In the last three decades, there has been a significant increase in the prevalence of cardiovascular diseases, which remains a major cause of mortality and morbidity. Simultaneously, an increase in the number of people with cardiometabolic risk (CMR) factors, such as high fasting plasma glucose, hypertension, obesity, and high low-density lipoprotein (LDL) cholesterol, has been recorded.
Although several studies have established the link between higher ultra-processed food (UPF) consumption and increased incidence of cardiovascular diseases, not many studies have documented how modifying UPF consumption affects CMR factors. Addressing this gap in research, a recent Atherosclerosis journal study investigates how changes in UPF consumption influence CMR factors.
Study: Increased ultra-processed food consumption is associated with worsening in cardiometabolic risk factors in adults with metabolic syndrome: Longitudinal analysis from a randomized trial. Image Credit: aquariagirl1970 / Shutterstock.com
Diet plays an important role in preventing the risk of developing cardiovascular disease. Typically, foods with high-density energy but low nutritional content increase CMR factors. Based on the NOVA classification, food, and beverages that are categorized as ultra-processed food (UPF) undergo a high level of industrial processing to make them more palatable, ready-to-eat, and accessible.
In the last decade, the rate of UPF consumption has increased significantly. UPF intake has been associated with lower diet quality due to high levels of total and saturated fats, free sugar, and low concentration of fibers, proteins, vitamins, and minerals in these products.
Several longitudinal, cross-sectional studies have established the link between UPF consumption and several CMR factors. A French study revealed that higher consumption of UPF increases the risk of diabetes and cardiovascular diseases. Another prospective study conducted by Navarra University (SUN) indicated that higher UPF consumption increases the risk of hypertension by 21%.
About the study
The prospective study analyzed how modifications in UPF consumption influence CMR factors, such as body mass index (BMI), weight, blood pressure, waist circumference, glycated hemoglobin (HbA1c), triglycerides, blood glucose, cholesterol (total, HDL, and LDL), and triglycerides and glucose index (TyG index).
Relevant data were collected during the first 12 months of follow-up of the PREDIMED-Plus study. The PREDIMED-Plus is an ongoing multi-center, randomized clinical trial that was designed to investigate how intensive weight loss intervention related to adherence to the Mediterranean diet, physical activity, and behavior prevents the incidence of cardiovascular diseases.
All participants were recruited between September 2013 and December 2016 from 23 centers across the Spanish territory and randomly assigned to two groups. Both male and female obese participants were employed.
All participants had three of the five risk factors of metabolic syndrome, including hypertension, plasma HDL cholesterol, fasting blood glucose, plasma triglycerides, and obesity. Data on participants' dietary intake was obtained through interviews, and answers were validated through a semi-quantitative food frequency questionnaire (FFQ) at baseline, six, and 12 months follow-up.
A total of 5,373 participants, 52% of whom were male and 48% female, met all eligibility criteria and were included in the present study. All participants were around 65 years of age. The participants with higher UPF consumption were significantly younger, less physically active, and least adept to adhere to an energy-restricted Mediterranean diet.
Higher intake of UPF was positively associated with waist circumference, weight, diastolic blood pressure, TyG index, HbA1c, triglycerides, and fasting blood glucose. In this context, several sociodemographic and lifestyle characteristics were adjusted.
UPF consumption rate was reduced during the 12 months of follow-up, which could be because participants were instructed on how to adhere to the Mediterranean diet. In this study, UPF presented 7.7% of the total amount of food consumed by weight.
The reduction in UPF consumption could be because all participants were obese and had metabolic syndrome at baseline. Thus, changes in their dietary intake could be a part of the healthcare regime.
Based on multivariable-adjusted analyses, higher UPF consumption was associated with obesity and greater waist circumference. However, such an association was not found in the lower UPF consumption group, as these associations exhibited a significant dose-response relationship. After 9.1 years of follow-up, individuals with the highest UPF consumption exhibited an elevated risk of developing hypertension as compared to those with a lower intake of UPF.
Higher UPF consumption has been strongly linked with an increase in diastolic blood pressure. However, when this effect was studied, no statistically significant association with systolic blood pressure was found when UPF consumption increased by 100 gm/day.
UPF consumption was also associated with unfavorable levels of plasma triglycerides and TyG index but not with total HDL, and LDL cholesterol. A positive association between total cholesterol and a 5% increment in UPF consumption was estimated.
The current study has several limitations, including the lack of generalizability in the cohort, as it comprised participants whose ages were between 55 and 75 years. In addition, all participants were overweight and had metabolic syndrome at baseline. Additionally, this study followed NOVA classification, which is not a perfect system to classify UPF.
Despite these limitations, this study re-emphasized the adverse effect of UPF consumption on cardiometabolic risk factors.
- González-Palacios, S., Oncina-Canovas, A., Garcia-de-la-Hera, M., et al. (2023) Increased ultra-processed food consumption is associated with worsening in cardiometabolic risk factors in adults with metabolic syndrome: Longitudinal analysis from a randomized trial. Atherosclerosis. doi:10.1016/j.atherosclerosis.2023.05.022