Ultra-processed foods, but not bread or breakfast cereals, linked to multimorbidity: The Lancet
Multimorbidity is when one develops two or more chronic diseases, such as cancer, cardiovascular disease, and type-2 diabetes.
The study, which analysed the diets of 266,666 Europeans across seven countries (Denmark, Germany, Italy, Spain, Sweden, the Netherlands, and the United Kingdom), showed that while consumption of some UPFs is linked to multimorbidity, not all UPFs are the same. Plant-based alternatives are, in fact, not linked to multimorbidity, while breakfast cereals and packaged breads were linked inversely so.
Analysing years of diet
The participants, who upon beginning the study were free of cancer, cardiovascular disease and type-2 diabetes, were recruited between 1992 and 2000. They filled out questionnaires on their diet, the results of which were assessed through the Nova classification (see fact box). Foods given the classification of four were considered ultra processed, or UPF (however, alcohol consumption was excluded from the study).
As many of the foods assessed were consumed in the 1990s, the study took into account the time and place the food was produced when ascertaining its level of processing.
The Nova classification is a classification system which assesses the level of processing that a certain food has undergone. These range from 1) unprocessed or minimally processed foods; 2) processed culinary ingredients; 3) processed foods and 4) ultra-processed foods. Ultra-processed foods include biscuits, processed meat, instant noodles, plant-based alternatives and ultra-processed bread.
Every three or four years, the participants were checked and asked whether they had developed a major disease. Once participants had developed multimorbidity, died, or their data was lost, they exited from the study.
The first disease each participant developed was noted first. 21,917 developed primary cancers, 10,939 experienced cardiovascular events, and 11,322 experienced type-2 diabetes events.
The most common multimorbidity pattern was cancer developed after cardiovascular disease, followed by cancer developed in people with type-2 diabetes, followed type-2 diabetes developed in those with cardiovascular disease.
The link between multimorbidity and food consumption
The study also assessed the links between different types of UPF and the level of development of multimorbidity. Not every UPF had the same effect on these links.
UPFs most strongly linked to the development of multimorbidity were processed animal products and sugary drinks. The consumption of sauces, spreads and condiments also showed a positive association with the development of multimorbidity, but with a lower level of certainty.
However, packaged breads and breakfast cereals showed an inverse link with the development of multimorbidity. Alongside this, sweets and desserts, savoury snacks, ready-to-eat/heat mixed dishes, plant-based alternatives and other unspecified ultra-processed foods did not present the link at all.
The health quality of plant-based alternatives is often called into question. A recent study, for instance, showed that it lacks certain animal-linked micronutrients, such as iron and zinc. However, the current study suggested that unlike many of its UPF brethren, it is not linked to multimorbidity.
Fact box: Some limitations were present. For example, the foods were processed a long time ago. This, while taken into account in the study, also meant the processing data for each food at the time wasn’t always available. Furthermore, researchers did not evaluate whether participants changed diets after developing their first disease. Thirdly, some treatments, such as that for type-2 diabetes, were not taken into account. Finally, study participants do not necessarily represent the general population.
Sourced From: The Lancet
'Consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study’
Published on: 13 November 2023
DOI: https://doi.org/10.1016/j.lanepe.2023.100771
Authors: R. Cordova, V. Viallon, E. Fontvieille, L. Peruchet-Noray, A. Jansana, K. Wagner, C. Kyrø, A. Tjønneland, V. Katzke, R. Bajracharya, M. B. Schulze, G. Masala, S. Sieri, S. Panico, F. Ricceri, R.Tumino, Jolanda M.A. Boer, W.M.Monique Verschuren, Y. T. der Schouw, P. Jakszyn, D. Redondo-Sánchez, F.Amiano, J. M. Huerta, M. Guevara, Y. Borné, E. Sonestedt, K. K. Tsilidis, C. Millett, A. K. Heath, E. K. Aglago, D. Aune, M. J. Gunter, P. Ferrari, I. Huybrechts, H. Freisling
