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345ANALESRANFwwwanalesranfcomUltra-processedFoodIntakeandRiskofCardiovascularDiseasea systematicreviewAmeliaMartidelMoral ySofíaAimiArrúeIshiyamaAnRealAcadFarmVol87nº3(2021)·pp339-350ModellingstudiesalsofoundapositiverelationbetweenintakeofUPFandcardiovascularmortality.IntheUK(23)ifthedietaryintakeofultra-processedandprocessedfoodsiscompletelyreplacedwithunprocessedorminimallyprocessedfoodsby2030thecVDmortalityrateisexpected tobereducedby13% Asimilarapproachusedinbrazil(24)concludedthatifUPFswerereducedby50%andreplacedwithunprocessedorminimallyprocessedfoodswithanadditional50%reductioninprocessedculinaryingredientscVDmortality wouldbeexpected tobereducedby11%However,notall studies yieldedapositiverelationshipbetweenconsumptionofUPFsandcVDriskthestudyconductedbyXuetal.(2016)(16)onready-to-eatcerealsdoesnotestablishapositiverelationandin fact findsareducingeffectonnotonlycVDbutalsoinotherdiseasessignificantinverseassociationsbetweenintakeofready-to-eatcerealandcVD type 2diabetescancerandrespiratoryandinfectiousdiseasesandall-causemortality was found thismaybedue to the fibercontentof this typeofUPF,asithasbeenshownthatconsuminghighamountsofdietaryfibercansignificantlyreducecVDmorbidityandmortality(3536) this findingis supportedby Juul etal.(2021)(18) whose study foundapositiverelationbetweenUPFandcardiovascularriskbutadecreasedriskofoverallcVD with theintakeofbreakfastcerealshaving founda statisticallysignificantnegativeassociationbetweenbreakfastcerealsandoverallcVD thereforeall studies(17 23 24)except forone(16) thatanalyzetherelationshipbetweenconsumptionofultra-processedfoodsanddeathfromcardiovasculardiseaseobservethatbyloweringUPFsintakecVDmortalitywoulddecreasebothprospectivestudies(1617)havealarge sample size(367 442(16)and91891(17))aswellasalongstudyduration(14and135yearsrespectively)andthisisstrongevidencethattheirresultsarereliablethusinour view,itcanbeassumed that thereisapositiveassociationbetween theconsumptionofUPFsanddeath fromcVDbutexceptionsexistForinstanceforbreakfastcerealswhicharefoodswithahigh fibercontent(canactasaprotectoragainst thesediseases)notonlyapositiverelationshipabsentbut theconsumptionofbreakfastcerealscanreducetheincidenceofcardiovasculardiseaseFurther studies shouldbeconducted toconfirm theseresultsand to study whether theseexceptionscanbeapplied toother foodsintheultra-processedcategory.However,itshouldbenotedthatallstudiesonmortality(16172324)assume thatUPFsandcVDarealready somehowrelatedotherwise studies wouldbe focusedoncVDincidenceandnotmortality.theseassumptionsmayaffectthevalidityofthestudiesZhongetal.(2021)(17)usedsrouretal.s(2019)(15)studytosupport theseassumptionsbutnoted thatdeath fromcardiovasculardiseaseduetoconsumptionofultra-processedfoodsisstillcontrotributed to saucesandcoronaryheartdiseasebutnotin theUs(18)Zhongetal.(2021)(17)documented726%heartdiseasedeathsoutofatotalof5490cardiovasculardeathsfindingahigherriskofdeathfromheartdiseaseinparticipantswithhigherintakesofUPFs thanlowerconsumersItcanbe suggested that therelationshipbetween theconsumptionofUPFsandcVDdoesexistHowever, further studies shouldbecarriedout touncover which foods within thisgrouparethegreatestcontributorscerebrovasculardiseaseisanotheroftheentitieswhichcVDrefers to(26)In thestudydonebysrouretal.(2019)(15) thetotalcerebrovasculareventrates for subjects withhighandlowUPFconsumptionwas163and144per100000person-yearsrespectively,withastatisticallysignificant11%increaseintheincidenceofcerebrovasculardiseasebyraisingUPFin thedietby10%saltysnacksandsugaryproductswerethefoodsassociatedwithanincreasedriskofcerebrovasculardiseaseHowever, Zhongetal.(2021)(17) foundnosignificantrelationship forcerebrovascularmortalityandintakeofUPF.thissecondstudydocumented5490cardiovasculardeathsof which1126(205%) werecerebrovascularafteranaveragefollow-upof135yearsthisfindingmaybebecausetheageofthesubjectsinthestudywas55-74whereotherfactorsanddiseases(cancer,cOPDetc)appear thatcancausedeath thusdisplacingdeathfromcerebrovasculardiseasethereforestudiesobtainedthatahighUPFconsumptionincreasestheincidenceofcerebrovasculardiseasebutadirectrelationship tocerebrovascularmortalityhasnotbeenestablishedZhongetal.(2021)(17)focusedontherelationbetweencardiovascularmortalityandUPFconsumption theresultsobtainedwereapositiveassociationbetweenhighconsumptionofUPFandmortalityfromcVDandheartdiseaseintheUspopulationAccordingtothisstudy,reducingintakeofUPFmayhelpreducecardiovascularmortality,especiallyforwomenPreviousscientificstudieshavealsofoundthatcomparedwithmenwomenhadhighercVDincidenceandmortalityrateswithconsumptionofsoftdrinksandprocessedmeats(2829)thisphenomenoncanbeexplainedbythelowerconcentrationsof testosterone that womenhave thanmensinceithasbeensuggestedthatthishormoneplaysanimportantroleincVHmaintenance(30)andanegativeassociationbetweentestosteronelevelsandcVDincidenceanddeathrateshavebeenobserved(31-34)Inadditioncompared withmen womenarelesscompliant withchronicmedications therefore thesedifferencesbetween sexmaybedue to thecausesmentionedaboveandotherunknownfactorsHowever,itshouldnotbeneglectedthatthesedifferencesmayplayanimportantroleincardiovascularmortalityandshouldbeinvestigatedinfuturestudies