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Associations Between Ultraprocessed Food Consumption and Adverse Brain Health Outcomes
abstract
This abstract is available on the publisher's site.
Access this abstract nowBackground and Objectives
Ultra-processed foods (UPFs) are linked to cardiometabolic diseases and neurologic outcomes, such as cognitive decline and stroke. However, it is unclear whether food processing confers neurologic risk independent of dietary pattern information. We aimed to (1) investigate associations between UPFs and incident cognitive impairment and stroke and (2) compare these associations with other commonly recommended dietary patterns in the REasons for Geographic and Racial Differences in Stroke study. This prospective, observational cohort study enrolled Black and White adults in the United States from 2003 to 2007.
Methods
The NOVA system was used to categorize items from a baseline food frequency questionnaire according to the level of processing. Participants with incomplete or implausible self-reported dietary data were excluded. Consumption for each category (grams) was normalized to total grams consumed. Scores quantifying adherence to a Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet were also calculated. Incident cognitive impairment was defined using performance relative to a normative sample on memory and fluency assessments. Incident stroke was identified through adjudicated review of medical records.
Results
The cognitive impairment cohort (n = 14,175) included participants without evidence of impairment at baseline who underwent follow-up testing. The stroke cohort (n = 20,243) included participants without a history of stroke. In multivariable Cox proportional hazards models, a 10% increase in relative intake of UPFs was associated with higher risk of cognitive impairment (hazard ratio [HR] = 1.16, 95% CI 1.09–1.24, p = 1.01 × 10−5) and intake of unprocessed or minimally processed foods with lower risk of cognitive impairment (HR = 0.88, 95% CI 0.83–0.94, p = 1.83 × 10−4). Greater intake of UPFs (HR = 1.08, 95% CI 1.02–1.14, p = 1.12 × 10−2) and unprocessed or minimally processed foods (HR = 0.91, 95% CI 0.86–0.95, p = 2.13 × 10−4) were also associated with risk of stroke in multivariable Cox models. The effect of UPFs on stroke risk was greater among Black than White participants (UPF-by-race interaction HR = 1.15, 95% CI 1.03–1.29, p = 1.50 × 10−2). Associations between UPFs and both cognitive impairment and stroke were independent of adherence to the Mediterranean, DASH, and MIND diets.
Discussion
Food processing may be important to brain health in older adults independent of known risk factors and adherence to recommended dietary patterns.
Additional Info
Disclosure statements are available on the authors' profiles:
Processed food intake and the risk of stroke and cognitive decline
Ultraprocessed foods (UPFs) are defined as food substances that are never or rarely used in a kitchen and have additives that are used to make food more tasteful or appealing. Or, to put it another way, UPFs require a food chemist to create unique additives that would not be found in nature.
The specific risk of UPFs is unknown but likely related to a higher density of calories, lack of whole foods, nutritional imbalance, the inclusion of potentially harmful chemicals, and the risk of over-consumption due to addictive properties. One example of a UPF would be a food sweetened with a non-nutritive sweetener, which prior research has correlated with an increase in stroke and cardiovascular risk.1,2
The REGARDS study included a biracial (involving Black and White participants) cohort of 30,239 individuals that was divided into stroke (n = 20,243) and cognition (n = 14,175) study groups and followed between 2003 and 2007. When the researchers removed multiple covariates from the risk profile, the negative effects of eating UPFs remained. For stroke, a high UPF score (NOVA4) compared with a low UPF score (NOVA1) resulted in a hazard ratio of 1.08 to 0.91. The risk was greater in Black participants than in White participants. For cognitive decline, a high UPF score compared with a low UPF score resulted in a hazard ratio of 1.16 to 0.88. These findings were independent of the adherence to the Mediterranean, DASH, or MIND diets, all of which were associated with a lower risk of stroke and cognitive decline.
The evidence is convincing that eating foods created in nature is healthier than eating those created in a lab. Other evidence-informed strategies to keep the brain healthy are below.
Strategies to maintain the brain health:
References