Table 2.
Association between UPF consumption and risk of conventional adenomas and serrated lesions in the 3 cohort studies (NHS, NHS II, HPFS)
| Energy-adjusted servings per day of UPF intake, OR (95% CI)a |
P nonlinearity b | P overall significance b | |||||
|---|---|---|---|---|---|---|---|
| Quintile 1 | Quintile 2 | Quintile 3 | Quintile 4 | Quintile 5 | |||
| Median intake | 4.0 | 5.2 | 6.2 | 7.3 | 9.3 | ||
| Conventional adenomas | |||||||
| Cases | 2064 | 2347 | 2364 | 2514 | 2355 | ||
| Model 1 | 1 (referent) | 1.05 (0.99 to 1.12) | 1.07 (1.01 to 1.14) | 1.17 (1.10 to 1.24) | 1.17 (1.10 to 1.25) | <.001 | <.001 |
| Model 2 | 1 (referent) | 1.06 (1.00 to 1.13) | 1.08 (1.01 to 1.15) | 1.18 (1.11 to 1.25) | 1.18 (1.11 to 1.26) | <.001 | <.001 |
| Model 2 (UPF excluding processed meat)c | 1 (referent) | 1.09 (1.03 to 1.16) | 1.07 (1.01 to 1.14) | 1.20 (1.13 to 1.28) | 1.18 (1.11 to 1.26) | <.001 | <.001 |
| Model 2 + BMI | 1 (referent) | 1.06 (0.99 to 1.12) | 1.07 (1.00 to 1.13) | 1.16 (1.09 to 1.23) | 1.16 (1.09 to 1.23) | <.001 | <.001 |
| Model 2 + Western dietary pattern score | 1 (referent) | 1.04 (0.98 to 1.10) | 1.04 (0.98 to 1.11) | 1.12 (1.06 to 1.20) | 1.12 (1.05 to 1.20) | .002 | <.001 |
| Model 2 + dietary fiber, folate, calcium, and vitamin D | 1 (referent) | 1.05 (0.99 to 1.11) | 1.06 (1.00 to 1.13) | 1.15 (1.08 to 1.23) | 1.16 (1.09 to 1.24) | <.001 | <.001 |
| Serrated lesions | |||||||
| Cases | 1827 | 2113 | 2111 | 2279 | 2148 | ||
| Model 1 | 1 (referent) | 1.06 (1.00 to 1.13) | 1.07 (1.00 to 1.14) | 1.18 (1.11 to 1.26) | 1.20 (1.13 to 1.28) | <.001 | <.001 |
| Model 2 | 1 (referent) | 1.08 (1.02 to 1.16) | 1.10 (1.03 to 1.17) | 1.21 (1.13 to 1.29) | 1.20 (1.13 to 1.28) | <.001 | <.001 |
| Model 2 (UPF excluding processed meat) | 1 (referent) | 1.13 (1.06 to 1.20) | 1.09 (1.02 to 1.17) | 1.23 (1.15 to 1.31) | 1.22 (1.14 to 1.30) | <.001 | <.001 |
| Model 2 + BMI | 1 (referent) | 1.07 (1.01 to 1.14) | 1.07 (1.01 to 1.14) | 1.17 (1.10 to 1.25) | 1.15 (1.08 to 1.23) | <.001 | <.001 |
| Model 2 + Western dietary pattern score | 1 (referent) | 1.06 (0.99 to 1.13) | 1.06 (0.99 to 1.13) | 1.15 (1.08 to 1.23) | 1.14 (1.07 to 1.22) | <.001 | <.001 |
| Model 2 + dietary fiber, folate, calcium, and vitamin D | 1 (referent) | 1.07 (1.00 to 1.14) | 1.07 (1.01 to 1.15) | 1.18 (1.11 to 1.26) | 1.18 (1.11 to 1.26) | <.001 | <.001 |
Model 1 was adjusted for age (years), race (Caucasian or non-Caucasian), cohort (NHS, NHS II, or HPFS), time period of endoscopy (in 2-year intervals), number of prior endoscopies (continuous), and time in years since the most recent endoscopy (continuous). CI = confidence interval; BMI = body mass index; HPFS = Health Professionals Follow-up Study; NHS = Nurses’ Health Study; NHS II = Nurses’ Health Study II; OR = odds ratio; UPF = ultra-processed food.
Model 2 was further adjusted for family history of colorectal cancer (yes or no), total alcohol intake (in g/d, <5, 5-10, 10-15, 15-30, or ≥30), physical activity (in metabolic equivalent-h/wk; <3, 3-9, 9-18, 18-27, or ≥27), smoking status and pack-years of smoking (never, past smoker with pack-years <5, past smoker with pack-years ≥5, current smoker with pack-years <20, current smoker with pack-years ≥20), regular aspirin use (yes or no), and additionally for menopausal status (yes or no) and postmenopausal hormone use (never or ever) in women.
The other models were further adjusted for BMI (continuous), Western dietary pattern score (continuous), or individual dietary factors (quintiles), respectively.
Derived from the restricted cubic spline analysis.
UPF items excluding bacon, beef, pork hotdogs; chicken or turkey hotdogs; salami, bologna, processed meat sandwiches; processed meats, sausages.