Table 4.
Ultra-processed food (weight ratio) and Food Standards Agency nutrient profiling system (FSAm-NPS) dietary index as explanatory factors of their respective association with all cause and cardiovascular disease mortality
| Outcome | FSAm-NPS dietary index (Q4 v Q1) | FSAm-NPS dietary index (Q4 v Q1) + UPF (continuous) | UPF (Q4 v Q1) | UPF (Q4 v Q1) + FSAm-NPS dietary index (continuous) | ||
|---|---|---|---|---|---|---|
| HR (95% CI) | HR (95% CI) | Attenuation, % (95% CI) | HR (95% CI) | HR (95% CI) | Attenuation, % (95% CI) | |
| All cause mortality | 1.19 (1.04 to 1.35) | 1.14 (1.00 to 1.31) | 22.3 (16.4 to 30.2) | 1.19 (1.05 to 1.36) | 1.20 (1.05 to 1.37) | −3.3 (−7.3 to 0.3) |
| Cardiovascular disease mortality | 1.32 (1.06 to 1.64) | 1.26 (1.01 to 1.58) | 15.4 (10.5 to 22.6) | 1.27 (1.02 to 1.58) | 1.27 (1.02 to 1.59) | 0.0 (−5.0 to 4.9) |
CI=confidence interval; HR=hazard ratio; Q1=quarter 1; Q4=quarter 4; UPF=ultra-processed food.
Hazard ratios with 95% CIs obtained from multivariable cause specific Cox proportional hazards regression models, using data obtained from multiple imputation (SAS PROC MI, followed by PROC MIANALYZE in SAS; n=10 imputed datasets).
Multivariable adjusted model was controlled for sex, age (continuous), energy intake (continuous), educational level (up to lower secondary, upper secondary, post-secondary), housing tenure (rent, 1 dwelling ownership, >1 dwelling ownership), smoking (never, current, former smokers), body mass index (continuous), leisure time physical activity (continuous), history of cancer (no/yes), history of cardiovascular disease (no/yes), diabetes (no/yes), hypertension (no/yes), hyperlipidaemia (no/yes), and residence (urban, rural).
Attenuation represents proportion of FSAm-NPS dietary index (or UPF consumption)-mortality association explained by UPF as weight ratio (or by FSAm-NPS dietary index), and was determined by calculating per cent attenuation in β coefficient for FSAm-NPS dietary index (or UPF intake; β0) after inclusion of UPF (or FSAm-NPS dietary index; β1) to multivariable adjusted model as follows: 100×(β0–β1)/(β0). 95% CI around percentage attenuation was obtained by using bootstrap method with 1000 re-samplings.