul, Alexandra Kopytek, Paul Elliott, Gary Frost

Journal: BMJ nutrition, prevention & health 2021;4(1):174-180

PMID: 34308125

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Plain Language Summary

Although, food processing is integral to feeding the worlds growing population, the consumption of ultra-processed foods has been associated with a deterioration in diet quality and non-communicable disease risk. The aim of this study was to examine the effect of the consumption of ultra-processed food on diet quality, and cardiometabolic risk (CMR) in an occupational cohort. This study is a cross-sectional study based on data from participants within the Airwave Health Monitoring Study. Results show that the consumption of ultra-processed food increases CMR through the worsening of the overall quality of the diet. Authors conclude that the negative impact of ultra-processed food consumption on diet quality needs to be addressed and controlled studies are needed to fully comprehend whether the relationship between ultra-processed food consumption and health is independent to its relationship with poor diet quality.

Abstract

OBJECTIVE

To examine the effect of the consumption of ultraprocessed food on diet quality, and cardiometabolic risk (CMR) in an occupational cohort.

DESIGN

Cross-sectional.

SETTING

Occupational cohort.

PARTICIPANTS

53 163 British police force employees enrolled (2004-2012) into the Airwave Health Monitoring Study. A total of 28 forces across the UK agreed to participate. 9009 participants with available 7-day diet record data and complete co-variate data are reported in this study.

MAIN OUTCOME MEASURES

A CMR and Dietary Approaches to Stop Hypertension score were treated as continuous variables and used to generate measures of cardiometabolic health and diet quality. Secondary outcome measures include percentage of energy from fat, saturated fat, carbohydrate, protein and non-milk extrinsic sugars (NMES) and fibre grams per 1000 kcal of energy intake.

RESULTS

In this cohort, 58.3%±11.6 of total energy intake was derived from ultraprocessed (NOVA 4) foods. Ultraprocessed food intake was negatively correlated with diet quality (r=-0.32, p<0.001), fibre (r=-0.20, p<0.001) and protein (r = -0.40, p<0.001) and positively correlated with fat (r=0.18, p<0.001), saturated fat (r=0.14, p<0.001) and nmes (r=0.10, p<0.001) intake. Multivariable analysis suggests a positive association between ultraprocessed food (NOVA 4) consumption and CMR. However, this main effect was no longer observed after adjustment for diet quality (p=0.209). Findings from mediation analysis indicate that the effect of ultraprocessed food (NOVA 4) intake on CMR is mediated by diet quality (p<0.001).

CONCLUSIONS

Ultraprocessed food consumption is associated with a deterioration in diet quality and positively associated with CMR, although this association is mediated by and dependent on the quality of the diet. The negative impact of ultraprocessed food consumption on diet quality needs to be addressed and controlled studies are needed to fully comprehend whether the relationship between ultraprocessed food consumption and health is independent to its relationship with poor diet quality.

Address: Nutrition and Dietetics Research Group, Imperial College London, London, London, UK.; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

DOI: 10.1136/bmjnph-2020-000225