Table 3.
Multivariable hazard ratios and 95% confidence intervals for mortality according to quarters of subgroups of ultra-processed food consumption*
| Energy adjusted ultra-processed food consumption† | P for trend | Per difference in medians between quarters 4 and 1 | ||||
|---|---|---|---|---|---|---|
| Quarter 1 | Quarter 2 | Quarter 3 | Quarter 4 | |||
| Total mortality | ||||||
| Ultra-processed breads and breakfast foods | 1 | 1.05 (1.02 to 1.07) | 1.06 (1.03 to 1.09) | 1.04 (1.02 to 1.07) | 0.01 | 1.03 (1.01 to 1.06) |
| Fats, condiments, and sauces | 1 | 1.01 (0.98 to 1.04) | 1.03 (1.01 to 1.06) | 1.00 (0.98 to 1.03) | 0.86 | 1.00 (0.98 to 1.03) |
| Packaged sweet snacks and desserts | 1 | 1.02 (0.99 to 1.05) | 0.99 (0.97 to 1.02) | 0.99 (0.97 to 1.02) | 0.17 | 0.98 (0.96 to 1.01) |
| Sugar and artificially sweetened beverages | 1 | 1.03 (1.01 to 1.06) | 1.06 (1.03 to 1.08) | 1.09 (1.07 to 1.12) | <0.001 | 1.09 (1.06 to 1.12) |
| Ready-to-eat/heat mixed dishes | 1 | 1.02 (1.00 to 1.05) | 1.05 (1.03 to 1.08) | 1.02 (0.99 to 1.05) | 0.03 | 1.03 (1.00 to 1.06) |
| Meat/poultry/seafood based ready-to-eat products | 1 | 1.06 (1.03 to 1.09) | 1.10 (1.07 to 1.13) | 1.13 (1.10 to 1.16) | <0.001 | 1.13 (1.10 to 1.16) |
| Packaged savory snacks | 1 | 1.05 (1.02 to 1.08) | 1.05 (1.02 to 1.08) | 1.01 (0.99 to 1.04) | 0.47 | 0.99 (0.97 to 1.02) |
| Dairy based desserts | 1 | 1.06 (1.03 to 1.08) | 1.06 (1.03 to 1.09) | 1.07 (1.04 to 1.10) | <0.001 | 1.06 (1.03 to 1.08) |
| Other | 1 | 1.00 (0.98 to 1.03) | 1.07 (1.05 to 1.10) | 1.08 (1.05 to 1.11) | <0.001 | 1.04 (1.03 to 1.06) |
| Cancer mortality | ||||||
| Ultra-processed breads and breakfast foods | 1 | 1.03 (0.98 to 1.08) | 1.05 (1.00 to 1.10) | 1.05 (1.00 to 1.10) | 0.08 | 1.04 (0.99 to 1.09) |
| Fats, condiments, and sauces | 1 | 1.00 (0.96 to 1.05) | 1.03 (0.98 to 1.08) | 0.99 (0.94 to 1.04) | 0.62 | 0.99 (0.94 to 1.04) |
| Packaged sweet snacks and desserts | 1 | 1.01 (0.97 to 1.06) | 1.00 (0.95 to 1.05) | 0.95 (0.90 to 0.99) | 0.01 | 0.94 (0.89 to 0.98) |
| Sugar and artificially sweetened beverages | 1 | 1.00 (0.95 to 1.04) | 1.03 (0.98 to 1.08) | 0.99 (0.95 to 1.05) | 0.92 | 1.00 (0.95 to 1.05) |
| Ready-to-eat/heat mixed dishes | 1 | 1.02 (0.98 to 1.07) | 1.04 (0.99 to 1.09) | 0.99 (0.94 to 1.04) | 0.85 | 1.00 (0.95 to 1.05) |
| Meat/poultry/seafood based ready-to-eat products | 1 | 1.02 (0.97 to 1.07) | 1.04 (0.99 to 1.10) | 1.06 (1.00 to 1.11) | 0.02 | 1.06 (1.01 to 1.11) |
| Packaged savory snacks | 1 | 1.03 (0.98 to 1.08) | 1.03 (0.98 to 1.09) | 1.01 (0.97 to 1.06) | 0.99 | 1.00 (0.96 to 1.05) |
| Dairy based desserts | 1 | 1.04 (0.99 to 1.09) | 1.03 (0.98 to 1.08) | 1.04 (0.99 to 1.09) | 0.16 | 1.03 (0.99 to 1.08) |
| Other | 1 | 0.96 (0.91 to 1.00) | 1.07 (1.02 to 1.13) | 1.02 (0.97 to 1.07) | 0.02 | 1.03 (1.01 to 1.07) |
| Cardiovascular mortality | ||||||
| Ultra-processed breads and breakfast foods | 1 | 1.04 (0.99 to 1.10) | 1.05 (1.00 to 1.11) | 1.02 (0.97 to 1.08) | 0.62 | 1.01 (0.96 to 1.07) |
| Fats, condiments, and sauces | 1 | 1.01 (0.96 to 1.07) | 1.01 (0.96 to 1.06) | 1.02 (0.97 to 1.08) | 0.33 | 1.03 (0.97 to 1.08) |
| Packaged sweet snacks and desserts | 1 | 0.99 (0.94 to 1.05) | 0.96 (0.91 to 1.01) | 0.94 (0.89 to 0.99) | 0.005 | 0.93 (0.88 to 0.98) |
| Sugar and artificially sweetened beverages | 1 | 1.03 (0.98 to 1.09) | 1.05 (1.00 to 1.11) | 1.13 (1.07 to 1.19) | <0.001 | 1.13 (1.06 to 1.19) |
| Ready-to-eat/heat mixed dishes | 1 | 0.99 (0.94 to 1.04) | 1.01 (0.96 to 1.07) | 0.96 (0.91 to 1.02) | 0.32 | 0.97 (0.91 to 1.03) |
| Meat/poultry/seafood based ready-to-eat products | 1 | 1.07 (1.01 to 1.13) | 1.14 (1.08 to 1.20) | 1.15 (1.09 to 1.21) | <0.001 | 1.14 (1.09 to 1.21) |
| Packaged savory snacks | 1 | 1.08 (1.03 to 1.14) | 1.09 (1.03 to 1.15) | 1.02 (0.97 to 1.08) | 0.72 | 0.99 (0.94 to 1.04) |
| Dairy based desserts | 1 | 1.04 (0.98 to 1.10) | 1.01 (0.96 to 1.07) | 0.97 (0.92 to 1.02) | 0.07 | 0.95 (0.91 to 1.00) |
| Other | 1 | 1.04 (0.98 to 1.09) | 1.12 (1.06 to 1.19) | 1.16 (1.09 to 1.22) | <0.001 | 1.07 (1.04 to 1.09) |
| Other mortality | ||||||
| Ultra-processed breads and breakfast foods | 1 | 1.05 (1.01 to 1.09) | 1.07 (1.03 to 1.11) | 1.04 (1.01 to 1.08) | 0.09 | 1.03 (0.99 to 1.07) |
| Fats, condiments, and sauces | 1 | 1.01 (0.98 to 1.05) | 1.05 (1.01 to 1.09) | 1.00 (0.97 to 1.04) | 0.99 | 1.00 (0.96 to 1.04) |
| Packaged sweet snacks and desserts | 1 | 1.04 (1.00 to 1.08) | 1.00 (0.97 to 1.04) | 1.05 (1.01 to 1.09) | 0.04 | 1.04 (1.00 to 1.08) |
| Sugar and artificially sweetened beverages | 1 | 1.05 (1.01 to 1.09) | 1.07 (1.03 to 1.11) | 1.14 (1.10 to 1.19) | <0.001 | 1.14 (1.09 to 1.18) |
| Ready-to-eat/heat mixed dishes | 1 | 1.04 (1.00 to 1.08) | 1.08 (1.04 to 1.12) | 1.07 (1.03 to 1.11) | <0.001 | 1.09 (1.04 to 1.14) |
| Meat/poultry/seafood based ready-to-eat products | 1 | 1.08 (1.04 to 1.13) | 1.11 (1.07 to 1.16) | 1.17 (1.13 to 1.21) | <0.001 | 1.17 (1.13 to 1.21) |
| Packaged savory snacks | 1 | 1.05 (1.01 to 1.09) | 1.04 (1.01 to 1.08) | 1.01 (0.97 to 1.04) | 0.44 | 0.99 (0.95 to 1.02) |
| Dairy based desserts | 1 | 1.07 (1.03 to 1.12) | 1.10 (1.06 to 1.14) | 1.15 (1.11 to 1.19) | <0.001 | 1.13 (1.09 to 1.17) |
| Other | 1 | 1.05 (1.01 to 1.09) | 1.07 (1.03 to 1.11) | 1.09 (1.05 to 1.13) | <0.001 | 1.04 (1.02 to 1.06) |
| Respiratory mortality | ||||||
| Ultra-processed breads and breakfast foods | 1 | 1.11 (1.01 to 1.22) | 1.11 (1.01 to 1.22) | 1.12 (1.02 to 1.22) | 0.03 | 1.11 (1.01 to 1.21) |
| Fats, condiments, and sauces | 1 | 0.96 (0.87 to 1.05) | 1.08 (0.99 to 1.18) | 1.02 (0.94 to 1.12) | 0.39 | 1.04 (0.95 to 1.14) |
| Packaged sweet snacks and desserts | 1 | 1.03 (0.93 to 1.13) | 0.95 (0.87 to 1.05) | 0.99 (0.91 to 1.09) | 0.70 | 0.98 (0.90 to 1.07) |
| Sugar and artificially sweetened beverages | 1 | 0.97 (0.89 to 1.06) | 1.01 (0.92 to 1.10) | 1.00 (0.91 to 1.10) | 0.86 | 1.01 (0.91 to 1.11) |
| Ready-to-eat/heat mixed dishes | 1 | 1.08 (0.99 to 1.18) | 1.15 (1.05 to 1.25) | 1.13 (1.03 to 1.24) | 0.003 | 1.17 (1.05 to 1.29) |
| Meat/poultry/seafood based ready-to-eat products | 1 | 1.15 (1.04 to 1.28) | 1.26 (1.14 to 1.39) | 1.43 (1.30 to 1.57) | <0.001 | 1.42 (1.30 to 1.56) |
| Packaged savory snacks | 1 | 1.03 (0.94 to 1.13) | 1.04 (0.95 to 1.14) | 1.03 (0.94 to 1.12) | 0.71 | 1.02 (0.93 to 1.11) |
| Dairy based desserts | 1 | 1.09 (1.00 to 1.20) | 1.07 (0.98 to 1.18) | 1.16 (1.06 to 1.27) | 0.003 | 1.14 (1.04 to 1.24) |
| Other | 1 | 1.03 (0.94 to 1.13) | 0.96 (0.87 to 1.06) | 1.01 (0.92 to 1.11) | 0.19 | 1.03 (0.98 to 1.08) |
| Neurodegenerative mortality | ||||||
| Ultra-processed breads and breakfast foods | 1 | 1.13 (1.05 to 1.21) | 1.12 (1.04 to 1.20) | 0.99 (0.93 to 1.06) | 0.27 | 0.96 (0.89 to 1.03) |
| Fats, condiments, and sauces | 1 | 1.03 (0.96 to 1.11) | 1.09 (1.01 to 1.17) | 0.97 (0.90 to 1.04) | 0.33 | 0.96 (0.89 to 1.04) |
| Packaged sweet snacks and desserts | 1 | 1.17 (1.08 to 1.26) | 1.15 (1.06 to 1.24) | 1.21 (1.13 to 1.30) | <0.001 | 1.18 (1.09 to 1.26) |
| Sugar and artificially sweetened beverages | 1 | 1.09 (1.02 to 1.16) | 1.08 (1.01 to 1.16) | 1.15 (1.07 to 1.25) | 0.002 | 1.14 (1.05 to 1.23) |
| Ready-to-eat/heat mixed dishes | 1 | 1.09 (1.02 to 1.16) | 1.06 (0.98 to 1.13) | 1.03 (0.95 to 1.11) | 0.58 | 1.02 (0.94 to 1.11) |
| Meat/poultry/seafood based ready-to-eat products | 1 | 1.04 (0.97 to 1.12) | 1.05 (0.97 to 1.12) | 1.02 (0.95 to 1.10) | 0.57 | 1.02 (0.95 to 1.10) |
| Packaged savory snacks | 1 | 1.11 (1.03 to 1.20) | 1.10 (1.02 to 1.18) | 1.10 (1.03 to 1.18) | 0.05 | 1.07 (1.00 to 1.15) |
| Dairy based desserts | 1 | 1.17 (1.08 to 1.26) | 1.36 (1.26 to 1.46) | 1.45 (1.35 to 1.56) | <0.001 | 1.41 (1.32 to 1.50) |
| Other | 1 | 1.04 (0.97 to 1.12) | 1.08 (1.00 to 1.16) | 1.04 (0.96 to 1.13) | 0.50 | 1.01 (0.98 to 1.05) |
*
Results from Cox proportional hazards model stratified by age (months), questionnaire cycle (two year interval), and cohort and adjusted for total energy intake, race, marital status, physical activity, body mass index, smoking status and pack years, alcohol consumption, physical examination performed for screening purposes, and family history of diabetes mellitus, myocardial infarction, or cancer; for women, also menopausal status and hormone use.
†
Quarter specific medians (servings/day) for each subgroup: ultra-processed breads and breakfast foods 0.1, 0.3, 0.6, 1.3; fats, condiments, and sauces 0.5, 1.0, 1.5, 2.5; packaged sweet snacks and desserts 0.4, 0,7, 1.1, 1.8; sugar sweetened and artificially sweetened beverages 0.09, 0.4, 0.8, 1.7; ready-to-eat/heat mixed dishes 0.07, 0.1, 0.2, 0.4; meat/poultry/seafood based ready-to-eat products 0.06, 0.2, 0.3, 0.5; packaged savory snacks 0.04, 0.1, 0.3, 0.6; dairy based desserts, 0.06, 0.1, 0.3, 0.5; other 0.009, 0.01, 0.01, 0.4.