Small increases in the overall rate of cancer and breast cancer after menopause have been found in women who had the highest proportion of ultra-processed food in their diet, reports a new study from France.
The term ultra-processed has been taken from the recently introduced NOVA classification system, which classifies foods based on the nature, extent and purpose of food processing.
These are defined as foods where complex processing has taken place using chemicals almost never found in kitchens, as opposed to more straightforward processing techniques like salting meat or putting vegetables or fruit into cans.
Examples include mass-produced breads and cakes, snacks and sweets, fizzy drinks, and ready-made meals.
Reasons Unclear
Researchers studied the diets of more than 100,000 people for 7 years to arrive at the findings. But due to the wide range of foods included in the ultra-processed category, it’s difficult to establish which specific foods might be responsible for the increased cancer risk, and why.
The increased risk could be caused by eating more high-sugar, high-fat processed food.
Or it may be that some people who eat more ultra-processed foods tend to be unhealthy in other ways, too. We know people who eat more ultra-processed food are also more likely to smoke, take less exercise and take in more calories. Correlation is not causation, as the saying goes.
The researchers also discussed the hypothesis that while the individual chemicals used in food processes are thought to be safe, they may be interacting with each other in unpredictable ways.
If you want to cut your risk of cancer, it is recommended that you quit smoking if you smoke, eat a healthy, balanced diet that includes plenty of fruit and vegetables, drink less alcohol, and get plenty of exercise.
Ultra-processed Foods Research
The study was conducted by researchers from several Parisian research institutions working together as the Nutritional Epidemiology Research Team, as well as the Institut National de la Recherche Agronomique and the University of Sao Paulo in Brazil.
It was a cohort study, which followed what happened to a large group of adults who volunteered to fill in health and diet questionnaires over several years. This type of observational study can spot links between factors, but can’t prove that one factor (such as a diet high in processed foods) causes another (cancer).
Researchers recruited adult volunteers to join the online study from 2009.
Participants filled in questionnaires about their health and background, as well as a questionnaire about all the food they had eaten in the past 24 hours.
The food questionnaire was repeated every 6 months up to January 2017. Researchers used results from the 104,980 people who’d filled in at least 2 questionnaires during that time.
They categorised people’s diets according to the proportion that was ultra-processed.
Factors taken into account included:
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age and sex
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body mass index and height
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physical activity
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smoking and alcohol intake
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overall energy intake in calories (excluding alcohol)
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family history of cancer
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educational level
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nutritional content of diet (fat, salt and carbohydrate) and “western dietary pattern”
For breast cancer, they also took account of:
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number of children
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menopausal status and use of HRT
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oral contraception use
After adjusting their figures to take account of potential confounding factors, they looked at whether people with a diet high in ultra-processed foods were more likely to get any type of cancer, or breast, prostate or colorectal cancer specifically.
Basic Results
There were 2,228 cancers over an average 5-year follow-up period among the 104,980 participants in the study.
Most of the people whose records were used in the study were women (78.3%).
After taking account of potential confounding factors, each 10% increase in the proportion of ultra-processed food in the diet was linked to:
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a 12% increase in risk of any cancer (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.06 to 1.18)
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no increase in risk of prostate cancer
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no increase in risk of colorectal cancer
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an 11% increase in risk of breast cancer (HR 1.11, 95% CI 1.02 to 1.22) – but this only held true for breast cancer after the menopause
Conclusions
The researchers said there are “several hypotheses” that could explain their results.
These include:
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the “generally poorer nutritional quality” of ultra-processed food
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the “wide range of additives” in some ultra-processed food, including the whitening agent titanium dioxide
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contaminants such as acrylamide, produced through heat treatment of some ultra-processed food
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contaminants from packaging of some ultra-processed foods, including the plastic softener bisphenol A (BPA)
Overall, they say, “Rapidly increasing consumption of ultra-processed foods may drive an increasing burden of cancer and other non-communicable diseases”, and governments should consider taking action such as taxation and marketing restrictions on these foods.
It shouldn’t be news to anyone that eating a healthy, balanced diet that includes plenty of fresh fruit and vegetables is good for our health.
This study suggests that eating too much ultra-processed food as part of your regular diet may slightly increase your risk of some types of cancer.
Ultra-processed foods are defined according to a scale that classifies foods by the way in which they have been prepared.
They tend to have additives and flavouring added to them during the manufacturing process to improve taste and extend shelf-life.
The study was carried out carefully, with a large number of people taking part, and the researchers did their best to take account of other confounding factors. But it has limitations that make it difficult to draw any firm conclusions.
Limitations
The way foods were divided into ultra-processed or other foods seems rather arbitrary. Is bread made in a manufacturing plant and wrapped in plastic very different from homemade bread or bread handmade in an artisan bakery?
Despite the authors’ efforts, it’s very hard to separate someone’s diet from the rest of their lifestyle.
We know people who ate more ultra-processed food were more likely to smoke, take less exercise, be less educated and take in more calories.
Other unmeasured aspects of their lives – such as deprivation and access to healthcare – might also have affected the results. All the questionnaires were filled in online, rather than being verified by researchers, so we can’t be sure of their accuracy.
The people who took part in the study were mainly women and tended to be more educated than the average person in France.
They also decided to take part in a health and diet study themselves, so were likely to be interested in their health.
So many things affect cancer risk, from inherited genetic susceptibility to lifestyle and environment. A small increase in risk from one factor may be easily cancelled out by others.
That said, ultra-processed foods tend to be high in fat, salt and sugar, so you should consider a diet that isn’t based on them.
THe work was supported by the Ministère de la Santé, Institut de Veille Sanitaire (InVS), Institut National de la Prévention et de l’Education pour la Santé (INPES), Région Ile-de-France (CORDDIM), Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Conservatoire National des Arts et Métiers (CNAM), and Université Paris 13.
Fiolet Thibault, Srour Bernard, Sellem Laury, Kesse-Guyot Emmanuelle, Allès Benjamin, Méjean Caroline et al.
Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort
BMJ 2018; 360 :k322