title: Ultraprocessed food consumption and risk of overweight and obesity: the University of Navarra Follow-Up (SUN) cohort study.
abstract: Ultraprocessed food consumption has increased in the past decade. Evidence suggests a positive association between ultraprocessed food consumption and the incidence of overweight and obesity. However, few prospective studies to our knowledge have investigated this potential relation in adults.
  
  
  
  We evaluated the association between ultraprocessed food consumption and the risk of overweight and obesity in a prospective Spanish cohort, the SUN (University of Navarra Follow-Up) study.
  
  
  
  We included 8451 middle-aged Spanish university graduates who were initially not overweight or obese and followed up for a median of 8.9 y. The consumption of ultraprocessed foods (defined as food and drink products ready to eat, drink, or heat and made predominantly or entirely from processed items extracted or refined from whole foods or synthesized in the laboratory) was assessed with the use of a validated semiquantitative 136-item food-frequency questionnaire. Cox proportional hazards models were used to estimate adjusted HRs and 95% CIs for incident overweight and obesity.
  
  
  
  A total of 1939 incident cases of overweight and obesity were identified during follow-up. After adjustment for potential confounders, participants in the highest quartile of ultraprocessed food consumption were at a higher risk of developing overweight or obesity (adjusted HR: 1.26; 95% CI: 1.10, 1.45; P-trend = 0.001) than those in the lowest quartile of consumption.
  
  
  
  Ultraprocessed food consumption was associated with a higher risk of overweight and obesity in a prospective cohort of Spanish middle-aged adult university graduates. Further longitudinal studies are needed to confirm our results. This trial was registered at clinicaltrials.gov as NCT02669602.
authors.affiliation: University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain.|Departments of Nutrition and.|CAPES Coordination for the Improvement of Higher Education Personnel Foundation, Ministry of Education of Brazil, Brasília, Brazil.
authors.forename: Raquel de Deus
authors.initials: RD
authors.lastname: Mendonça
authors.affiliation: University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain.|Maternal-Child Nursing and Public Health, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Adriano Marçal
authors.initials: AM
authors.lastname: Pimenta
authors.affiliation: University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain.|Navarra Health Research Institute, Pamplona, Spain.|Biomedical Research Center Network in Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid, Spain; and.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gea
authors.affiliation: University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain.|Navarra Health Research Institute, Pamplona, Spain.|Biomedical Research Center Network in Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid, Spain; and.
authors.forename: Carmen
authors.initials: C
authors.lastname: de la Fuente-Arrillaga
authors.affiliation: University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain.|Navarra Health Research Institute, Pamplona, Spain.|Biomedical Research Center Network in Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid, Spain; and.|Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Martinez-Gonzalez
authors.affiliation: Departments of Nutrition and.
authors.forename: Aline Cristine Souza
authors.initials: AC
authors.lastname: Lopes
authors.affiliation: University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; mbes@unav.es.|Navarra Health Research Institute, Pamplona, Spain.|Biomedical Research Center Network in Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid, Spain; and.
authors.forename: Maira
authors.initials: M
authors.lastname: Bes-Rastrollo
mesh_terms: D000328:Adult; D015992:Body Mass Index; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004043:Dietary Fiber / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D015444:Exercise; D005227:Fatty Acids / Q000008:administration & dosage; D005229:Fatty Acids, Monounsaturated / Q000008:administration & dosage; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005511:Food Handling; D005638:Fruit; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014675:Vegetables
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004043:Dietary Fiber; D004044:Dietary Proteins; D005227:Fatty Acids; D005229:Fatty Acids, Monounsaturated; D005231:Fatty Acids, Unsaturated
keywords: SUN cohort; food-processing industry; obesity; overweight; prospective studies; ultra-processed food