Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohortBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k322 (Published 14 February 2018) Cite this as: BMJ 2018;360:k322
- Thibault Fiolet, epidemiology and biostatistics master intern1,
- Bernard Srour, pharmacist, PhD candidate in epidemiology1,
- Laury Sellem, nutrition and public health master intern1,
- Emmanuelle Kesse-Guyot, senior researcher in nutritional epidemiology1,
- Benjamin Allès, junior researcher in nutritional epidemiology1,
- Caroline Méjean, senior researcher in nutritional epidemiology2,
- Mélanie Deschasaux, post-doctoral researcher in nutritional epidemiology1,
- Philippine Fassier, post-doctoral researcher in nutritional epidemiology1,
- Paule Latino-Martel, nutrition and public health master intern1,
- Marie Beslay, senior researcher in nutritional epidemiology1,
- Serge Hercberg, professor of nutrition and public health, head of the EREN team1 4,
- Céline Lavalette, epidemiology and biostatistics master intern1,
- Carlos A Monteiro, professor of nutrition and public health3,
- Chantal Julia, senior researcher in nutritional epidemiology1 4,
- Mathilde Touvier, senior researcher in nutritional epidemiology, head of the nutrition and cancer group at EREN1
- 1Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny, France
- 2INRA, UMR 1110 MOISA, 34000 Montpellier, France
- 3Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
- 4Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
- Correspondence to: B Srour
- Accepted 10 January 2018
Objective To assess the prospective associations between consumption of ultra-processed food and risk of cancer.
Design Population based cohort study.
Setting and participants 104 980 participants aged at least 18 years (median age 42.8 years) from the French NutriNet-Santé cohort (2009-17). Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants’ usual consumption for 3300 different food items. These were categorised according to their degree of processing by the NOVA classification.
Main outcome measures Associations between ultra-processed food intake and risk of overall, breast, prostate, and colorectal cancer assessed by multivariable Cox proportional hazard models adjusted for known risk factors.
Results Ultra-processed food intake was associated with higher overall cancer risk (n=2228 cases; hazard ratio for a 10% increment in the proportion of ultra-processed food in the diet 1.12 (95% confidence interval 1.06 to 1.18); P for trend<0.001) and breast cancer risk (n=739 cases; hazard ratio 1.11 (1.02 to 1.22); P for trend=0.02). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (lipid, sodium, and carbohydrate intakes and/or a Western pattern derived by principal component analysis).
Conclusions In this large prospective study, a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in risks of overall and breast cancer. Further studies are needed to better understand the relative effect of the various dimensions of processing (nutritional composition, food additives, contact materials, and neoformed contaminants) in these associations.
Study registration Clinicaltrials.gov NCT03335644.
Contributors: TF and BS contributed equally and are co-first authors. TF, BS, CJ, EKG, CAM, BA, and MT designed the research. SH, MT, CJ, and EKG conducted the research. TF did the statistical analysis, supervised by MT and BS. TF and MT wrote the paper. BS did sensitivity analyses and was in charge of the revision of the paper. All authors contributed to the data interpretation, revised each draft for important intellectual content, and read and approved the final manuscript. MT is the guarantor.
Funding: The NutriNet-Santé study was supported by the following public institutions: Ministère de la Santé, Institut de Veille Sanitaire (InVS), Institut National de la Prévention et de l’Education pour la Santé (INPES), Région Ile-de-France (CORDDIM), Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Conservatoire National des Arts et Métiers (CNAM), and Université Paris 13. MD and PF were funded by a PhD grant from the Cancéropôle Ile de France/Région Ile de France (public funding). BS was funded by the French National Cancer Institute (grant number INCa_8085). Researchers were independent from funders. Funders had no role in the study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the article for publication.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work other than that described above; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The NutriNet-Santé study was approved by the Institutional Review Board of the French Institute for Health and Medical Research (IRB Inserm No 0000388FWA00005831) and the Commission Nationale de l’Informatique et des Libertés (CNIL No 908450/No 909216). Electronic informed consent was obtained from each participant.
Transparency statement: MT (the guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Data sharing: No additional data available.
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