TY - JOUR
T1 - Different levels of ultraprocessed food and beverage consumption and associations with environmental sustainability and all-cause mortality in EPIC-NL
AU - Vellinga, Reina E
AU - van den Boomgaard, Iris
AU - M A Boer, Jolanda
AU - van der Schouw, Yvonne T
AU - Harbers, Marjolein C
AU - Verschuren, W M Monique
AU - van 't Veer, Pieter
AU - H M Temme, Elisabeth
AU - Biesbroek, Sander
N1 - Funding Information:
The authors’ responsibilities were as follows – REV, IvdB, EHMT, SB: conceptualization; REV, IvdB: investigation, methodology, formal analysis, visualization; REV, IvdB: writing – original draft; REV, IvdB, JMAB, YTvdS, MCH, WMMV, PvtV, EHMT, SB: writing – review and editing; EHMT, SB: supervision; and all authors: read and approved the final manuscript. The authors report no conflicts of interest.
Publisher Copyright:
© 2023 The Authors
PY - 2023/7
Y1 - 2023/7
N2 - BACKGROUND: The adverse health effects of high ultraprocessed food and drink (UPFD) consumption are well documented. However, the environmental impact remains unclear, and the separate effects of ultraprocessed foods (UPFs) and drinks (UPDs) on all-cause mortality have not been studied previously.OBJECTIVES: To assess the association between levels of UPFD, UPF, and UPD consumption and diet-related environmental impacts and all-cause mortality in Dutch adults.METHODS: Habitual diets were assessed by a Food Frequency Questionnaire (FFQ) from 1993-1997 in 38,261 participants of the Dutch European Prospective Investigation into Cancer and Nutrition cohort. The mean follow-up time was 18.2 y (SD = 4.1); 4,697 deaths occurred. FFQ items were categorized according to the NOVA classification. Associations between quartiles of UPFD, UPF, and UPD consumption and environmental impact indicators were analyzed using general linear models and all-cause mortality by Cox proportional hazard models. The lowest UPFD, UPF, and UPD consumption quartiles were used as comparator.RESULTS: The average UPFD consumption was 181 (SD = 88) g/1000 kcal. High UPF consumption was statistically significantly inversely associated with all environmental impact indicators (Q4vsQ1: -13.6% to -3.0%), whereas high UPD consumption was, except for land use, statistically significant positively associated with all environmental impact indicators (Q4vsQ1: 1.2% to 5.9%). High UPFD consumption was heterogeneously associated with environmental impacts (Q4vsQ1: -4.0% to 2.6%). After multivariable adjustment, the highest quartiles of UPFD and UPD consumption were significantly associated with all-cause mortality (HR
Q4vsQ1: 1.17, 95%CI: 1.08, 1.28 and HR
Q4vsQ1: 1.16, 95%CI: 1.07, 1.26, respectively). UPF consumption of Q2 and Q3 were associated with a borderline significant lower risk of all-cause mortality (HR
Q2vsQ1: 0.93, 95% CI: 0.85, 1.00; HR
Q3vsQ1: 0.91, 95% CI: 0.84, 0.99) whereas Q4 was not statistically significant (HR
Q4vsQ1: 1.06, 95% CI: 0.97, 1.15).
CONCLUSIONS: Reducing UPD consumption may lower environmental impact and all-cause mortality risk; however, this is not shown for UPFs. When categorizing food consumption by their degree of processing, trade-offs are observed for human and planetary health aspects.
AB - BACKGROUND: The adverse health effects of high ultraprocessed food and drink (UPFD) consumption are well documented. However, the environmental impact remains unclear, and the separate effects of ultraprocessed foods (UPFs) and drinks (UPDs) on all-cause mortality have not been studied previously.OBJECTIVES: To assess the association between levels of UPFD, UPF, and UPD consumption and diet-related environmental impacts and all-cause mortality in Dutch adults.METHODS: Habitual diets were assessed by a Food Frequency Questionnaire (FFQ) from 1993-1997 in 38,261 participants of the Dutch European Prospective Investigation into Cancer and Nutrition cohort. The mean follow-up time was 18.2 y (SD = 4.1); 4,697 deaths occurred. FFQ items were categorized according to the NOVA classification. Associations between quartiles of UPFD, UPF, and UPD consumption and environmental impact indicators were analyzed using general linear models and all-cause mortality by Cox proportional hazard models. The lowest UPFD, UPF, and UPD consumption quartiles were used as comparator.RESULTS: The average UPFD consumption was 181 (SD = 88) g/1000 kcal. High UPF consumption was statistically significantly inversely associated with all environmental impact indicators (Q4vsQ1: -13.6% to -3.0%), whereas high UPD consumption was, except for land use, statistically significant positively associated with all environmental impact indicators (Q4vsQ1: 1.2% to 5.9%). High UPFD consumption was heterogeneously associated with environmental impacts (Q4vsQ1: -4.0% to 2.6%). After multivariable adjustment, the highest quartiles of UPFD and UPD consumption were significantly associated with all-cause mortality (HR
Q4vsQ1: 1.17, 95%CI: 1.08, 1.28 and HR
Q4vsQ1: 1.16, 95%CI: 1.07, 1.26, respectively). UPF consumption of Q2 and Q3 were associated with a borderline significant lower risk of all-cause mortality (HR
Q2vsQ1: 0.93, 95% CI: 0.85, 1.00; HR
Q3vsQ1: 0.91, 95% CI: 0.84, 0.99) whereas Q4 was not statistically significant (HR
Q4vsQ1: 1.06, 95% CI: 0.97, 1.15).
CONCLUSIONS: Reducing UPD consumption may lower environmental impact and all-cause mortality risk; however, this is not shown for UPFs. When categorizing food consumption by their degree of processing, trade-offs are observed for human and planetary health aspects.
KW - all-cause mortality
KW - environmental impact
KW - EPIC-NL
KW - NOVA classification
KW - planetary health
KW - ultraprocessed drinks
KW - ultraprocessed foods
UR - http://www.scopus.com/inward/record.url?scp=85161697260&partnerID=8YFLogxK
U2 - 10.1016/j.ajcnut.2023.05.021
DO - 10.1016/j.ajcnut.2023.05.021
M3 - Article
C2 - 37207984
SN - 0002-9165
VL - 118
SP - 103
EP - 113
JO - American Journal of Clinical Nutrition
JF - American Journal of Clinical Nutrition
IS - 1
ER -