Table 2.
Association between energy-adjusted ultra-processed food consumption (daily serving) and cardiovascular mortality
| Causes of mortality | Quintiles of energy-adjusted ultra-processed food consumption, range (mean), servings/day | Ptrend | ||||
|---|---|---|---|---|---|---|
| < 0.5 (0.1) | 0.5–< 1.1 (0.8) | 1.1–< 2.1 (1.6) | 2.1–≤4.0 (3.0) | > 4.0 (8.2) | ||
| No. of participants | 18,378 | 18,378 | 18,379 | 18,377 | 18,379 | |
| Person-years | 247,441.39 | 247,018.70 | 247,436.48 | 247,501.44 | 246,651.21 | |
| Cardiovascular disease | ||||||
| No. of deaths | 991 | 1006 | 1002 | 1135 | 1356 | |
| Death rate a | 40.05 | 40.73 | 40.50 | 45.86 | 54.98 | |
| Model 1 b | 1.00 (reference) | 1.01 (0.93, 1.11) | 1.01 (0.93, 1.11) | 1.24 (1.14, 1.35) | 1.62 (1.49, 1.76) | < 0.001 |
| Model 2 c | 1.00 (reference) | 1.00 (0.91, 1.09) | 1.01 (0.92, 1.11) | 1.20 (1.09, 1.31) | 1.50 (1.36, 1.64) | < 0.001 |
| Heart disease | ||||||
| No. of deaths | 670 | 689 | 683 | 846 | 1097 | |
| Death rate a | 27.08 | 27.89 | 27.60 | 34.18 | 44.48 | |
| Model 1 b | 1.00 (reference) | 1.02 (0.92, 1.14) | 1.01 (0.91, 1.13) | 1.34 (1.20, 1.48) | 1.87 (1.69, 2.06) | < 0.001 |
| Model 2 c | 1.00 (reference) | 1.01 (0.90, 1.12) | 0.99 (0.89, 1.11) | 1.26 (1.13, 1.41) | 1.68 (1.50, 1.87) | < 0.001 |
| Cerebrovascular disease | ||||||
| No. of deaths | 256 | 236 | 246 | 212 | 176 | |
| Death rate a | 10.35 | 9.55 | 9.94 | 8.57 | 7.14 | |
| Model 1 b | 1.00 (reference) | 0.93 (0.77, 1.11) | 0.99 (0.83, 1.19) | 0.95 (0.79, 1.15) | 0.90 (0.74, 1.10) | 0.406 |
| Model 2 c | 1.00 (reference) | 0.91 (0.76, 1.10) | 1.04 (0.86, 1.25) | 1.00 (0.82, 1.21) | 0.94 (0.76, 1.17) | 0.741 |
Values are hazard ratios (95% confidence intervals)
a Crude death rate per 10,000 person-years
b Adjusted for age (years), sex (male, female), race (non-Hispanic white, non-Hispanic black, Hispanic, others), educational level (college below, college graduate, postgraduate), marital status (married, widowed, divorced, separated, never married), and study center (10 categories)
c Adjusted for model 1 plus aspirin use (yes, no), history of hypertension (yes, no), history of diabetes (yes, no), smoking status (current, former, never), alcohol consumption (g/day), body mass index (< 18.5, 18.5–24.9, 25.0–30.0, > 30.0 kg/m2), physical activity (min/week), and energy intake from diet (kcal/day)