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Cited by 390Consumer Attitudes and Food LabelingNutritional Studies and DietGlobal Public Health Policies and Epidemiology

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

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Schnabel, Laure, Kesse-Guyot, Emmanuelle, Allès, Benjamin, Touvier, Mathilde, Srour, Bernard, Hercberg, Serge, Buscail, Camille, Julia, Chantal·2019·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2018.7289PMC PMC6450295
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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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  1. Le Moullec, 1996, Validation du manuel-photos utilisé pour l’enquête alimentaire de l’étude SU. VI. MAX., Cah Nutr Diét, 31, 158
  2. Nutrinet-Santé, 2013, Table de Composition des Aliments de l’étude NutriNet-Santé
  3. World Health Organization, 1992, International Statistical Classification of Diseases, Tenth Revision (ICD-10)

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Metadata

Authors
Schnabel, L., Kesse-Guyot, E., Allès, B., Touvier, M., Srour, B., Hercberg, S., Buscail, C., & Julia, C.
Affiliations
  • Université Sorbonne Paris Nord (FR)
  • Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche Epidémiologie et Statistique, Sorbonne Paris Cité, Bobigny, France
Corresponding author
Schnabel, Laure
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2019-04-01
Volume
179
Issue
4
Pages
490
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2018.7289
PMC
PMC6450295
OpenAlex
W2911872206
Cited by
390
References
61
Citations by year
2026: 22 · 2025: 32 · 2024: 49 · 2023: 46 · 2022: 66 · 2021: 84 · 2020: 52 · 2019: 38
FWCI
55.23
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Consumer Attitudes and Food Labeling
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Public Health Policies and Epidemiology
Keywords
ultra-processed foods, all-cause mortality, NOVA classification, middle-aged adults, dietary intake, food processing, mortality risk, NutriNet-Santé cohort, energy intake, non-communicable diseases, food additives, dietary habits, French adults, age differences in diet, sex differences in diet, socioeconomic status, physical activity, alcohol consumption, smoking, body mass index
MeSH terms
Energy Intake, Cause of Death, Female, Follow-Up Studies, Food Handling, France, Humans, Male, Middle Aged, Obesity, Prospective Studies, Risk Factors, Exercise, Survival Rate, Risk Assessment, Fast Foods

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