Ultra-processed foods and risk of hypertension: mediation analyses by critical nutrients in NutriNet-Brasil
1
Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
2
Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil
3
Department of Nutrition, University of São Paulo, São Paulo, Brazil
4
Department of Nutrition, Federal University of Health Science of Porto Alegre, Porto Alegre, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A3004
ABSTRACT
INTRODUCTION:
Hypertension is one of the leading causes of global mortality and disability1. Ultra-processed food (UPF) consumption has been consistently associated with an increased risk of hypertension2. The high sodium and fat and low fiber and potassium content of UPFs have been proposed as potential mechanisms underlying this association3. Thus, this study aimed to assess the mediating effects of selected nutrients on the association between UPF consumption and the risk of hypertension among Brazilian adults.
METHODS:
NutriNet-Brasil is an on-going, web-based cohort study launched in January 2020, including participants aged 18 years or older residing in Brazil. The current study included 16856 participants without hypertension at baseline. The dietary share of UPF (expressed as % kcal/day) was estimated using the mean of the first two 24-hour dietary recalls (Nova24h) completed 6-12 months apart. Incident cases were defined as participants who had their blood pressure measured and reported a medical diagnosis of hypertension during follow-up. Covariates included sociodemographic and lifestyle factors, as well as comorbidities, all assessed at baseline. Mediation analyses considered dietary intake of sodium, potassium, total fat, saturated fat, and fiber. Separate mediation models were fitted for each mediator, with adjustment for confounders.
RESULTS:
Each 10% increase in UPF consumption was associated with a 14% (95%CI: 1.09-1.19) higher risk of hypertension, and the association persisted after simultaneous adjustment for all mediators, although attenuated (HR: 1.11; 95%CI: 1.05–1.18). Mediation analyses indicated that lower intake of potassium (16.1%; 95%CI: 5.7-28.8) and fiber (14.9%; 95%CI: 8.1-24.0) partially mediated the association between UPF consumption and hypertension. However, a substantial direct effect of UPF consumption on hypertension incidence persisted in both models.
CONCLUSIONS:
The association between UPF and hypertension is partially mediated by reduced intake of fiber and potassium, suggesting that mechanisms beyond these nutrients may contribute to the observed association.
Hypertension is one of the leading causes of global mortality and disability1. Ultra-processed food (UPF) consumption has been consistently associated with an increased risk of hypertension2. The high sodium and fat and low fiber and potassium content of UPFs have been proposed as potential mechanisms underlying this association3. Thus, this study aimed to assess the mediating effects of selected nutrients on the association between UPF consumption and the risk of hypertension among Brazilian adults.
METHODS:
NutriNet-Brasil is an on-going, web-based cohort study launched in January 2020, including participants aged 18 years or older residing in Brazil. The current study included 16856 participants without hypertension at baseline. The dietary share of UPF (expressed as % kcal/day) was estimated using the mean of the first two 24-hour dietary recalls (Nova24h) completed 6-12 months apart. Incident cases were defined as participants who had their blood pressure measured and reported a medical diagnosis of hypertension during follow-up. Covariates included sociodemographic and lifestyle factors, as well as comorbidities, all assessed at baseline. Mediation analyses considered dietary intake of sodium, potassium, total fat, saturated fat, and fiber. Separate mediation models were fitted for each mediator, with adjustment for confounders.
RESULTS:
Each 10% increase in UPF consumption was associated with a 14% (95%CI: 1.09-1.19) higher risk of hypertension, and the association persisted after simultaneous adjustment for all mediators, although attenuated (HR: 1.11; 95%CI: 1.05–1.18). Mediation analyses indicated that lower intake of potassium (16.1%; 95%CI: 5.7-28.8) and fiber (14.9%; 95%CI: 8.1-24.0) partially mediated the association between UPF consumption and hypertension. However, a substantial direct effect of UPF consumption on hypertension incidence persisted in both models.
CONCLUSIONS:
The association between UPF and hypertension is partially mediated by reduced intake of fiber and potassium, suggesting that mechanisms beyond these nutrients may contribute to the observed association.
| eISSN: | 2654-1459 |
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