Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort

Thibault Fiolet, Bernard Srour, Laury Sellem, Emmanuelle Kesse-Guyot, Benjamin Allès, Caroline Méjean, Mélanie Deschasaux, Philippine Fassier, Paule Latino-Martel, Marie Beslay, Serge Hercberg, Céline Lavalette, Carlos A Monteiro, Chantal Julia, Mathilde Touvier, Thibault Fiolet, Bernard Srour, Laury Sellem, Emmanuelle Kesse-Guyot, Benjamin Allès, Caroline Méjean, Mélanie Deschasaux, Philippine Fassier, Paule Latino-Martel, Marie Beslay, Serge Hercberg, Céline Lavalette, Carlos A Monteiro, Chantal Julia, Mathilde Touvier

Abstract

Objective: To assess the prospective associations between consumption of ultra-processed food and risk of cancer.

Design: Population based cohort study.

Setting and participants: 104 980 participants aged at least 18 years (median age 42.8 years) from the French NutriNet-Santé cohort (2009-17). Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants' usual consumption for 3300 different food items. These were categorised according to their degree of processing by the NOVA classification.

Main outcome measures: Associations between ultra-processed food intake and risk of overall, breast, prostate, and colorectal cancer assessed by multivariable Cox proportional hazard models adjusted for known risk factors.

Results: Ultra-processed food intake was associated with higher overall cancer risk (n=2228 cases; hazard ratio for a 10% increment in the proportion of ultra-processed food in the diet 1.12 (95% confidence interval 1.06 to 1.18); P for trend<0.001) and breast cancer risk (n=739 cases; hazard ratio 1.11 (1.02 to 1.22); P for trend=0.02). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (lipid, sodium, and carbohydrate intakes and/or a Western pattern derived by principal component analysis).

Conclusions: In this large prospective study, a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in risks of overall and breast cancer. Further studies are needed to better understand the relative effect of the various dimensions of processing (nutritional composition, food additives, contact materials, and neoformed contaminants) in these associations.

Study registration: Clinicaltrials.gov NCT03335644.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work other than that described above; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Fig 1
Fig 1
Relative contribution of each food group to ultra-processed food consumption in diet
Fig 2
Fig 2
Cumulative cancer incidence (overall cancer risk) according to quarters of proportion of ultra-processed food in diet

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