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Relation
Fiolet T, Srour B, Sellem L, et al. Ultra-processed food consumption and cancer risk: results from the NutriNet-Santé prospective cohort.BMJ. 2018;360:k322.
Draft
Population-based cohort study
Objective
To assess the prospective associations between consumption of ultra-processed foods* and cancer risk
Participant
Participants in this study are the French NutriNet-Santé cohort (2009-17), which includes 104,980 adults (mean age 42.8 years).
Study parameters assessed
Dietary intake was assessed through repeated 24-hour dietary records designed to capture usual consumption of 3,300 different foods. Items were categorized according to their level of processing using the NOVA classification, a classification of foods based on the extent and purpose of industrial food processing. Cancer cases were identified and confirmed using self-reports, medical records, data from the French national health insurance system and the French national death registry.
Target parameters
Associations between ultra-processed food intake and overall risk of breast, prostate and colorectal cancer assessed by multivariable Cox proportional hazard models adjusted for known risk factors.
Key insights
Intake of ultra-processed foods was associated with a higher risk of breast cancer (n = 739 cases) and total cancer (n = 2,228 cases). When increasing the proportion of ultra-processed foods in the diet by 10% the hazard ratio [HR] was 1.12 (95% confidence interval [CI]: 1.06-1.18;Pfor trend < 0.001) for cancer overall and 1.11 (CI: 1.02–1.22;Pfor trend=0.02) for breast cancer. This means that a 10% increase in the proportion of ultra-processed foods in the diet was associated with a statistically significant 12% increase in overall cancer risk and an 11% increase in breast cancer risk. These results remained statistically significant after adjustment for several markers of nutritional quality of the diet (lipid, sodium, and carbohydrate intakes and/or a Western pattern derived by principal component analysis).
Practice implications
The American Institute for Cancer Research claims that about a third of the world's most common cancers could be prevented by changing lifestyle and dietary habits in developed countries.1Within naturopathy, we have seen statements suggesting that up to 95% of cancers are preventable through diet and lifestyle.2This seems exaggerated and leaves us wondering: exactly how much risk of cancer development can be attributed to diet?
In recent years, diets in many countries have shifted dramatically toward higher amounts of ultra-processed foods, which are foods that have undergone multiple physical and chemical processes to increase their palatability, shelf life, safety and affordability.3
Surveys conducted in Europe, the United States, Canada, New Zealand and Brazil have found that these ultra-processed foods now account for between 25% and 50% of total daily energy intake.4-7While it may be difficult for us to imagine this level of consumption, we must remember that we health practitioners and our patients are not representative of the average global consumer.
If every 10 percent increase in calories from ultra-processed foods is associated with an 11 percent increase in overall cancer risk, we certainly have a serious brewing problem.
There are a number of reasons why ultra-processed foods may increase the risk of cancer. They are higher in total fat and saturated fat than less processed foods. Eating fat may or may not be associated with a risk of some types of cancer (prostate cancer, yes; breast cancer, no). The low vitamin density and the high sugar and salt content of these foods can also play a role. The low fiber content affects the intestinal biome and can therefore alter the risk of cancer.8Processing can result in the formation of cancer-causing chemicals such as acrylamide, heterocyclic amines and polycyclic hydrocarbons.9.10Food packaging may contain carcinogens that enter the food during storage or preparation, such as: B. Bisphenol A. Some food additives, such as: Some substances, such as sodium nitrite, can be legally added to processed meats but can still be carcinogenic.
The actual concept of studying the effects of food processing on disease risk is still in its infancy. It wasn't until this NOVA classification system was created in the last year or two that these impacts could potentially be quantified.11
While these data only seem to confirm a message we have been trying to convey to our patients for decades, the magnitude of the impact is surprising. If every 10 percent increase in calories from ultra-processed foods is associated with an 11 percent increase in overall cancer risk, we certainly have a serious brewing problem. Many segments of the population consume well over 10% of their energy from ultra-processed foods.
Many of our patients believe that foods labeled as natural, organic, free of genetically modified organisms (GMOs), or gluten-free are a healthy choice. None of these labeled categories measure levels of processing, and little data links these categories to significant reverse cancer risk. Therefore, for patients looking to reduce their risk of cancer, reducing consumption of ultra-processed foods now appears to be a decent, evidence-based food choice.
*This paper defines ultra-processed foods according to the NOVA classification system and includes the following:
"mass-produced packaged breads and rolls; sweet or savory packaged snacks; industrial confectionery and desserts; sodas and sweetened beverages; meatballs, poultry and fish nuggets, and other reconstituted meat products processed with the addition of preservatives other than salt (e.g., nitrites); instant noodles and soups; frozen or shelf-stable prepared meals; and other food products made largely or entirely from sugars, oils and fats, and other substances not commonly used in culinary preparations, such as hydrogenated oils, modified starches, and protein isolates. Industrial processes include, in particular, hydrogenation, hydrolysis, extrusion, molding, forming and pre-processing by frying. flavorings, colorings, Emulsifiers, humectants, sugar-free sweeteners and other cosmetic additives are often added to these products to mimic the sensory properties of unprocessed or minimally processed foods and their culinary preparations or to disguise undesirable characteristics of the final product.”