Summary:
Multimorbidity, meaning the presence of two or more chronic diseases, has become increasingly common over recent decades. This study looked at the multimorbidity of cancer, cardiovascular disease and type 2 diabetes, as these conditions are major contributors to global illness and share preventable risk factors, including diet quality. Ultra‑processed foods have become a dominant part of modern diets, sometimes accounting for more than half of daily energy intake. Their increasing consumption has raised concerns about long‑term health effects. Prior research has linked higher intake of ultra‑processed foods to greater risks of cancer, cardiovascular disease, type 2 diabetes and weight gain, all of which may contribute to multimorbidity. However, evidence specifically examining whether ultra‑processed food intake relates to the co‑occurrence of these diseases has been limited. This study is a large prospective cohort analysis which followed more than 266,000 adults who were free of cancer, cardiovascular disease and type 2 diabetes at baseline. Dietary intake over the previous year was assessed using food‑frequency questionnaires, and foods were classified according to the Nova processing system. The study evaluated whether total and subgroup consumption of ultra‑processed foods predicted the development of multimorbidity involving cancer and cardiometabolic diseases. Over a follow‑up of 11.2 years, higher consumption of ultra‑processed foods was associated with an increased risk of developing multimorbidity. The strongest associations were observed for animal‑based ultra‑processed products and sweetened beverages. These findings suggest that greater intake of certain ultra‑processed food groups may contribute to the combined development of cancer, cardiovascular disease and type 2 diabetes, highlighting diet as a modifiable factor in the prevention of multimorbidity.
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Abstract:
Background: It is currently unknown whether ultra-processed foods (UPFs) consumption is associated with a higher incidence of multimorbidity. We examined the relationship of total and subgroup consumption of UPFs with the risk of multimorbidity defined as the co-occurrence of at least two chronic diseases in an individual among first cancer at any site, cardiovascular disease, and type 2 diabetes. Methods: This was a prospective cohort study including 266,666 participants (60% women) free of cancer, cardiovascular disease, and type 2 diabetes at recruitment from seven European countries in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Foods and drinks consumed over the previous 12 months were assessed at baseline by food-frequency questionnaires and classified according to their degree of processing using Nova classification. We used multistate modelling based on Cox regression to estimate cause-specific hazard ratios (HR) and their 95% confidence intervals (CI) for associations of total and subgroups of UPFs with the risk of multimorbidity of cancer and cardiometabolic diseases. Findings: After a median of 11.2 years of follow-up, 4461 participants (39% women) developed multimorbidity of cancer and cardiometabolic diseases. Higher UPF consumption (per 1 standard deviation increment, ∼260 g/day without alcoholic drinks) was associated with an increased risk of multimorbidity of cancer and cardiometabolic diseases (HR: 1.09, 95% CI: 1.05, 1.12). Among UPF subgroups, associations were most notable for animal-based products (HR: 1.09, 95% CI: 1.05, 1.12), and artificially and sugar-sweetened beverages (HR: 1.09, 95% CI: 1.06, 1.12). Other subgroups such as ultra-processed breads and cereals (HR: 0.97, 95% CI: 0.94, 1.00) or plant-based alternatives (HR: 0.97, 95% CI: 0.91, 1.02) were not associated with risk.
Article Publication Date: 13/11/2023
DOI: 10.1016/j.lanepe.2023.100771
