title: Ultra-Processed Food Consumption and the Incidence of Hypertension in a Mediterranean Cohort: The Seguimiento Universidad de Navarra Project.
abstract: BACKGROUND
  Some available evidence suggests that high consumption of ultra-processed foods (UPFs) is associated with a higher risk of obesity. Collectively, this association and the nutritional characteristics of UPFs suggest that UPFs might also be associated with hypertension.
  
  
  METHODS
  We prospectively evaluated the relationship between UPF consumption and the risk of hypertension in a prospective Spanish cohort, the Seguimiento Universidad de Navarra project. We included 14,790 Spanish adult university graduates who were initially free of hypertension at baseline who were followed for a mean of 9.1 years (SD, 3.9 years; total person-years: 134,784). UPF (industrial formulations of chemical compounds which, beyond substances of common culinary use such as salt, sugar, oils, and fats, include substances also derived from foods but not used in culinary preparations) consumption was assessed using a validated semi-quantitative 136-item food-frequency questionnaire. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for hypertension incidence.
  
  
  RESULTS
  During follow-up, 1,702 incident cases of hypertension were identified. Participants in the highest tertile of UPF consumption had a higher risk of developing hypertension (adjusted HR, 1.21; 95% CI, 1.06, 1.37; P for trend = 0.004) than those in the lowest tertile after adjusting for potential confounders.
  
  
  CONCLUSIONS
  In this large prospective cohort of Spanish middle-aged adult university graduates, a positive association between UPF consumption and hypertension risk was observed. Additional longitudinal studies are needed to confirm our results.
authors.affiliation: Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.|Departament of Nutrition, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil.|CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil.
authors.forename: Raquel de Deus
authors.initials: RD
authors.lastname: Mendonça
authors.affiliation: Departament of Nutrition, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Aline Cristine Souza
authors.initials: AC
authors.lastname: Lopes
authors.affiliation: Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.|Department of 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: Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.|Navarra's Health Research Institute (IDISNA), Pamplona, Spain.|Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gea
authors.affiliation: Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.|Navarra's Health Research Institute (IDISNA), Pamplona, Spain.|Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain.|Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Martinez-Gonzalez
authors.affiliation: Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.|Navarra's Health Research Institute (IDISNA), Pamplona, Spain.|Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain.
authors.forename: Maira
authors.initials: M
authors.lastname: Bes-Rastrollo
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D004032:Diet / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005511:Food Handling; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D015430:Weight Gain; D055815:Young Adult
keywords: SUN cohort.; blood pressure; feeding food-processing industry; hypertension; prospective studies