Abstract
BACKGROUND: Ultraprocessed foods (UPFs) have been linked to adverse cardiometabolic outcomes and increased atherosclerotic cardiovascular disease (CVD) (ASCVD) risk. However, prior research has largely focused on homogenous populations, lacking racial and ethnic diversity. OBJECTIVES: The objectives are to examine the longitudinal relationship between UPF consumption and ASCVD risk and to investigate whether these associations differ by race/ethnicity, sex, or socioeconomic status. METHODS: The MESA (Multiethnic Study of Atherosclerosis) is a prospective cohort study of 6,814 U.S. adults aged 45 to 84 years, without clinically apparent CVD. UPF consumption was classified according to the Nova classification system. Multivariable cox proportional hazards models were used to evaluate the association between UPF intake and incident CVD events. Incident CVD events included nonfatal myocardial infarction, resuscitated cardiac arrest, death resulting from coronary heart disease, stroke (not transient ischemic attack), and death resulting from stroke. RESULTS: Each additional daily serving of UPF was associated with a 5.1% increased risk of ASCVD events (HR: 1.051; 95% CI: 1.011-1.093). Participants in the highest quintile of UPF consumption had a 66.8% higher risk compared to those in the lowest (HR: 1.668; 95% CI: 1.196-2.325). A significant multiplicative interaction was observed between UPF intake and Black race (P = 0.010), with stratified analyses demonstrating a higher ASCVD risk in Black Americans (HR: 1.061; 95% CI: 1.016-1.108), compared to non-Black Americans (HR: 1.032; 95% CI: 1.001-1.065). CONCLUSIONS: In a large, multiethnic cohort, higher UPF consumption was significantly associated with an increased risk for ASCVD events, with a more pronounced association among Black Americans.