358 American Journal of Hypertension 30(4) April 2017 ORIGINAL ARTICLE Hypertension accounts for approximately 10.4 million deaths, 208.1 million disability-adjusted life-years, and 7% of the disease burden worldwide. 1,2 Moreover, hypertension is a risk factor for cardiovascular disease and responsible for at least 45% and 51% of deaths due to heart disease and stroke, respectively. 3 Te prevalence of hypertension was approxi- mately 22% worldwide in 2014 and 25% in the European region. 1 Modifable risk factors for hypertension include an unhealthy diet (consumption of foods containing excess salt and saturated fat and insufcient fruit and vegetables intake), harmful alcohol use, lack of physical activity, and excess weight. 4 In several countries, ultra-processed foods (UPFs) are common sources of salt. According to Monteiro et al. UPFs are defned as drink and food products 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 preparation and are ready to eat, drink, or heat. 5–7 Tey have high amounts of salt, total fat, saturated fat, and trans fat, free sugar, and high energy density, and low fber and micronutrients content. 8–11 Consumption of UPFs has been associated with higher risks of overweight/obesity, 12 metabolic syndrome in ado- lescents, 13 and increased total cholesterol and low-density lipoprotein cholesterol levels in children. 14 Collectively, the nutritional characteristics of UPFs and the association Ultra-Processed Food Consumption and the Incidence of Hypertension in a Mediterranean Cohort: The Seguimiento Universidad de Navarra Project Raquel de Deus Mendonça 1–3 , Aline Cristine Souza Lopes 2 , Adriano Marçal Pimenta 1,4 , Alfredo Gea 1,5,6 , Miguel Angel Martinez-Gonzalez 1,5–7 , and Maira Bes-Rastrollo 1,5,6 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 charac- teristics of UPFs suggest that UPFs might also be associated with hypertension. METHODS We prospectively evaluated the relationship between UPF consump- tion 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 base- line 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% confdence intervals (CIs) for hypertension incidence. RESULTS During follow-up, 1,702 incident cases of hypertension were identi fed. Participants in the highest tertile of UPF consumption had a higher risk of devel- oping 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 univer- sity graduates, a positive association between UPF consumption and hypertension risk was observed. Additional longitudinal studies are needed to confrm our results. Keywords: blood pressure; feeding food-processing industry; hyperten- sion; prospective studies; SUN cohort. doi:10.1093/ajh/hpw137 Correspondence: Maira Bes-Rastrollo (mbes@unav.es). Initially submitted July 19, 2016; date of frst revision October 4, 2016; accepted for publication October 14, 2016; online publication December 7, 2016. © American Journal of Hypertension, Ltd 2016. All rights reserved. For Permissions, please email: journals.permissions@oup.com 1 Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; 2 Departament of Nutrition, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil; 3 CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil; 4 Department of Maternal-Child Nursing and Public Health, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil; 5 Navarra’s Health Research Institute (IDISNA), Pamplona, Spain; 6 Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain; 7 Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA. Downloaded from https://academic.oup.com/ajh/article-abstract/30/4/358/2645510 by guest on 21 May 2020