Ultra-processed foods and coronary artery disease severity: a cross-sectional study of at-risk normal-weight and overweight patients undergoing elective angiography

Abstract Introduction There is growing interest in the connection between ultra-processed food (UPF) and cardiovascular diseases. This study explores how UPF intake relates to the severity of coronary artery disease (CAD) in at-risk patients undergoing elective angiography. Methods Data covering demographic, and clinical details, and dietary intakes (using a validated food frequency questionnaire) were gathered from the Nutrition Heshmat Registry (NUTHER) in Rasht, Iran. UPF consumption was evaluated using the NOVA food classification system, with the exception of core grain foods. The study comprised 1,015 participants, who were classified based on the severity of CAD using the Gensini score (severe-CAD = Gensini score ≥ 60). Logistic regression was used to analyze the odd ratio (OR) and 95%confidence interval (95%CI) for severe-CAD across UPF quartiles (percentage of energy), and for each 10% increase in UPF intake. Restricted cubic spline (RCS) regression was employed to explore nonlinear relationships between UPF and severe-CAD. Results Following controlling for potential confounders, normal-weight participants in the highest quartile of UPF exhibited about 5 times greater odds of severe-CAD than those in the lowest category (OR(95%CI): 5.01 (1.89, 13.29); P-for-trend = 0.002). Overweight/obese participants in the higher UPF quartiles had approximately 2-3.5 times greater odds for severe-CAD than those in the 1st quartile (ORs (95%CIs): 3rd quartile 1.91 (1.14, 3.21); and 4th quartile: 3.53 (2.07, 5.99); P-for-trend < 0.001). Each 10% increase in daily energy intake from UPF was associated with about 1.6-2 times increased severe-CAD risk among overweight/obese and normal-weight individuals (ORs (95%CIs) of 1.64 (1.28, 2.11), and 2.24 (1.24, 4.05), respectively). RCS analysis showed an upward trend toward higher UPF intake in relation to increased risk of severe-CAD (P-for-overall-trend < 0.0001; P-for-nonlinearity = 0.005). Conclusion The findings obtained underscore a direct association between UPF and the risk of CAD progression among at-risk patients, independent of BMI. However, further prospective studies are essential to confirm these results and better understand this relationship.