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Original Investigation
December 5, 2022

Association Between Consumption of Ultraprocessed Foods and Cognitive Decline

Author Affiliations
  • 1Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
  • 2Adventist University of São Paulo, Engenheiro Coelho, Brazil
  • 3Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
  • 4Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
  • 5Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 6Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
  • 7Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
  • 8Behavioral and Cognitive Neurology Research Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  • 9Federal University of Bahia, Salvador, Brazil
JAMA Neurol. 2023;80(2):142-150. doi:10.1001/jamaneurol.2022.4397
Key Points

Question  Is the consumption of ultraprocessed foods associated with cognitive decline?

Findings  In a cohort study of 10 775 individuals, higher consumption of ultraprocessed foods was associated with a higher rate of global and executive function decline after a median follow-up of 8 years.

Meaning  These findings suggest that limiting consumption of ultraprocessed food could be associated with reduced cognitive decline in middle-aged and older adults.


Importance  Although consumption of ultraprocessed food has been linked to higher risk of cardiovascular disease, metabolic syndrome, and obesity, little is known about the association of consumption of ultraprocessed foods with cognitive decline.

Objective  To investigate the association between ultraprocessed food consumption and cognitive decline in the Brazilian Longitudinal Study of Adult Health.

Design, Setting, and Participants  This was a multicenter, prospective cohort study with 3 waves, approximately 4 years apart, from 2008 to 2017. Data were analyzed from December 2021 to May 2022. Participants were public servants aged 35 to 74 years old recruited in 6 Brazilian cities. Participants who, at baseline, had incomplete food frequency questionnaire, cognitive, or covariate data were excluded. Participants who reported extreme calorie intake (<600 kcal/day or >6000 kcal/day) and those taking medication that could negatively interfere with cognitive performance were also excluded.

Exposures  Daily ultraprocessed food consumption as a percentage of total energy divided into quartiles.

Main Outcomes and Measures  Changes in cognitive performance over time evaluated by the immediate and delayed word recall, word recognition, phonemic and semantic verbal fluency tests, and Trail-Making Test B version.

Results  A total of 15 105 individuals were recruited and 4330 were excluded, leaving 10 775 participants whose data were analyzed. The mean (SD) age at the baseline was 51.6 (8.9) years, 5880 participants (54.6%) were women, 5723 (53.1%) were White, and 6106 (56.6%) had at least a college degree. During a median (range) follow-up of 8 (6-10) years, individuals with ultraprocessed food consumption above the first quartile showed a 28% faster rate of global cognitive decline (β = −0.004; 95% CI, −0.006 to −0.001; P = .003) and a 25% faster rate of executive function decline (β = −0.003, 95% CI, −0.005 to 0.000; P = .01) compared with those in the first quartile.

Conclusions and Relevance  A higher percentage of daily energy consumption of ultraprocessed foods was associated with cognitive decline among adults from an ethnically diverse sample. These findings support current public health recommendations on limiting ultraprocessed food consumption because of their potential harm to cognitive function.

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2 Comments for this article
When will this be applied?
Eric Potter, MD | Sanctuary Functional Medicine
I always appreciate when researchers are able to confirm the suspicions we have had from clinical experience and from extrapolation of known mechanisms. As one in the front lines caring for patients, I don't have the time nor resources (nor skills) to complete this time of study. Thank you to those who dedicate themselves to the work of discerning truth in medicine.

With that being said, I hope this knowledge of the effects of ultra-processed food will not take the average 17 years before it becomes mainstream and standard in the clinical office. We have an
epidemic of neurologic decline in a growing aged population. Our elderly patients have worked through their productive years only to retire with diminished or compromised cognitive abilities thanks to the ultra-processed foods of our society. We are already seeing the negative effects. The true impact will be seen as the 40 year olds of today reach their 60s. It is this coming generation of elderly in 10-20 years who lived their entire lives under the weight of highly processed foods. If something is not done to alter their course, the tsunami will be far more destructive in their lives.

How will busy and overworked, if not burnt out providers, have time to guide their patients in this lifestyle change when the providers are just as caught up in this processed nutrition lifestyle? We must recognize that this is worthy of major changes to our practice habits. We must recognize that we need to incorporate other ancillary health providers into our patient's team care. We must speak up and stand up.

Dr. Eric Potter
Re: When will this be applied?
Natalia Gomes Gonçalves, PhD | University of São Paulo Medical School
Dear Dr. Potter,
Thank you for your kind letter about our study. The increase in consumption of ultra-processed foods worldwide is indeed worrisome. However, several countries have tried to curb these products' consumption. For example, the UK has instituted a tax that increased the prices of sodas and other sugar-sweetened beverages that are rich in added sugar.(1) This measure was also adopted in several US cities and had positive results in decreasing the consumption of sugar-sweetened beverages.(2) Brazil has updated the labels of ultra-processed foods to include information about sugar, salt, and fat content.(3) Recent dietary guidelines from several countries
have also incorporated directions to better dietary habits for the general population and health professionals.(4) These guidelines should be widely used to guide the population to develop a healthy lifestyle.

Also, we would like to emphasize that our study was observational and needs to be confirmed by randomized clinical trials. Previous clinical trials, such as the PREDIMED trial have shown that participants adhering to a Mediterranean diet rich in olive oil and nuts had reduced risk of cardiovascular events in a high-risk cohort.(5) Currently, the Worldwide FINGERS network is also investigating the combination of several lifestyle habits, including dietary orientation based on the MIND diet, to improve cognitive performance.(6)

We hope that our work will help people worldwide transition into a healthier lifestyle and it will guide public policies to advance access to healthy food choices.

Drs. Natalia Gomes Goncalves and Claudia Kimie Suemoto


1. Institute for Government. Sugar Tax. Available at https://www.instituteforgovernment.org.uk/explainers/sugar-tax [accessed December 15, 2022]
2. Falbe J, Thompson HR, Becker CM et al. Impact of the Berkeley Excise Tax on Sugar-Sweetened Beverage Consumption. Am J Public Health. 2016 Oct;106(10):1865-71. doi: 10.2105/AJPH.2016.303362.
3. Instituto Brasileiro de Defesa do Consumidor. Ultraprocessados: entenda mudança na rotulagem de alimentos. Available at https://idec.org.br/idec-na-imprensa/ultraprocessados-entenda-mudanca-na-rotulagem-de-alimentos [accessed December 15, 2022]
4. Food and Agriculture Organization of the United Nations. Food-based dietary guidelines. Available at https://www.fao.org/nutrition/education/food-based-dietary-guidelines [accessed December 15, 2022]
5. Estruch R, Ros E, Salas-Salvadó J et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018 ;378(25):e34. doi: 10.1056/NEJMoa1800389
6. Kivipelto M, Mangialasche F, Snyder HM et al. World-Wide FINGERS Network: A global approach to risk reduction and prevention of dementia. Alzheimers Dement. 2020 Jul;16(7):1078-1094. doi: 10.1002/alz.12123.