To investigate the association between food consumption stratified by processing level and cardiovascular risk factors in rheumatoid arthritis. In this cross-sectional study, 56 patients (age: 62.5 ± 7.9 years, BMI: 28.4 ± 5.1 kg/m2) had food consumption evaluated according to the processing level (e.g., unprocessed or minimally processed foods, processed foods, and ultra-processed foods) and associated with cardiovascular risk factors. The most prevalent food processing level was unprocessed or minimally processed foods (42.6 ± 12.6% of total energy intake [TEI]), followed by processed (24.2 ± 11.9%TEI), ultra-processed (18.1 ± 11.8%TEI), and culinary ingredients (15.1 ± 6.4%TEI). Adjusted regression models showed that higher consumption of ultra-processed foods was positively associated with Framingham risk score (β = 0.06, CI: 95% 0.001, 0.11, p = 0.045) and glycated hemoglobin (β = 0.04, CI: 95% 0.01, 0.08, p = 0.021). In contrast, higher consumption of unprocessed or minimally processed foods was associated with lower 10-year risk of developing cardiovascular diseases (β = −0.05, CI: 95% − 0.09, −0.003, p = 0.021) and LDL (β = −1.09, CI: 95% − 1.94, −0.24, p = 0.013). Patients with rheumatoid arthritis consuming more ultra-processed foods showed worse metabolic profile, whereas those consuming more unprocessed or minimally processed foods had lower cardiovascular risks. A food pattern characterized by a high ultra-processed food consumption appears to emerge as a novel, modifiable risk factor for cardiovascular diseases in rheumatoid arthritis.
• Higher ultra-processed food consumption was associated with worse metabolic profile and increased cardiovascular risk, whereas higher unprocessed or minimally processed food consumption was associated with lower 10-year risk of developing cardiovascular diseases.
• A food pattern characterized by a high ultra-processed food consumption appears to emerge as a novel, modifiable risk factor for cardiovascular diseases in rheumatoid arthritis.
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Sarzi-Puttini P, Atzeni F, Gerli R, Bartoloni E, Doria A, Barskova T, Matucci-Cerinic M, Sitia S, Tomasoni L, Turiel M (2010) Cardiac involvement in systemic rheumatic diseases: an update. Autoimmun Rev 9(12):849–852. https://doi.org/10.1016/j.autrev.2010.08.002
Rennie K, Hughes J, Lang R, Jebb S (2003) Nutritional management of rheumatoid arthritis: a review of the evidence. J Hum Nutr Diet 16(2):97–109. https://doi.org/10.1046/j.1365-277x.2003.00423.x
Ioannidis JPA (2018) The challenge of reforming nutritional epidemiologic research. JAMA 320(10):969–970. https://doi.org/10.1001/jama.2018.11025
Monteiro CA (2009) Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutr 12(5):729–731. https://doi.org/10.1017/S1368980009005291
Monteiro CA, Cannon G, Levy R, Moubarac J-C, Jaime P, Martins AP, Canella D, Louzada M, Parra D, Ricardo C, Calixto G, Machado P, Martins C, Martinez E, Baraldi L, Garzillo J, Sattamini I (2016) NOVA. The star shines bright. World Nutr 7(1–3):28–38
Monteiro CA, Cannon G, Levy RB, Moubarac J-C, Louzada ML, Rauber F, Khandpur N, Cediel G, Neri D, Martinez-Steele E, Baraldi LG, Jaime PC (2019) Ultra-processed foods: what they are and how to identify them. Public Health Nutr 22(5):936–941. https://doi.org/10.1017/S1368980018003762
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, Medsger TA, Mitchell DM, Neustadt DH, Pinals RS, Schaller JG, Sharp JT, Sharp RL, Hunder GG (1988) The American rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31(3):315–324
Food, Nutrition Board I (2005) Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). National Academy Press, Washington (DC). https://doi.org/10.17226/10490
Mahmood SS, Levy D, Vasan RS, Wang TJ (2014) The Framingham heart study and the epidemiology of cardiovascular disease: a historical perspective. Lancet 383(9921):999–1008. https://doi.org/10.1016/s0140-6736(13)61752-3
Jaime P, Augusto Monteiro C, Martins AP, Martins C, Canella D, Coitinho D, Jacoby E, Lima F, Cannon G, Moubarac J-C, Garzillo J, Baraldi L, Barciotte M, Louzada ML, Claro R, Rodrigues R, Levy R, Domene S (2015) Brazil. Ministry of Health of Brazil. Secretariat of Health Care. Primary Health Care Department. Dietary Guidelines for the Brazilian population / Ministry of Health of Brazil, Secretariat of Health Care, Primary Health Care Department; translated by Carlos Augusto Monteiro. – Brasiĺ ia : Ministry of Health of Brazil, p 150
Marrón-Ponce JA, Sánchez-Pimienta TG, da Costa Louzada ML, Batis C (2018) Energy contribution of NOVA food groups and sociodemographic determinants of ultra-processed food consumption in the Mexican population. Public Health Nutr 21(1):87–93
Costa Louzada ML, Martins AP, Canella DS, Baraldi LG, Levy RB, Claro RM, Moubarac JC, Cannon G, Monteiro CA (2015) Ultra-processed foods and the nutritional dietary profile in Brazil. Rev Saude Publica 49:38. https://doi.org/10.1590/S0034-8910.2015049006132
Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, Chung ST, Costa E, Courville A, Darcey V, Fletcher LA, Forde CG, Gharib AM, Guo J, Howard R, Joseph PV, McGehee S, Ouwerkerk R, Raisinger K, Rozga I, Stagliano M, Walter M, Walter PJ, Yang S, Zhou M (2019) Ultra-processed diets cause excess calorie intake and weight gain: a one-month inpatient randomized controlled trial of ad libitum food intake. Cell Metab 30:1–11. https://doi.org/10.1016/j.cmet.2019.05.008
Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB (2011) The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol 57(11):1299–1313. https://doi.org/10.1016/j.jacc.2010.09.073
Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, Okamura T, Miyamoto Y (2014) Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med 174(4):577–587. https://doi.org/10.1001/jamainternmed.2013.14547
Fabiana Infante Smaira, Tiago Peçanha, Bruno Gualano, and Ana Jéssica Pinto were supported by grants from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP; 2017/17837-1; 2016/23319-0; 2017/13552-2; 2015/26937-4). Hamilton Roschel, Fernanda Baeza Scagliusi, and Bruna Caruso Mazzolani were supported by grants from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq; 301571/2017-1; 309514/2018-5).
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Smaira, F.I., Mazzolani, B.C., Peçanha, T. et al. Ultra-processed food consumption associates with higher cardiovascular risk in rheumatoid arthritis. Clin Rheumatol 39, 1423–1428 (2020). https://doi.org/10.1007/s10067-019-04916-4
- Cardiometabolic risk factors
- NOVA classification
- Ultra-processed food