{"doi":"10.1136/bmj.l1949","title":"Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study","abstract":"<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate the association between consumption of ultra-processed foods and all cause mortality.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Prospective cohort study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>19 899 participants (12 113 women and 7786 men) aged 20-91 years followed-up every two years between December 1999 and February 2014 for food and drink consumption, classified according to the degree of processing by the NOVA classification, and evaluated through a validated 136 item food frequency questionnaire.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measure</jats:title><jats:p>Association between consumption of energy adjusted ultra-processed foods categorised into quarters (low, low-medium, medium-high, and high consumption) and all cause mortality, using multivariable Cox proportional hazard models.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>335 deaths occurred during 200 432 persons years of follow-up. Participants in the highest quarter (high consumption) of ultra-processed foods consumption had a higher hazard for all cause mortality compared with those in the lowest quarter (multivariable adjusted hazard ratio 1.62, 95% confidence interval 1.13 to 2.33) with a significant dose-response relation (P for linear trend=0.005). For each additional serving of ultra-processed foods, all cause mortality relatively increased by 18% (adjusted hazard ratio 1.18, 95% confidence interval 1.05 to 1.33).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>A higher consumption of ultra-processed foods (&gt;4 servings daily) was independently associated with a 62% relatively increased hazard for all cause mortality. For each additional serving of ultra-processed food, all cause mortality increased by 18%.</jats:p></jats:sec><jats:sec><jats:title>Study registration</jats:title><jats:p>ClinicalTrials.gov<jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT02669602\">NCT02669602</jats:ext-link>.</jats:p></jats:sec>","journal":"BMJ","year":2019,"id":13552,"datarank":13.29905778968192,"base_score":6.280395838960195,"endowment":6.280395838960195,"self_citation_contribution":0.9420593758440294,"citation_network_contribution":12.35699841383789,"self_endowment_contribution":0.9420593758440294,"citer_contribution":12.35699841383789,"corpus_percentile":null,"corpus_rank":null,"citation_count":533,"citer_count":200,"citers_with_citation_signal":200,"citers_with_endowment":200,"datacite_reuse_total":14,"is_dataset":false,"is_dataset_confidence":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":110769,"name":"Miguel A Martínez-González","orcid":null,"position":1,"is_corresponding":false},{"id":110770,"name":"Ismael 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