Cohort studyindependent cross-checkabstract checked I-UPF-107 standard review
Ultra-processed food and death in 9 European countries
Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countries.
Overview
González-Gil EM et al.. Lancet Reg Health Eur 2025 · PMID 39867840 · DOI 10.1016/j.lanepe.2024.101208
In 429,000 Europeans, more UPF was linked to more deaths from heart and circulation diseases, but not from cancer.
Does the study support the specific claim? Partly · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
To link processing level with causes of death.
- How was the study done?
Large European cohort (EPIC).
- How many people, animals or samples were studied?
428,728 adults.
- What was actually found?
More circulatory and digestive deaths; no link with cancer deaths.
- How large was the observed effect?
Circulatory HR 1.09 per SD.
- What do the results mean in everyday life?
Relevant to European diets.
- What are the study's limitations?
Observational; one diet measurement.
- What does it say about Elawady's specific claim?
Supports C-UPF-03 except cancer.
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
Cannot prove causation.
Scientific in-depth review
1. Full reference
- Authors
- González-Gil EM et al.
- Journal
- Lancet Reg Health Eur
- Year
- 2025
- Identifier
- PMID 39867840 DOI 10.1016/j.lanepe.2024.101208 · PMC11764076
- Verification
- verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
COI statement in record: FMB was supported by a Wellcome Trust PhD studentship in Molecular, Genetic and Lifecourse Epidemiology (224982/Z/22/Z). RB, FR, KC, and IH were supported by the World Cancer Research Fund International (IIG_FULL_2020_033). CML was supported by the Heisenberg program of the Deutsche Forschungsgemein; funding listed: Wellcome Trust, World Health Organization
2. Research question
Is food intake by degree of processing associated with all-cause and cause-specific mortality?
3. Study design and population
- Study design
- Cohort study – Prospective multicentre cohort (EPIC, 9 European countries)
- Population
European adults
- Country
9 European countries
- Period
Mean follow-up 15.9 years
- Sample size
428,728; 40,016 deaths
- Inclusion and exclusion criteria
EPIC participants
4. Methods and endpoints
- Exposure / intervention
Nova groups (% g/day)
- Comparator
Per 1-SD increment; substitution analyses
- Endpoints
All-cause and cause-specific mortality
- Statistical methods
Multivariable Cox regression; substitution models
5. Actual results
- Results
UPF per 1 SD: all-cause mortality HR 1.04 (1.02-1.05); circulatory diseases 1.09 (1.07-1.12); cerebrovascular 1.11 (1.05-1.17); ischaemic heart disease 1.10 (1.06-1.15); digestive diseases 1.12 (1.05-1.20); Parkinson's disease 1.23 (1.06-1.42). No association with cancer or Alzheimer's mortality. Replacing processed foods and UPF with unprocessed/minimally processed foods associated with lower mortality.
- Absolute risks
not reported in abstract
- Authors' conclusion
Higher UPF consumption was associated with greater mortality from circulatory and digestive diseases and Parkinson's disease.
6. Strengths
- Very large pan-European cohort
- Long follow-up
7. Weaknesses
- Single baseline dietary assessment
- Nova applied retrospectively to questionnaires
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Observational.
9. Assessment of the statistical interpretation
Small per-SD effects; narrow CIs.
10. Relevance to the specific claim
Supports CVD and all-cause mortality associations; contradicts cancer-mortality part.
11. Independent contrary findings
No cancer mortality association.
12. Transferability to Germany and Europe
High (European).
13. Overall methodological judgement
Strong European support for cardiovascular mortality associations.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Causality.