Markers of ultra-processed food and incident arterial hypertension in the UK Biobank.
BACKGROUND AND AIMS Intake of ultra-processed food (UPF) is positively associated with arterial hypertension; however, the association with specific markers of ultra-processing (MUPs) has not been assessed so far. METHODS This exploratory prospective cohort study included 101 560 non-hypertensive UK Biobank participants who completed at least one 24-h dietary recall (Oxford WebQ). Intake of UPFs and specific MUPs was assessed by matching up to 10 commercial products to each Oxford WebQ item. The ingredient lists of these products contained 37 specific MUPs grouped into nine MUP categories. Cox proportional hazards regression models assessed arterial hypertension in relation to intake of foods containing these MUP categories and specific MUPs, modelled with penalized cubic splines as a percentage of total food intake (%TFI). The hazard ratio (HR) nadir was defined as the minimum HR along the %TFI axis and was rescaled to 1. RESULTS Over a median follow-up period of 10.5 years, 7633 hypertension cases appeared. Positive associations with hypertension risk were found for foods containing the MUP categories flavour, colouring agent, sweetener, and varieties of sugar with HRs and corresponding 95% confidence intervals observed relative to the HR nadir: flavour [40% vs 8%TFI; HR (95% confidence interval) 1.37 (1.22-1.54)], colouring agent [20% vs 0%TFI; 1.55 (1.36-1.77)], sweetener [20% vs 0%TFI; 1.42 (1.31-1.55)], and varieties of sugar [10% vs 0%TFI; 1.19 (1.11-1.27)]. Intake of foods containing flavour enhancer, processing aid, modified oil, protein source, and added fibre showed no significant associations. Among specific MUPs, increasing amounts of foods containing acesulfame, aspartame, erythritol, saccharin, sucralose, xylitol, bulking agent, dextrose, fructose, hydrolysed protein, and whey protein were significantly and positively associated with hypertension risk, whereas a negative correlation was observed for firming agent, foaming agent, and glazing agent. CONCLUSIONS Only some MUP categories, i.e. flavour, colouring agent, sweetener, and varieties of sugar, are positively linked to incident arterial hypertension. These are prime candidates for UPF reduction strategies and mechanistic studies.