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Ultra-processed food consumption associates with higher cardiovascular risk in rheumatoid arthritis

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Abstract

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.

Key-Points

• 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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Funding

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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Author notes

  1. Fabiana Infante Smaira, Bruna Caruso Mazzolani, Maria Eugênia Araujo, Bruno Gualano and Ana Jéssica Pinto contributed equally to this work.

Authors and Affiliations

  1. Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, Sao Paulo, SP, 01246-903, Brazil

    Fabiana Infante Smaira, Bruna Caruso Mazzolani, Tiago Peçanha, Kamila Meireles dos Santos, Diego Augusto Nunes Rezende, Maria Eugênia Araujo, Hamilton Roschel, Bruno Gualano & Ana Jéssica Pinto

  2. Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, Sao Paulo, SP, 05403-900, Brazil

    Karina Bonfiglioli, Ana Lúcia de Sá Pinto, Fernanda Rodrigues Lima & Rosa Maria R. Pereira

  3. School of Public Health, Department of Nutrition, Universidade de Sao Paulo, Av. Dr. Arnaldo, 715, Sao Paulo, SP, 01246-904, Brazil

    Fernanda Baeza Scagliusi

  4. School of Applied Sciences, State University of Campinas, R. Pedro Zaccaria, 1300, Limeira, SP, 13484-350, Brazil

    Fabiana Braga Benatti

  5. Food Research Center, University of São Paulo, R. do Lago, 250, São Paulo, SP, 05508-080, Brazil

    Bruno Gualano

Authors
  1. Fabiana Infante Smaira
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  2. Bruna Caruso Mazzolani
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  7. Karina Bonfiglioli
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  8. Fernanda Baeza Scagliusi
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  9. Fabiana Braga Benatti
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  10. Ana Lúcia de Sá Pinto
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  11. Fernanda Rodrigues Lima
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  12. Rosa Maria R. Pereira
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  13. Hamilton Roschel
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  14. Bruno Gualano
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  15. Ana Jéssica Pinto
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Contributions

Fabiana Infante Smaira: conceptualization, methodology, formal analysis, investigation, writing – original draft, visualization, funding acquisition. Bruna Caruso Mazzolani: conceptualization, methodology, formal analysis, investigation, writing – original draft, visualization, funding acquisition. Tiago Peçanha: methodology, investigation, funding acquisition. Kamila Meireles dos Santos: investigation. Diego Augusto Nunes Rezende: investigation. Maria Eugênia Araujo: investigation. Karina Bonfiglioli: resources, writing - review and editing. Fabiana Braga Benatti: writing – review and editing. Fernanda Baeza Scagliusi: writing – review and editing. Ana Lúcia de Sá Pinto: resources, writing – review and editing. Fernanda Rodrigues Lima: resources, writing – review and editing. Rosa Maria R. Pereira: resources, writing – review and editing. Hamilton Roschel: writing - review and editing, funding acquisition. Bruno Gualano: conceptualization, methodology, writing – original draft, supervision, project administration, funding acquisition. Ana Jéssica Pinto: conceptualization, methodology, writing – original draft, supervision, project administration, funding acquisition. All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published.

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Correspondence to Bruno Gualano.

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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

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  • DOI: https://doi.org/10.1007/s10067-019-04916-4

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