Ultra-processed food consumption and risk of all-cause mortality in the Atherosclerosis Risk in Communities Study (ARIC)

Background Ultra-processed food (UPF) consumption has increased substantially in the United States and globally, driven by its convenience, palatability, and aggressive marketing. While prior studies have linked UPF consumption with adverse cardiometabolic outcomes, evidence on its relationship with mortality remains limited, particularly in racially and geographically diverse U.S. populations. Methods The study included 11,185 participants (mean age 54 years; 55% female; 24% Black) from the Atherosclerosis Risk in Communities (ARIC) study at baseline (1987–1989). Diet was assessed using a validated 66-item food frequency questionnaire. Foods were classified according to the Nova classification system based on their degree of processing. UPF was measured in servings per day and assessed categorically and continuously. All-cause mortality was ascertained through December 31, 2022. We used multivariable Cox proportional hazards models to evaluate total UPF intake and intake of nine UPF subgroups in relation to all-cause mortality. Results Over a median follow-up of 30 years (301,093 person-years), 6,656 deaths occurred. No significant association was observed between the highest and lowest quartiles of UPF intake and all-cause mortality (HR: 0.99; 95% CI: 0.92, 1.06). The highest quartile of consumption of ultra-processed meats and spirits was associated with an 11% (95% CI: 1%, 21%) and 12% (95% CI: 2%, 23%) higher risk of all-cause mortality compared with the lowest quartile, respectively. In contrast, the highest quartile consumption of cereals was associated with a 13% (95% CI: 4%, 20%) lower risk of mortality. Conclusions In this large prospective cohort of U.S. adults, overall UPF intake was not associated with all-cause mortality, though heterogeneous associations were observed with specific types of UPF. These findings highlight differences across UPF categories and warrant further investigation rather than treating UPF as a uniform exposure.