Introduction: Studies of the association between ultra-processed foods (UPF) and cardiovascular disease risk factors have been mainly focused on the adult population. The present study examined the association between usual percent of calories (%kcal) from UPF and the American Heart Association’s “Life’s Simple 7” cardiovascular health (CVH) metrics among US adolescents aged 12-19 years.
Hypothesis: A higher %kcal from UPF is associated with lower CVH score.
Methods: We used data from the National Health and Nutrition Examination Survey 2007-2016 (n=4532). UPF was assigned based on the NOVA food system, according to the extent and purpose of food processing. By summing up the number of ideal CVH metrics (excluding the dietary component), we categorized adolescents into 3 groups: ideal (with 5-6 ideal CHV metrics), intermediate (3-4) and poor (0-2). We estimated the usual %kcal from UPF using up to two 24-hour dietary recalls and the National Cancer Institute methods to account for measurement error. We used multivariable linear and multinomial logistic regression to assess the association between UPF and CVH, adjusted for age, gender, race and Hispanic origin, parents’ education attainment, poverty and health insurance status.
Results: The prevalence of meeting 0-2, 3-4 and 5-6 ideal CVH metrics was 6.2%, 53.6%, and 40.2%, respectively. The mean usual %kcal from UPF was 65.7%, and the mid-points of quartiles of intake ranged from 54.5% (Q1) to 76.8% (Q4). Every 10% increase in calories from UPF was associated with 0.125 lower number of ideal CVH metrics as a continuous outcome (p<0.001). Comparing the highest and lowest quartiles of UPF intake, the adjusted odds ratios for meeting 0-2 vs. 5-6 ideal CVH was 2.48 (95% CI, 1.26-4.91). The corresponding odds ratios for meeting 3-4 vs. 5-6 ideal CVH were 1.92 (95% CI, 1.29-2.88). The pattern of association was largely consistent across subgroups (all false discovery rate adjusted p values >0.05).
Conclusions: UPF represented about two-thirds of total daily calorie intake among US adolescents. There was a graded inverse association between %kcal from UPF and CVH score. Raising awareness of the negative health impact of UPF may encourage adolescents to adopt healthier diets, which could improve cardiovascular health.
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