Central Adiposity and Inflammation Mediate the Association Between Ultraprocessed Food Intake and Cardiovascular Disease Risk.
Abstract
Background
Higher consumption of ultraprocessed foods (UPFs) has been consistently associated with increased cardiovascular disease (CVD) risk, but the biological pathways underlying this relationship remain incompletely understood.
Objectives
The study aims to examine whether body composition, systemic inflammation, and metabolic biomarkers mediate the association between UPF consumption and incident CVD.
Methods
MESA (Multi-Ethnic Study of Atherosclerosis) is a population-based, prospective cohort study of men and women aged 45 to 84 years who were free of clinically apparent CVD at baseline. UPFs were classified according to the Nova classification system. To evaluate potential pathways linking UPF intake with incident CVD, mediation analyses were conducted using generalized structural equation modeling and counterfactual-based causal mediation analysis.
Results
Among 6,531 participants, higher UPF intake was associated with adverse cardiometabolic profiles. In single-mediator generalized structural equation models, both waist-to-height ratio (β: 0.012; CI: 0.007-0.017) and interleukin (IL)-6 (β: 0.003; CI: 0.001-0.006) significantly mediated the association between UPF intake and incident CVD, with waist-to-height ratio mediating 44% and IL-6 mediating 13% of the total association. In parallel mediation models including waist-to-height ratio and IL-6 simultaneously, both mediators retained independent indirect effects, with adiposity contributing 38% and IL-6 contributing 9% of the proportion mediated. Results were consistent in magnitude and direction across counterfactual mediation analyses.
Conclusions
The association between UPF consumption and CVD risk appears to be partially mediated through central adiposity and systemic inflammation. These findings provide mechanistic insight into how UPFs may contribute to CVD risk and support dietary strategies that limit UPFs to reduce cardiometabolic risk.