Ultra-Processed Food Consumption As a Risk Factor for Gastrointestinal Cancer and Other Causes of Mortality in Southern Italy: A Competing Risk Approach

Overview

Journal Nutrients

Date 2024 Jul 13

PMID 38999742

Authors

Angelo Campanella

Rossella Tatoli

Caterina Bonfiglio

Rossella Donghia

Francesco Cuccaro

Gianluigi Giannelli

Affiliations

Soon will be listed here.

Abstract

Background: Ultra-Processed Foods (UPFs) are increasingly consumed worldwide, even in regions with strong dietary traditions like the Mediterranean and can play a crucial role in the development of chronic diseases, including cancer. This population-based prospective cohort study investigates the association between UPF consumption and gastrointestinal cancers and other causes of mortality in Southern Italy.

Methods: Data were collected from 4870 participants in the MICOL and NUTRIHEP cohorts. The EPIC questionnaire was used to elicit information on food and drink consumption and UPFs were categorized by degree of processing according to the NOVA classification. Cox proportional hazards regression and competing risk models were employed for statistical analysis.

Results: UPF consumption was positively associated with all-cause mortality: participants in the 3rd UFP quartile, as compared to the lowest, had a 27% higher risk of death (SHR 1.27 95% CI, 1.03; 1.57), while in the highest quartile as compared to the lowest, the risk was 34% higher (SHR 1.34 95% CI, 1.00; 1.79). Higher UPFs intake was also correlated with an increased gastrointestinal cancers mortality risk, especially the 2nd (SHR 1.65, 95% CI: 1.01; 2.71) and 4th quartile (SHR 3.14 95% CI: 1.56; 6.32), with a dose-dependent effect. For the other cancers, a SHR 1.61 (95% CI 1.03; 2.54) was observed for the 3rd quartile.

Conclusions: Our results reinforce the link between UPF consumption and cancer risk, emphasizing the urgent need for interventions targeting dietary patterns.

References

Martini D, Godos J, Bonaccio M, Vitaglione P, Grosso G . Ultra-Processed Foods and Nutritional Dietary Profile: A Meta-Analysis of Nationally Representative Samples. Nutrients. 2021; 13(10). PMC: 8538030. DOI: 10.3390/nu13103390. View

Attili A, Capocaccia R, Carulli N, Festi D, Roda E, Barbara L . Factors associated with gallstone disease in the MICOL experience. Multicenter Italian Study on Epidemiology of Cholelithiasis. Hepatology. 1997; 26(4):809-18. DOI: 10.1002/hep.510260401. View

Morales-Berstein F, Biessy C, Viallon V, Goncalves-Soares A, Casagrande C, Hemon B . Ultra-processed foods, adiposity and risk of head and neck cancer and oesophageal adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition study: a mediation analysis. Eur J Nutr. 2023; 63(2):377-396. PMC: 10899298. DOI: 10.1007/s00394-023-03270-1. View

Viennois E, Merlin D, Gewirtz A, Chassaing B . Dietary Emulsifier-Induced Low-Grade Inflammation Promotes Colon Carcinogenesis. Cancer Res. 2016; 77(1):27-40. PMC: 5214513. DOI: 10.1158/0008-5472.CAN-16-1359. View

Pagliai G, Dinu M, Madarena M, Bonaccio M, Iacoviello L, Sofi F . Consumption of ultra-processed foods and health status: a systematic review and meta-analysis. Br J Nutr. 2020; 125(3):308-318. PMC: 7844609. DOI: 10.1017/S0007114520002688. View

Cozzolongo R, Osella A, Elba S, Petruzzi J, Buongiorno G, Giannuzzi V . Epidemiology of HCV infection in the general population: a survey in a southern Italian town. Am J Gastroenterol. 2009; 104(11):2740-6. DOI: 10.1038/ajg.2009.428. View

Moubarac J, Parra D, Cannon G, Monteiro C . Food Classification Systems Based on Food Processing: Significance and Implications for Policies and Actions: A Systematic Literature Review and Assessment. Curr Obes Rep. 2015; 3(2):256-72. DOI: 10.1007/s13679-014-0092-0. View

Dinu M, Tristan Asensi M, Pagliai G, Lotti S, Martini D, Colombini B . Consumption of Ultra-Processed Foods Is Inversely Associated with Adherence to the Mediterranean Diet: A Cross-Sectional Study. Nutrients. 2022; 14(10). PMC: 9147239. DOI: 10.3390/nu14102073. View

Shaper A, Wannamethee G, Walker M . Alcohol and mortality in British men: explaining the U-shaped curve. Lancet. 1988; 2(8623):1267-73. DOI: 10.1016/s0140-6736(88)92890-5. View

10.

Marron-Ponce J, Sanchez-Pimienta T, Louzada M, Batis C . Energy contribution of NOVA food groups and sociodemographic determinants of ultra-processed food consumption in the Mexican population. Public Health Nutr. 2017; 21(1):87-93. PMC: 10260747. DOI: 10.1017/S1368980017002129. View

11.

Riboli E, Kaaks R . The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol. 1997; 26 Suppl 1:S6-14. DOI: 10.1093/ije/26.suppl_1.s6. View

12.

Fiolet T, Srour B, Sellem L, Kesse-Guyot E, Alles B, Mejean C . Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ. 2018; 360:k322. PMC: 5811844. DOI: 10.1136/bmj.k322. View

13.

Campanella A, Bonfiglio C, Cuccaro F, Donghia R, Tatoli R, Giannelli G . High Adherence to a Mediterranean Alcohol-Drinking Pattern and Mediterranean Diet Can Mitigate the Harmful Effect of Alcohol on Mortality Risk. Nutrients. 2024; 16(1). PMC: 10780794. DOI: 10.3390/nu16010059. View

14.

Bonfiglio C, Cuccaro F, Campanella A, Rosso N, Tatoli R, Giannelli G . Effect of Intake of Extra Virgin Olive Oil on Mortality in a South Italian Cohort with and without NAFLD. Nutrients. 2023; 15(21). PMC: 10649270. DOI: 10.3390/nu15214593. View

15.

Lane M, Gamage E, Du S, Ashtree D, McGuinness A, Gauci S . Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. 2024; 384:e077310. PMC: 10899807. DOI: 10.1136/bmj-2023-077310. View

16.

Monteiro C, Levy R, Claro R, de Castro I, Cannon G . Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil. Public Health Nutr. 2011; 14(1):5-13. DOI: 10.1017/S1368980010003241. View

17.

Srour B, Kordahi M, Bonazzi E, Deschasaux-Tanguy M, Touvier M, Chassaing B . Ultra-processed foods and human health: from epidemiological evidence to mechanistic insights. Lancet Gastroenterol Hepatol. 2022; 7(12):1128-1140. DOI: 10.1016/S2468-1253(22)00169-8. View

18.

Debras C, Chazelas E, Srour B, Druesne-Pecollo N, Esseddik Y, de Edelenyi F . Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study. PLoS Med. 2022; 19(3):e1003950. PMC: 8946744. DOI: 10.1371/journal.pmed.1003950. View

19.

Romaguera D, Fernandez-Barres S, Gracia-Lavedan E, Vendrell E, Azpiri M, Ruiz-Moreno E . Consumption of ultra-processed foods and drinks and colorectal, breast, and prostate cancer. Clin Nutr. 2021; 40(4):1537-1545. DOI: 10.1016/j.clnu.2021.02.033. View

20.

Crimarco A, Landry M, Gardner C . Ultra-processed Foods, Weight Gain, and Co-morbidity Risk. Curr Obes Rep. 2021; 11(3):80-92. PMC: 8532572. DOI: 10.1007/s13679-021-00460-y. View