Ultra-processed foods, plant and animal source, and all-cause, cardiovascular, and cancer mortality in older adults in the United States: results from the Cardiovascular Health Study

Background: Ultra processed food (UPF) consumption is associated with adverse health outcomes. Plant- and animal-sourced UPF have a unique nutritional composition to improve palatability which may impact health, but evidence is limited. The objective of this study aimed to investigate the association between UPF intake, plant-, and animal-sourced UPF, and mortality outcomes in older adults. Methods: We conducted prospective analyses of 2,582 participants (median age: 77 years) in the Cardiovascular Health Study who completed a food frequency questionnaire (FFQ) in 1995-1996. We used responses from the FFQ to identify UPF and classify UPF based on their source (plant or animal). Cox proportional hazard regression models were used to study the association between UPF, plant-, and animal-sourced UPF, and mortality outcomes [all-cause, cardiovascular (CVD) related, non-CVD related, and cancer]. Results: Over a median follow-up of 10 years, there were 2,242 deaths. After adjusting for sociodemographic characteristics and health behaviors, per standard deviation (SD) higher intake of UPF was associated with 8-10% higher risk of all-cause mortality (HR: 1.08, 95% CI: 1.02, 1.14), non-CVD related mortality (HR: 1.10, 95% CI: 1.03, 1.18), and cancer mortality (HR: 1.13, 95% CI: 1.08, 1.46). Similarly, per SD higher intake of plant-sourced UPF and animal-sourced UPF was associated with a 4-17% higher risk of all-cause mortality, non-CVD related mortality, and cancer mortality. However, in a model additionally adjusting for clinical factors, the associations between plant-sourced UPF and mortality attenuated, except for cancer mortality. No significant associations were observed for CVD related mortality. Conclusion: Higher consumption of UPF, plant-, and animal-sourced UPF was associated with higher risk of all-cause, non-CVD related, and cancer mortality. Our findings emphasize the need to consider the impact of food processing, even in plant-sourced foods to prevent shorter lifespan in older adults. Findings on plant-sourced UPF and mortality requires replication.