Ultra-processed Food Intake and Long-Term Risk of Cardiovascular Disease Mortality among Patients with Myocardial
Maria G Jacobo Cejudo1, Daisy Coyle2, Iris van Damme1
1Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
Background:
The impact of a diet high in ultra-processed foods (UPFs) on mortality risk in patients with cardiovascular disease (CVD) remains unclear.
Objectives:
We examined the diet quality of a high UPF diet and its association with risk of total CVD mortality, coronary heart disease (CHD) mortality, and stroke mortality in patients with prior myocardial infarction (MI).
Methods:
We analyzed data from 4365 patients with a history of MI in the Alpha Omega Cohort (79% males). Dietary intake at baseline was collected using a 203-item food-frequency questionnaire. Diet quality was assessed using the Dutch Healthy Diet Index adapted for patients with CVD (DHD-CVD, range 0-160). UPFs were identified and categorized according to the Nova classification system. Q1 and Q4 of %g/d of UPF represented a low and a high ultra-processed diet, respectively. Hazard ratios (HRs) for CVD, CHD, and stroke mortality were obtained from multivariable Cox regression models.
Results:
Mean UPF contribution to the diet was 18%g/d (Q1 compared with Q4 = 9%g/d compared with 29%g/d). Compared with Q1, patients in Q4 had higher intakes of total energy and lower intakes of fruit and vegetables. DHD-CVD scores decreased slightly across quartiles (Q1 compared with Q4 = 95 compared with 82). Over a median follow-up of 14 y, 1012 patients died from CVD (659 from CHD, 208 from stroke). Compared with Q1, a high ultra-processed diet was not consistently or significantly associated with CVD and CHD mortality. However, it was associated with a higher risk of stroke mortality (HRper10% point increase: 1.21; 95% confidence interval: 1.02, 1.42). This association was stronger in older patients, females, and those with a higher BMI, lower physical activity levels, and lower socioeconomic status and robust to sensitivity analysis.
Conclusions:
In patients withprior MI, a high UPF diet was lower in whole, cardioprotective foods. Our study highlights the adverse association of a high UPF diet with stroke mortality risk among patients who have previously experienced an MI.
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