Ultra-processed food consumption and cardiovascular events rate: An analysis from Isfahan Cohort Study (ICS)

Background and aims The contribution of ultra-processed foods (UPFs) to daily energy intake and therefore their health effects may vary between countries. We aimed to investigate the association between UPFs and the incidence risk of cardiovascular events (CVE) and cardiovascular mortality in the Isfahan cohort study. Methods and results In 2001, 6504 participants aged ≥ 35 years were enrolled and followed until 2017. Dietary intake was assessed using a validated food frequency questionnaire and NOVA system was applied for UPF classification. Any new case of CVE, including fatal and non-fatal myocardial infarction (MI) or stroke, unstable angina (UA), and CVD death was recorded. Hazard ratio (HR)s and 95% confidence interval (CI)s were estimated through Cox proportional hazards regression models. A total number of 819 CVE, 164 MI, 348 UA, 172 stroke, and 181 cardiovascular deaths were recorded during 61352.5 person-years of follow-up. The median (IQR) of UPFs consumption was 2.47 (1.00-5.23) times/week. In the fully-adjusted model, individuals in the fourth quartile of UPFs had no higher risk for incident MI and UA (HR= 1.12, 95% CI: 0.87, 1.46; P for trend= 0.364), stroke (HR= 0.93, 95% CI: 0.58, 1.46; P for trend= 0.601), cardiovascular mortality (HR= 0.95, 95% CI: 0.61, 1.47; P for trend= 0.596), and CVE (HR= 1.08, 95% CI: 0.88,1.34; P for trend= 0.515) in comparison with those in the first quartile. Conclusion This mid-term prospective cohort study provides no evidence for a significant association between UPF and CVEs risk. Longer studies are required to confirm this association.