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Original Investigation
February 11, 2019

Association Between Ultraprocessed Food Consumption and Risk of Mortality Among Middle-aged Adults in France

Author Affiliations
  • 1Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche Epidémiologie et Statistique, Sorbonne Paris Cité, Bobigny, France
  • 2Département de Santé Publique, Hôpital Avicenne (AP-HP), Bobigny, France
JAMA Intern Med. 2019;179(4):490-498. doi:10.1001/jamainternmed.2018.7289
Key Points

Question  Is high consumption of ultraprocessed food associated with an increase in overall mortality risk?

Findings  In this cohort study of 44 551 French adults 45 years or older, a 10% increase in the proportion of ultraprocessed food consumption was statistically significantly associated with a 14% higher risk of all-cause mortality.

Meaning  An increase in ultraprocessed food consumption may be associated with an overall higher mortality risk; further prospective research is needed to confirm these findings.

Abstract

Importance  Growing evidence indicates that higher intake of ultraprocessed foods is associated with higher incidence of noncommunicable diseases. However, to date, the association between ultraprocessed foods consumption and mortality risk has never been investigated.

Objective  To assess the association between ultraprocessed foods consumption and all-cause mortality risk.

Design, Setting, and Participants  This observational prospective cohort study selected adults, 45 years or older, from the French NutriNet-Santé Study, an ongoing cohort study that launched on May 11, 2009, and performed a follow-up through December 15, 2017 (a median of 7.1 years). Participants were selected if they completed at least 1 set of 3 web-based 24-hour dietary records during their first 2 years of follow-up. Self-reported data were collected at baseline, including sociodemographic, lifestyle, physical activity, weight and height, and anthropometrics.

Exposures  The ultraprocessed foods group (from the NOVA food classification system), characterized as ready-to-eat or -heat formulations made mostly from ingredients usually combined with additives. Proportion (in weight) of ultraprocessed foods in the diet was computed for each participant.

Main Outcomes and Measures  The association between proportion of ultraprocessed foods and overall mortality was the main outcome. Mean dietary intakes from all of the 24-hour dietary records available during the first 2 years of follow-up were calculated and considered as the baseline usual food-and-drink intakes. Mortality was assessed using CépiDC, the French national registry of specific mortality causes. Hazard ratios (HRs) and 95% CIs were determined for all-cause mortality, using multivariable Cox proportional hazards regression models, with age as the underlying time metric.

Results  A total of 44 551 participants were included, of whom 32 549 (73.1%) were women, with a mean (SD) age at baseline of 56.7 (7.5) years. Ultraprocessed foods accounted for a mean (SD) proportion of 14.4% (7.6%) of the weight of total food consumed, corresponding to a mean (SD) proportion of 29.1% (10.9%) of total energy intake. Ultraprocessed foods consumption was associated with younger age (45-64 years, mean [SE] proportion of food in weight, 14.50% [0.04%]; P < .001), lower income (<€1200/mo, 15.58% [0.11%]; P < .001), lower educational level (no diploma or primary school, 15.50% [0.16%]; P < .001), living alone (15.02% [0.07%]; P < .001), higher body mass index (calculated as weight in kilograms divided by height in meters squared; ≥30, 15.98% [0.11%]; P < .001), and lower physical activity level (15.56% [0.08%]; P < .001). A total of 602 deaths (1.4%) occurred during follow-up. After adjustment for a range of confounding factors, an increase in the proportion of ultraprocessed foods consumed was associated with a higher risk of all-cause mortality (HR per 10% increment, 1.14; 95% CI, 1.04-1.27; P = .008).

Conclusions and Relevance  An increase in ultraprocessed foods consumption appears to be associated with an overall higher mortality risk among this adult population; further prospective studies are needed to confirm these findings and to disentangle the various mechanisms by which ultraprocessed foods may affect health.

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    2 Comments for this article
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    Mace Moneta |
    There are a collection of lifestyle behaviors that are associated with high consumption of ultra-processed foods, many of which are not dietary in nature.
    CONFLICT OF INTEREST: None Reported
    Comment: Association Between Ultraprocessed Food Consumption and Risk of Mortality Among Middle-aged Adults in France1
    Adrienne Samuels, Ph.D. | Truth in Labeling Campaign
    Schnabel et al. have demonstrated an association between ultraprocessed food consumption and risk of mortality among middle-aged adults in France.

    High sodium, excessive added sugar, reduced fiber content, high-temperature processing, and frequent use of additives were offered as hypotheses to explain the association. Titanium dioxide, emulsifiers, and artificial intense sweeteners were mentioned as possible additives.

    Not considered was excitotoxic glutamic acid (glutamate), present in quantity in monosodium glutamate (MSG), hydrolyzed protein products, and more than 40 additional ingredients found in ultraprocessed foods.

    Glutamate is essential for normal body function. But when present in amounts greater
    than humans were designed to accommodate (excess) glutamate becomes excitotoxic.

    There are three kinds of damage done by manufactured free glutamate (MfG). The first manifests through its action as a flavor enhancer. MfG encourages consumption of more food than needed for normal body function, leading to obesity.

    Adverse reactions are the second type of damage. Their relation to MfG is fairly easy to trace. Asthma, seizures, tachycardia, and other reactions that occur as side effects of neurological drugs such as glutamate, have been reported. In infants and children, glutamate-induced asthma, headache, irritable bowel, nausea and vomiting, skin rash, and seizures are not uncommon.

    Brain damage is the third kind of damage done by MfG. Brain damage was first demonstrated in laboratory animals.2 Immature humans are impacted when MfG in mothers’ milk and infant formula is fed to infants, and by MfG passed by pregnant mothers to their fetuses.3-5

    Lack of BBB development in the fetus and the infant make them extremely vulnerable to exposure to MfG passed through their mothers’ diets. Damage done to BBBs of mature humans through use of drugs, seizures, stroke, head trauma, hypoglycemia, hypertension, extreme physical stress, high fever, and the normal process of aging render them vulnerable.

    Excess glutamate will be found in ultraprocessed foods. Reformulation of MSG in 1957 allowed virtually unlimited MSG production, and use of MSG and other flavor enhancers skyrocketed. Now excesses of glutamate and other excitotoxins are readily obtainable from groceries, pharmacies, restaurants, and health food stores.

    The free glutamate in ultraprocessed foods consumed by humans of all ages will cause adverse reactions, nutrient deficient foods, and over-eating. Ultraprocess food consumed in quantity by pregnant and/or lactating women will cause brain damage in fetuses and neonates that may not manifest until the young approach maturity.

    References

    1.Schnabel L, Kesse-Guyot E, Allès B, Touvier M, Srour B, Hercberg S, Buscail, Julia C. Association Between Ultraprocessed Food Consumption and Risk of Mortality Among Middle-aged Adults in France. JAMA Intern Med. 2019;179(4):490-498.

    2.Olney JW. Excitotoxins in food. Neurotoxicology. 1994;15(3):535-44.

    3.Frieder B, Grimm VE. Prenatal monosodium glutamate (MSG) treatment given through the mother's diet causes behavioral deficits in rat offspring. Intern J Neurosci. 1984;23(2):117-126.

    4.Yu T, Zhao Y, Shi W, Ma R, Yu L. Effects of maternal oral administration of monosodium glutamate at a late stage of pregnancy on developing mouse fetal brain. Brain Res. 1997;747(2):195-206.

    5.Price MT, Olney JW, Lowry OH, Buchsbaum S. Uptake of exogenous glutamate and aspartate by circumventricular organs but not other regions of brain. J Neurochem. 1981;36(5):1774-1780.
    CONFLICT OF INTEREST: None Reported
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