The Lancet Regional Health. Europe (Mar 2025)
Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countriesResearch in context
- Esther M. González-Gil,
- Michèle Matta,
- Fernanda Morales Berstein,
- Manon Cairat,
- Geneviève Nicolas,
- Jessica Blanco,
- Nathalie Kliemann,
- Renata Bertazzi Levy,
- Fernanda Rauber,
- Inarie Jacobs,
- Aline Al Nahas,
- Emine Koc Cakmak,
- Eszter P. Vamos,
- Kiara Chang,
- Sahar G. Yammine,
- Christopher Millett,
- Mathilde Touvier,
- Maria Gabriela Matias Pinho,
- Konstantinos K. Tsilidis,
- Alicia K. Heath,
- Christina M. Lill,
- Valeria Pala,
- Conchi Moreno-Iribas,
- Maria Santucci De Magistris,
- Christina C. Dahm,
- Niels Bock,
- Anja Olsen,
- Anne Tjønneland,
- Yvonne T. van der Schouw,
- Pilar Amiano,
- Franziska Jannasch,
- Matthias B. Schulze,
- Francesca Romana Mancini,
- Chloé Marques,
- Claire Cadeau,
- Catalina Bonet,
- Daniel Redondo-Sánchez,
- Kristin Benjaminsen Borch,
- Magritt Brustad,
- Guri Skeie,
- Jesús Humberto-Gómez,
- Alessandra Macciotta,
- Pietro Ferrari,
- Laure Dossus,
- Marc J. Gunter,
- Inge Huybrechts
Affiliations
- Esther M. González-Gil
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France; Corresponding author. Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, France.
- Michèle Matta
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
- Fernanda Morales Berstein
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Manon Cairat
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif 94805, France
- Geneviève Nicolas
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
- Jessica Blanco
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
- Nathalie Kliemann
- Cancer Research Centre (CEPON), Santa Catarina, Brazil
- Renata Bertazzi Levy
- Department of Preventive Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Fernanda Rauber
- Department of Preventive Medicine, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Centre for Epidemiological Studies in Nutrition and Health, School of Public Health, University of São Paulo, Brazil
- Inarie Jacobs
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
- Aline Al Nahas
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
- Emine Koc Cakmak
- Department of Epidemiology and Biostatistics, School of Public Health, MRC Centre for Environment and Health, Imperial College London, London, United Kingdom
- Eszter P. Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- Kiara Chang
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- Sahar G. Yammine
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny F-93017, France
- Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), NOVA University Lisbon, Lisbon, Portugal
- Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny F-93017, France
- Maria Gabriela Matias Pinho
- Copernicus Institute of Sustainable Development, Department Environmental Sciences, Utrecht University, Utrecht, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands
- Konstantinos K. Tsilidis
- Cancer Epidemiology and Prevention Research Unit, School of Public Health, Imperial College London, London, UK; Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Alicia K. Heath
- Cancer Epidemiology and Prevention Research Unit, School of Public Health, Imperial College London, London, UK
- Christina M. Lill
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK; Institute of Epidemiology and Sociology, University of Münster, Münster, Germany
- Valeria Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori- Milan, Italy
- Conchi Moreno-Iribas
- Instituto de Salud Pública y Laboral de Navarra, Pamplona 31003, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona 31008, Spain
- Maria Santucci De Magistris
- Azienda Ospedaliera Universitaria (AOU) Federico II, Naples, Italy
- Christina C. Dahm
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Niels Bock
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Anja Olsen
- Department of Public Health, Aarhus University, Aarhus, Denmark; Danish Cancer Institute, Copenhagen, Denmark
- Anne Tjønneland
- Danish Cancer Institute, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Denmark
- Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain; Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain; BioGipuzkoa (BioDonostia) Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
- Franziska Jannasch
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
- Francesca Romana Mancini
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif 94805, France
- Chloé Marques
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif 94805, France
- Claire Cadeau
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif 94805, France
- Catalina Bonet
- Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, L'Hospitalet de Llobregat, Spain; Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Spain
- Daniel Redondo-Sánchez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain; Escuela Andaluza de Salud Pública (EASP), Granada 18011, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada 18012, Spain
- Kristin Benjaminsen Borch
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Magritt Brustad
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway; The Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway
- Guri Skeie
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France; Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Jesús Humberto-Gómez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain; Department of Epidemiology, Murcia Regional Health Council-IMIB, Murcia, Spain
- Alessandra Macciotta
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, TO, Italy; Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Pietro Ferrari
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
- Laure Dossus
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
- Marc J. Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France; Cancer Epidemiology and Prevention Research Unit, School of Public Health, Imperial College London, London, UK
- Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
- Journal volume & issue
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Vol. 50
p. 101208
Abstract
Summary: Background: Ultra-processed food (UPF) consumption has been linked with higher risk of mortality. This multi-centre study investigated associations between food intake by degree of processing, using the Nova classification, and all-cause and cause-specific mortality. Methods: This study analyzed data from the European Prospective Investigation into Cancer and Nutrition. All-cause mortality and cause-specific mortality due to cancer, circulatory diseases, digestive diseases, Parkinson’s disease, and Alzheimer’s disease served as endpoints. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazards regression models. Substitution analyses were also performed. Findings: Overall, 428,728 (71.7% female) participants were included in the analysis and 40,016 deaths were documented after 15.9 years of follow-up. UPFs (in percentage grams per day [g/d]) were positively associated with all-cause mortality (HRs per 1-SD: 1.04; 95% CI: 1.02,1.05), as well as mortality from circulatory diseases (1.09; 95% CI: 1.07,1.12), cerebrovascular disease (1.11; 95% CI: 1.05,1.17), ischemic heart disease (1.10; 95% CI: 1.06,1.15), digestive diseases (1.12; 95% CI: 1.05,1.20), and Parkinson’s disease (1.23; 95% CI: 1.06,1.42). No associations were found between UPFs and mortality from cancer or Alzheimer’s disease. Replacing processed and UPFs with unprocessed/minimally processed foods was associated with lower mortality risk. Interpretation: In this pan-European analysis, higher UPF consumption was associated with greater mortality from circulatory diseases, digestive diseases, and Parkinson’s disease. The results support growing evidence that higher consumption of UPFs and lower consumption of unprocessed foods may have a negative impact on health. Funding: l’Institut National du Cancer, and World Cancer Research Fund International.
