In a study recently published in the journal Nutrients, researchers investigated the association between consumption of ultra-processed foods (UPF) and gastrointestinal (GI) cancers and other causes of mortality in southern Italy.
Their findings indicate that increased UPF intake is associated with increased overall mortality and mortality from gastrointestinal cancer, highlighting the need for dietary intervention.
Study: Ultra-processed food intake as a risk factor for gastrointestinal cancers and other causes of mortality in Southern Italy: a competing risks approach. Image credit: beauty-box/Shutterstock.com
background
Previous studies have shown that chronic diseases such as cancer, type 2 diabetes and cardiovascular disease are leading causes of mortality worldwide, and diet is an important factor that can be modified for prevention.
UPF now accounts for 30% to 50% of daily calorie intake worldwide and is on the rise even in the Mediterranean region, known for its traditionally healthy diets.
The Nova classification highlights that UPF is industrially produced, often containing degraded food ingredients and additives, and is high in sugar and fat but lacking in nutrients.
Studies have shown that consumption of UPF is associated with a variety of health risks, including gut microbiome abnormalities and increased risk of cancer, especially colon cancer.
Despite these findings, the impact of UPF intake on all-cause mortality and gastrointestinal cancer remains poorly understood.
About the Research
This study aimed to fill a gap in existing research by investigating how UPF consumption is associated with mortality in the Southern Italian population.
The study recruited 4,870 participants from two cohorts in southern Italy: the Mineral and Cardiovascular Outcomes Longitudinal Study (MICOL) included subjects randomly selected from the electoral register of Castellana Grotte and followed up over multiple years, while the Nutrition and Hepatology (NUTRIHEP) study included adults from the general practitioner register of Putignano.
Participants provided informed consent and written assent and completed an interview on socio-demographic, health, lifestyle and dietary information using the European Prospective Investigation into Cancer (EPIC) food frequency questionnaire (FFQ).
Physical measurements including weight, height and blood pressure were taken, and fasting blood samples were analysed for biochemical markers.
UPF intake was assessed and classified according to the Nova classification, which groups foods by their level of processing. Study participants were divided into quartiles based on their daily UPF intake.
Cox proportional hazards regression and competing risks models were used to analyze the association between UPF intake and mortality, adjusting for age, sex, body mass index (BMI), marital status, occupation, smoking, daily calorie intake, and alcohol intake.
This analysis aimed to estimate hazard ratios (HRs) and subdistribution hazard ratios (SHRs) for all-cause mortality and for specific causes of death, including cardiovascular diseases, gastrointestinal diseases, and other cancers.
Investigation result
During the study period, 935 participants (19.2%) died, for an incidence rate of 33.9 deaths per 1,000 person-years over a total of 27,562.3 person-years.
Of the deaths, 271 people (29.5%) died from cardiovascular disease, and 268 people (28.7%) died from various cancers. Of these, 105 people (11.2%) died from digestive cancer (22 from colorectal cancer, 34 from liver/intrahepatic bile duct cancer, 20 from pancreatic cancer, etc.), and 396 people (42.3%) died from other causes.
Further analysis revealed that compared with the lowest quartile of UPF, the risk of all-cause mortality was 27% higher in the third quartile (SHR 1.27) and 34% higher in the highest quartile (SHR 1.34).
Specifically, mortality from gastrointestinal cancer was associated with a dose-dependent relationship, with significantly elevated risks in the second (SHR 1.65) and fourth (SHR 3.14) quartiles, while the third quartile was associated with a 61% increased risk of other types of cancer (SHR 1.61).
These results highlight the significant association between increased UPF intake and increased risk of mortality, especially from gastrointestinal cancer, and underscore the importance of dietary interventions to reduce UPF intake.
Conclusion
The results of this study support previous studies by showing a dose-dependent positive correlation between UPF intake and the incidence of gastrointestinal cancer and all-cause mortality.
This study highlights the increased risks associated with increased UPF intake, especially among younger people in Mediterranean countries, where UPF consumption is increasing due to affordability and convenience.
The strengths of this study are the use of a competing risks approach and reliable cancer registry data, but it is limited by potential residual confounding factors and the inability of the baseline food frequency questionnaire to fully capture the extent of food processing.
In comparison, previous studies have established an association between UPF consumption and various cancers and metabolic diseases, including colon cancer, breast cancer, and type 2 diabetes. The high caloric density, added sugars, and fats found in UPF contribute to obesity and other metabolic problems, making them significant risk factors for chronic disease.
Future studies should consider factors such as nutritional value and the effects of food additives and aim to clarify the causal mechanisms between UPF and health outcomes.
Public health interventions and dietary education programs are essential to reduce UPF-related health risks and promote traditional Mediterranean dietary patterns.
Journal References:
Campanella, A., Tatoli, R., Bonfiglio, C., Donghia, R., Cuccaro, F., Giannelli, G. (2024) Intake of ultra-processed foods as a risk factor for gastrointestinal cancer and other causes of mortality in Southern Italy: a competing risks approach. Nutrients. doi:https://doi.org/10.3390/nu16131994. https://www.mdpi.com/2072-6643/16/13/1994
