Ultra-processed foods: Implications for gastrointestinal health

Table 7 Summary of available studies on the use of ultra-processed food and risk of cancers

Ref.	Study design	Population characteristics, n	Outcome parameters	Main findings
Fiolet et al[109], 2018, France	Prospective cohort (NutriNet-Sante)	Adults > 18 years, n = 104980	Overall cancer, breast cancer, CRC, prostate cancer	A 10% ↑ increase in the proportion of UPFs in the diet is associated with; 13% ↑ risk of overall cancer, an 11% ↑ risk of breast cancer. No significant association between UPFs consumption and risk of CRC or prostate cancer
Wang et al[112], 2022, United States	Prospective cohort	Adults: 25-75 years, 206248	CRC	Males in the highest quintile of UPFs consumption had a 29% ↑ risk of CRC compared to males in the lowest quintile. No association was found between UPFs consumption and CRC risk in females
Zhong et al[113], 2023, United States	Prospective cohort	Adults: 55-74 years, n = 98265	Pancreatic cancer	Adults in the highest quartile of UPFs consumption had a 49% ↑ risk of pancreatic cancer compared to individuals in the lowest quartile
[114], 2023	Multicentric prospective cohort	n = 450111	Head and neck cancers, esophageal cancer, gastric cancer, colon cancer, rectal cancer, hepatocellular carcinoma, gallbladder cancer, pancreatic cancer, lung cancer, renal cell carcinoma, bladder cancer, glioma, thyroid cancer, multiple myeloma, non-Hodgkin lymphoma, leukaemia, melanoma, breast cancer (premenopausal and postmenopausal), cervical cancer, endometrial cancer, ovarian cancer, and prostate cancer	A substitution of 10% of processed foods with an equal amount of minimally processed foods was associated with ↓ a risk of: Overall cancer (HR 0.96, 95%CI: 0.95-0.97), head and neck cancers (HR 0.80, 95%CI: 0.75-0.85); Esophageal squamous cell carcinoma (HR 0.57, 95%CI: 0.51-0.64); Colon cancer (HR 0.88, 95%CI: 0.85-0.92); Rectal cancer (HR 0.90, 95%CI: 0.85-0.94); Hepatocellular carcinoma (HR 0.77, 95%CI: 0.68-0.87), and Postmenopausal breast cancer (HR 0.93, 95%CI: 0.90-0.97); Replacement of processed and ultra-processed foods and drinks with an equal amount of minimally processed foods might ↓ the risk of various cancer types
Chang et al[115], 2023, United Kingdom	Prospective cohort	Adults: 40-69 years	Overall, cancer and 34-site site-specific cancers	Every 10% point ↑ in UPF consumption was associated with: ↑ overall cancer (HR: 1.02, 95%CI: 1.01-1.04); ↑ ovarian cancer (HR: 1.19, 95%CI: 1.08-1.30)
El Kinany et al[118], 2022, Morocco	Case-control	Adults > 18 years; Cases (n = 1453); Controls (n = 1453)	CRC	Individuals in the highest tertile of UPFs consumption compared to the lowest tertile had: 40% ↑ OR of having overall CRC; 36% ↑ OR of having colon cancer; 44% ↑ OR of having rectal cancer
Jafari et al[119], 2023, Iran	Case-control	Adults: 40-75 years; Cases (n = 71); Controls (n = 142)	CRC	Individuals in the highest tertile of UPFs consumption had a 332% ↑ OR of CRC compared to individuals in the lowest tertile
Romaguera et al[117], 2021, Spain	Case-control	Adults: 20-85 years; CRC; Cases (n = 1852); Controls (n = 3447); Breast cancer; Cases (n = 1486); Controls (n = 1652); Prostate cancer; Cases (n = 953); Controls (n = 1283)	CRC; breast cancer; prostate cancer	Individuals in the highest tertile of UPFs consumption had a 30% ↑ OR of CRC compared to the lowest tertile; No significant association between UPFs consumption and prostate cancer or overall breast cancer
Romieu et al[121], 2022, Chile, Colombia, Costa Rica, Mexico	Case-control	Adults 20-45 years; Cases (n = 525); Controls (n = 525)	Premenopausal breast cancer	Participants in the highest tertile of UPFs consumption had a 93% ↑ OR of having overall premenopausal breast cancer compared to the lowest tertile
Solans et al[116], 2021, Spain	Case-control	Adults: 20-85 years; Cases (n = 230); Controls (n = 1634)	CLL	In incident cases only, a 10% ↑ in UPFs in the diet was associated with a 22% ↑ OR of being diagnosed with CLL
Trudeau et al[122], 2020, Canada	Case-control (PROtEuS)	Adults: 39-75 years; Cases (n = 1919); Controls (n = 1991)	Prostate cancer	No association was found between UPFs consumption and prostate cancer when comparing quartiles of UPF consumption
Esposito et al[123], 2023, Italy	Case-control	Adults, > 18 years; Cases (n = 44); Controls (n = 88)	CNS tumours	1% ↑ in UPFs in diet was associated with: 6% ↑ OR of overall CNS tumors; 9% ↑ OR of malignant CNS tumors
Jacobs et al[120], 2022, South-Africa	Case-control	Adults > 18 years; Cases (n = 396); Controls (n = 396)	Breast cancer	No statistically significant association between UPFs consumption and breast cancer when comparing tertiles of UPFs consumption

CLL: Chronic lymphocytic leukemia; CNS: Central nervous system; CRC: Colorectal cancer; HR: Hazard ratio; OR: Odds ratio; UPF: Ultra-processed foods; CI: Confidence interval.