(LB03-17-26) Ultra-Processed Food Intake and Cardiovascular Mortality in U.S. Adults With Heart Failure: A Nationally Representative Cohort Study

Objectives: Ultra-processed foods (UPFs) account for >50% of total energy intake among U.S. adults and are associated with cardiovascular (CV) mortality in the general population. No study has examined this association in individuals with established heart failure (HF). This study investigated whether UPF intake predicts CV and all-cause mortality in US adults with HF.

Methods: This population-based cohort study analyzed NHANES 2001-2004 data linked to the National Death Index through 2019. Adults aged ≥20 years with HF and a reliable 24-hour dietary recall were included. UPF intake was classified according to the NOVA framework (Group 4) and expressed as a % of total energy. Survey-weighted cause-specific Cox (csHR) and Fine-Gray competing risk models (sHR) estimated hazard ratios across 3 models: unadjusted, adjusted for demographics, lifestyle, and total energy, and further adjusted for NT-proBNP. Spline, subgroup, and sensitivity analyses were performed.

Results: Among 308 adults with HF (representing ≈5.06 million US adults; median age 69 years, BMI 30 kg/m²; 52% male), 248 died (80.5%) over a median 8-year follow-up (112 CV deaths). UPF intake above the median (52% of total energy) was associated with 81% higher CV mortality after multivariable adjustment (csHR 1.81; 95% CI 1.14-2.87; P = 0.016), but not all-cause mortality (HR 1.07; 95% CI 0.72-1.57; P = 0.736). In the competing risk model, sHR was 1.99 (95% CI 1.27-3.11; P=0.005). Further adjustment for NT-proBNP attenuated the CV signal (csHR 1.58; 95% CI 0.87-2.85; P=0.133) and (sHR 1.77; 95% CI 1.00-3.14; P=0.058). Associations persisted after adjustments for sodium or total energy. Subgroup analyses revealed effect modification: high UPF intake was associated with higher CV mortality in non-obese individuals (sHR 3.13; 95% CI 1.60-6.14; P< 0.001) and among those with elevated NT-proBNP (sHR 2.28; 95% CI 1.15-4.51; P=0.018). Spline analysis showed a positive dose-response trend.

Conclusions: In this first nationally representative cohort, consuming >52% of energy from UPF was associated with markedly higher CV mortality in HF. These findings identify UPF consumption as a potential modifiable secondary prevention target in HF, suggesting that food processing level merits consideration in future HF dietary guidance.

Funding Sources: N/A