Ultra-processed food and risk of cholecystitis and cholelithiasis: a prospective cohort study

The global rise in ultra-processed food (UPF) consumption has been linked to several chronic diseases. However, its association with cholecystitis and cholelithiasis remains underexplored.

This prospective cohort study included 154,376 UK Biobank participants. UPF consumption (assessed as percentage of total food weight, g/day) was categorized by the NOVA classification using Oxford WebQ-based 24-hour dietary assessments. Cox proportional hazards models were performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident cholecystitis and cholelithiasis risk with the adjustments for demographics, lifestyle factors, nutrients, and comorbidities. Restricted cubic splines analyses were used to evaluate dose-response relationships.

During a median follow-up of 13.2 years, higher UPF intake was associated with increased risks of cholecystitis and cholelithiasis. Participants in the highest quartile of UPF consumption (Q4) had higher risks of cholecystitis (HR:1.20, 95% CI: 1.07-1.34, P = 0.001) and cholelithiasis (HR:1.15, 95% CI: 1.05-1.25, P = 0.002), compared with the lowest quartile. Sensitivity analyses confirmed the robustness of these findings. Nonlinear relationships were observed for both diseases, with risk increasing beyond specific UPF consumption thresholds (27% of total food weight for cholecystitis and 16% for cholelithiasis). Additionally, subgroup analyses revealed inverse associations of breakfast cereals with both cholelithiasis and cholecystitis, and of ultra-processed breads with cholelithiasis, whereas snacks and desserts were positively associated with cholelithiasis risk.

Higher total UPF consumption was independently associated with elevated risks of cholecystitis and cholelithiasis, although inverse associations were observed for certain subgroups such as breakfast cereals and ultra-processed breads. However, reducing snacks and desserts may help lower biliary disease risk, but further studies are needed to clarify the role of specific UPF subgroups.