The relationship between ultra processed food consumption and premature coronary artery disease: Iran premature coronary artery disease study (IPAD)

Shakila Ansari; Noushin Mohammadifard; Fahimeh Haghighatdoost; Ehsan Zarepur; Shirin Mahmoudi; Fatemeh Nouri; Fereidoon Nouhi; Hassan Alikhasi; Fariborz Sharifianjazi; Ketevan Tavamaishvili; Shahin Shirani; Tooba Kazemi; Nahid Azdaki; Nahid Salehi; Masoud Lotfizadeh; Kamal Solati; Samad Ghaffari; Elmira Javanmardi; Arsalan Salari; Mostafa Dehghani; Mostafa Cheraghi; Ahmadreza Assareh; Habib Haybar; Seyedeh M Namayandeh; Reza Madadi; Nizal Sarrafzadegan

doi:10.3389/fnut.2023.1145762

The relationship between ultra processed food consumption and premature coronary artery disease: Iran premature coronary artery disease study (IPAD)

Front Nutr. 2023 Jun 30:10:1145762. doi: 10.3389/fnut.2023.1145762. eCollection 2023.

Authors

Shakila Ansari¹, Noushin Mohammadifard², Fahimeh Haghighatdoost³, Ehsan Zarepur^{2

4}, Shirin Mahmoudi³, Fatemeh Nouri³, Fereidoon Nouhi^{5

6}, Hassan Alikhasi⁷, Fariborz Sharifianjazi⁸, Ketevan Tavamaishvili⁹, Shahin Shirani¹⁰, Tooba Kazemi¹¹, Nahid Azdaki¹², Nahid Salehi¹³, Masoud Lotfizadeh¹⁴, Kamal Solati¹⁵, Samad Ghaffari¹⁶, Elmira Javanmardi¹⁷, Arsalan Salari¹⁸, Mostafa Dehghani¹⁹, Mostafa Cheraghi¹⁹, Ahmadreza Assareh²⁰, Habib Haybar²⁰, Seyedeh M Namayandeh^{21

22}, Reza Madadi²³, Nizal Sarrafzadegan^{3

24}

Affiliations

¹ Department of Community Nutrition, Nutrition and Food Security Research Center, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
² Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
³ Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
⁴ Department of Cardiology, Medicine School, Isfahan University of Medical Sciences, Isfahan, Iran.
⁵ Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
⁶ Iranian Network of Cardiovascular Research (INCVR), Tehran, Iran.
⁷ Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
⁸ School of Science and Technology, The University of Georgia, Tbilisi, Georgia.
⁹ Georgian American University, Tbilisi, Georgia.
¹⁰ Department of Cardiology, Tehran University of Medical Science, Dr Ali Shariati Hospital, Tehran, Iran.
¹¹ Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
¹² Clinical Research Development Unit, Razi Hospital, Birjand University of Medical Sciences, Birjand, Iran.
¹³ Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
¹⁴ Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
¹⁵ Department of Psychiatry, Shahrekord University of Medical Science, Shahrekord, Iran.
¹⁶ Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
¹⁷ Department of Cardiovascular Medicine, Amiralmomenin Hospital, Maragheh University of Medical Sciences, Maragheh, Iran.
¹⁸ Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
¹⁹ Department of Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Science, Khorramabad, Iran.
²⁰ Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
²¹ Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Science, Yazd, Iran.
²² Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
²³ Zanjan University of Medical Sciences, Zanjan, Iran.
²⁴ Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.

Abstract

Background: Ultra-processed foods (UPF) consumption may affect the risk of PCAD through affecting cardio metabolic risk factors. This study aimed to evaluate the association between UPFs consumption and premature coronary artery disease (PCAD).

Methods: A case-control study was conducted on 2,354 Iranian adults (≥ 19 years). Dietary intake was assessed using a validated 110-item food frequency questionnaire (FFQ) and foods were classified based on the NOVA system, which groups all foods according to the nature, extent and purposes of the industrial processes they undergo. PCAD was defined as having an stenosis of at least single coronary artery equal and above 75% or left main coronary of equal or more than 50% in women less than 70 and men less than 60 years, determined by angiography. The odds of PCAD across the tertiles of UPFs consumption were assessed by binary logistic regression.

Results: After adjustment for potential confounders, participants in the top tertile of UPFs were twice as likely to have PCAD compared with those in the bottom tertile (OR: 2.52; 95% CI: 1.97-3.23). Moreover, those in the highest tertile of the UPFs consumption had more than two times higher risk for having severe PCAD than those in the first tertile (OR: 2.64; 95% CI: 2.16-3.22). In addition, there was a significant upward trend in PCAD risk and PCAD severity as tertiles increased (P-trend < 0.001 for all models).

Conclusion: Higher consumption of UPFs was related to increased risk of PCAD and higher chance of having severe PCAD in Iranian adults. Although, future cohort studies are needed to confirm the results of this study, these findings indicated the necessity of reducing UPFs intake.

Keywords: cardiovascular disease; coronary artery diseases; premature coronary artery disease; processed food; ultra-processed food.

Copyright © 2023 Ansari, Mohammadifard, Haghighatdoost, Zarepur, Mahmoudi, Nouri, Nouhi, Alikhasi, Sharifianjazi, Tavamaishvili, Shirani, Kazemi, Azdaki, Salehi, Lotfizadeh, Solati, Ghaffari, Javanmardi, Salari, Dehghani, Cheraghi, Assareh, Haybar, Namayandeh, Madadi and Sarrafzadegan.