Ultra-Processed Food And Hypertension Incidence In The Regards Cohort

Background: A growing body of evidence demonstrates that diets high in ultra-processed food products (UPF)—ready-to-eat formulations of processed substances that have been extracted or refined from whole foods and that typically contain added flavors, colors, and other cosmetic additives -- lack nutrient quality and contribute to energy imbalance. However, few studies have examined the impact on hypertension, a diet-sensitive condition characterized by racial disparities across the disease spectrum. We sought to determine black-white differences in UPF consumption and associations with incident hypertension. Methods: Data from the Reasons for Geographic and Racial Disparities in Stroke (REGARDS) Cohort Study was used. Participants free of hypertension at baseline (2003-2007) who had complete food intake data and completed visit 2 (2013-2017) were included. The NOVA classification system was used to categorize participants food and drink into categories according to their level of processing, from 1 (minimally processed) to 4 (ultra-processed). The percent gram contribution of UPF to total grams consumed was calculated and used to create quartiles of UPF intake. The outcome, incident hypertension, was defined as systolic blood pressure of =>140 mm Hg or diastolic pressure =>90 mm Hg or taking antihypertensive medication at visit 2. Summary statistics were used to examine participant demographics by UPF consumption. Multivariable logistic regression was used to assess the hypothesis that UPF consumption is associated with incident hypertension and that the association varies by race. Results: A total of 5,957 participants were included in analyses, 23 percent were Black and 77 White. Black participants had higher UPF intake compared to White participants. Thirty-eight percent of Black participants were in the top quartile of UPF consumption compared to 21 percent among White participants. Women, those with lower educational attainment, lower physical activity, and income below 35K were more likely to be in the top quartile of UPF consumption. Regression model results showed individuals in the top quartile of UPF consumption had 38 percent greater odds of incident hypertension (CI=1.11-1.53) after adjustment for sociodemographic characteristics. Race-stratified model results showed that Blacks in the top quartile had 47 percent greater odds (CI=1.06-2.03) of incident hypertension. UPF consumption was not significantly associated with incident hypertension among Whites (OR=1.19, CI=0.99-1.43). Conclusions: Findings demonstrate racial disparities in consumption of UPF and that disparities contribute to higher incident hypertension among Black persons. Results contribute to the growing evidence base needed to inform equitable food system policies, support healthier dietary consumption, and address hypertension disparities.