News Brief by Kip Hansen —  6 September 2024 — 1100 words

Thanks to the New York Times, in an article in the EAT section, we have the news that “those who consumed the most ultraprocessed foods were 11 percent more likely to develop cardiovascular disease and 16 percent more likely to develop coronary heart disease during the study period”. 

The article is written by Alice Callahan and titled:  “Are Some Ultraprocessed Foods Worse Than Others?”

Callahan’s summary of a Lancet research paper is:

“The researchers also combined their findings with those from 19 other studies, for a separate analysis of about 1.25 million adults. They found that those who consumed the most ultraprocessed foods were 17 percent more likely to develop cardiovascular disease, 23 percent more likely to develop coronary heart disease and 9 percent more likely to have a stroke compared with the lowest consumers.”

What is the evidence presented in the Lancet paper [Mendoza et al. 2024]?  Here’s the money chart:

Now, before I say anything further about the study, the results, and those Hazard Ratios — the original study states the following in its Summary:

“Interpretation

Total UPF intake was adversely associated with CVD and CHD risk in US adults, corroborated by prospective studies from multiple countries, also suggesting a small excess stroke risk.”

Take a look at the hazard ratio chart again with that interpretation in mind.  What do you think?

Give us your view in the Comment section – now —  before I give my take on the study findings.

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Let me start again. 

There is a new Lancet study titled as an “analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies” that dealt with the relationship between “ultra-processed foods and cardiovascular disease”. 

Here are their findings, in a chart showing their findings as Hazard Ratios for adverse conditions based on the uptake (consumption)  of various categories of ultraproccessed foods (UPFs):

CVD – Cardiovascular Disease     CHD – Coronary Heart Disease ASBs – artificially sweetened beverages

If this was a display on a digital whiteboard, projected on the giant screen at a conference, I’d do the following:

I have circled the ONLY findings that are even close to being clinically significant.

Notice that the majority of the hazard ratios, for most categories of UPFs, are less than 1 – usually interpreted as being, in this case,  beneficial – preventative of the harm.    Many of those that are greater than 1 have uncertainty/error bars that include ‘1’, which is correctly interpreted as ‘no effect’.  Only those circled in red could even be considered statistically to be harmful, associated with the adverse effect, in any way. 

Using the logic of the authors of this paper, all those below boxed in blue could be considered to prevent the ‘bad thing’ – CVD, CHD, Stroke:

To complete the set of images:

The highlighted values, though positive, include ‘1’, the unity, which fall under this general rule:

“Statistically significant hazard ratios cannot include unity (one) in their confidence intervals.” [ source ]

As for the bottom two items, ASBs – artificially sweetened beverages, it seems that the failure to find a positive enough hazard ratio may have led them to recalculate the HR “adjusting for dieting behaviours and time-varying BMI”.  They still end up as a nothing done.

Now, consider again the statement made by the authors – the plain language Interpretation of their findings:

“Total UPF intake was adversely associated with CVD and CHD risk in US adults, corroborated by prospective studies from multiple countries, also suggesting a small excess stroke risk.”

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Junk Science:

Only “sugar-sweetened beverages” and “processed red meat, poultry, and fish” show ANY adverse association with CVD and CHD.  The lead author of the study is quoted in the Times as saying “When these two categories were excluded from the data, most of the risk associated with ultraprocessed food consumption disappeared…”.  That is exactly correct.  In fact, whatever ‘risk’ remained would be tiny, with uncertainty overlapping ‘1’, and not be even statistically significant, and never could be properly considered either clinically significant or a “minimal clinically important difference”.

So, the interpretation offered by the study’s authors is just not true in plain language – they did not find UPF consumption associated with CVD and CHD, but only consumption of the two of the ten categories to be so associated.

Scientific Controversies:

Both categories that were found to have an associated adverse effect are themselves Modern Scientific Controversies:  the War on Sugar and the Meat Wars. 

This means that the studies included in the meta-analysis are quite possibly (or stronger, probably) questionable and may just “be simply accurate measures of the prevailing bias.”

Bottom Line:

The NY Times article and the study in The Lancet are prime examples of how junk science findings are transformed into actionable science.  Findings with tiny questionable effects are elevated by the study authors to apply widely (in the Interpretation, to apply to all UPFs as a broad category of foods) and then again elevated by the media to be important to the lives of everyday people.  

Studying UPFs is a new Science Fad with study after study desperately trying to find that “UPFs are bad for you”. UPFs are not even a distinct category of food by ingredients or type – only by the fact of how they are produced (yes, really).

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Author’s Comment:

I have been collecting material on UPFs for a couple of years, towards writing a new Modern Scientific Controversies segment on the topic. Coming soon-ish.

There are total diets that do not promote good health.  These certainly include diets with excessive amounts of sugars of all types.  The case against excessive sugars depends exclusively on the perceived relationship between sugars and diabetes and obesity, both of which are controversial.  Exactly what constitutes ‘excessive’ is the open question, but you’ve seen men and women walking and driving drinking from refillable giant convenience-store soda cups, 44-52 oz, full of what is essentially sugar syrup.  Big box stores have hundreds of feet of shelf space dedicated to extra large containers of candies in huge bags and large square plastic jars. 

The case against meats and processed meats is far less clear and may be even non-existent – maybe entirely an example of prevailing bias.

I have long maintained that diet is a personal and cultural choice, that diets should be well-rounded and varied, including a wide range of vegetables and fruits and grains.  Personally, my religious health code calls for meats to be eaten “sparingly”.

Thanks for reading.

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