Ultra-processed food consumption and the trajectory of cardio-renal-metabolic multimorbidity: insights from multi-state modelling.

Background

The global increase in ultra-processed food (UPF) consumption has been associated with individual cardio-renal-metabolic (CRM) diseases, but its role in multimorbidity progression remains unclear.

Objective

This study aimed to examine the relationship between UPF intake and transitions across successive CRM disease stages.

Methods

We included 115 745 UK Biobank participants free of CRM diseases at the baseline, each completing at least two 24-hour dietary assessments. Multi-state models were applied to estimate associations between UPF consumption and transitions from disease-free status to first, double, and triple CRM conditions. Substitution analyses were used to assess the impact of replacing UPFs with unprocessed or minimally processed foods (UNPFs).

Results

Over a median follow-up of 13.7 years, 16 114 participants developed incident CRM disease, with 2274 progressing to double and 227 to triple multimorbidity. An interquartile range increase in UPF intake was linked to higher risks of developing a first CRM disease (HR: 1.16; 95% CI: 1.14-1.19), progressing to double disease (HR: 1.13; 95% CI: 1.08-1.20), and advancing to triple disease (HR: 1.22; 95% CI: 1.05-1.43). The associations were primarily driven by UPF beverages and processed fruits/vegetables, whereas yogurts and whole-grain cereals showed neutral or inverse associations. Replacing 15% of UPF intake with UNPFs was associated with a 13% reduction in the risk of developing a first CRM disease and a 17% reduction in the risk of progressing to triple disease, with the most significant benefits observed in lean individuals.

Conclusions

UPF consumption is associated with CRM multimorbidity progression. Replacing UPFs with UNPFs may serve as a potential strategy for preventing the progression of CRM multimorbidity.