Consumption of ultra-processed foods and health status: a systematic review and meta-analysis

G Pagliai, M Dinu, M P Madarena, M Bonaccio, L Iacoviello, F Sofi, G Pagliai, M Dinu, M P Madarena, M Bonaccio, L Iacoviello, F Sofi

Abstract

Increasing evidence suggests that high consumption of ultra-processed foods (UPF) is associated with an increase in non-communicable diseases, overweight and obesity. The present study systematically reviewed all observational studies that investigated the association between UPF consumption and health status. A comprehensive search of MEDLINE, Embase, Scopus, Web of Science and Google Scholar was conducted, and reference lists of included articles were checked. Only cross-sectional and prospective cohort studies were included. At the end of the selection process, twenty-three studies (ten cross-sectional and thirteen prospective cohort studies) were included in the systematic review. As regards the cross-sectional studies, the highest UPF consumption was associated with a significant increase in the risk of overweight/obesity (+39 %), high waist circumference (+39 %), low HDL-cholesterol levels (+102 %) and the metabolic syndrome (+79 %), while no significant associations with hypertension, hyperglycaemia or hypertriacylglycerolaemia were observed. For prospective cohort studies evaluating a total population of 183 491 participants followed for a period ranging from 3·5 to 19 years, highest UPF consumption was found to be associated with increased risk of all-cause mortality in five studies (risk ratio (RR) 1·25, 95 % CI 1·14, 1·37; P < 0·00001), increased risk of CVD in three studies (RR 1·29, 95 % CI 1·12, 1·48; P = 0·0003), cerebrovascular disease in two studies (RR 1·34, 95 % CI 1·07, 1·68; P = 0·01) and depression in two studies (RR 1·20, 95 % CI 1·03, 1·40; P = 0·02). In conclusion, increased UPF consumption was associated, although in a limited number of studies, with a worse cardiometabolic risk profile and a higher risk of CVD, cerebrovascular disease, depression and all-cause mortality.

Keywords: CVD; Health; Meta-analysis; Mortality; Ultra-processed food.

Figures

Fig. 1.
Fig. 1.
Preferred Reporting Items for Systematic Reviews and Meta-analysis flow diagram for search strategy. RCT, randomised controlled trials.
Fig. 2.
Fig. 2.
Forest plot of cross-sectional studies investigating the association between ultra-processed foods consumption and different health outcomes. P value is for Z test of no overall association between exposure and outcome; Phet is for test of no differences in association measure among studies; I2 estimates from heterogeneity rather than sampling error. WC, waist circumference.
Fig. 3.
Fig. 3.
Forest plot of prospective cohort studies investigating the association between ultra-processed foods consumption and different health outcomes. P value is for Z test of no overall association between exposure and outcome; Phet is for test of no differences in association measure among studies; I2 estimates from heterogeneity rather than sampling error. CV, cerebrovascular.

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