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(OR05-03-26) Substitution Models of Non-Ultra-Processed Food Alternatives for Ultra-Processed Foods: Association With Obesity-Related Cancers in Three Prospective US Adult Cohorts

Saturday, July 25, 2026
10:24 AM - 10:36 AM ET
Location: Maryland Ballroom C
Early Career Research Award Competition

    Presenting Author(s)

  • Kenny Mendoza Herrera, PhD, MS (he/him/his)

    Assistant Professor
    Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center
    Dallas, Texas, United States

    Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • AE

    Alan Espinosa

    Harvard T.H. Chan School of Public Health, United States

  • JD

    Jean-Philippe Drouin-Chartier

    Université Laval, Canada

  • ZC

    Zhangling Chen

    The Second Xiangya Hospital, Central South University, China (People's Republic)

  • CW

    Cong Wang

    Brigham and Women’s Hospital, United States

  • EG

    Edward Giovannucci

    Harvard T.H. Chan School of Public Health, United States

  • HZ

    Hong Zhang

    Yale Schools of Nursing, United States

  • SB

    Shilpa N. Bhupathiraju

    Brigham and Women’s Hospital and Harvard Medical School, Harvard T. H. Chan School of Public Health, United States

  • SM

    Sarah E. Messiah

    Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, United States

  • DL

    David S. López

    Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, United States

  • Frank B. Hu, MD, MPH, PhD (he/him/his)

    Chair, Department of Nutrition; Fredrick J. Stare Professor of Nutrition and Epidemiology
    Harvard T.H. Chan School of Public Health
    Boston, Massachusetts, United States

  • JM

    Josiemer Mattei

    Harvard T.H. Chan School of Public Health, United States

  • QS

    Qi Sun

    Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital and Harvard Medical School, United States

  • JM

    JoAnn E. Manson, MD MPH DrPH

    Brigham and Women's Hospital and Harvard Medical School; Harvard T.H. Chan School of Public Health
    Boston, Massachusetts, United States

  • Deirdre K. Tobias, ScD (she/her/hers)

    Associate Professor
    Brigham and Women's Hospital
    Boston, Massachusetts, United States

Disclosure(s):
Kenny Mendoza Herrera, PhD, MS: No relevant financial relationship(s) with ineligible companies to disclose.
Frank B. Hu, MD, MPH, PhD: No relevant financial relationship(s) with ineligible companies to disclose.
Deirdre K. Tobias, ScD: No relevant financial relationship(s) with ineligible companies to disclose.
Objectives: To assess the associations between replacing overall and group-specific ultra-processed food (UPF) intake with non-UPF alternatives and the risk of obesity-related cancers in three prospective US adult cohorts.

Methods: Cumulatively averaged dietary intakes were evaluated with validated repeated food frequency questionnaires among US cohorts of adults without cancer at baseline: Nurses’ Health Study (NHS; 1984–2016; n = 76,559), NHSII (1991–2017; n= 91,707), and Health Professionals Follow-Up Study (1986–2016; n = 43,304). Cohort-specific multivariable Cox models estimated the associations between substituting 10% of total energy intake from UPF (Nova 4) with the same percentage from unprocessed/minimally processed (Nova 1) or processed (Nova 3) foods and the risk of obesity-related cancers (women: 12 types; men: 9 types). We also modeled substitutions for 10 UPF and non-UPF subgroups. Each substitution pair was jointly modeled: log-hazard ratios (HRs) computed as β-coefficient differences and 95% CIs based on standard errors derived from variances/covariance. Fixed-effects meta-analysis pooled cohort estimates.

Results: The baseline mean proportion of UPF in total energy intake was 31.3% in NHS, 34.4% in NHSII, and 27.8% in HPFS.We identified 12,868 obesity-related cancer cases in NHS (2,047,302 person-years [PY] of follow-up), 5,210 in NHSII (2,301,877 PY), and 2,689 in HPFS (1,053,574 PY). Substituting 10% of energy intake from UPF with unprocessed/minimally processed foods was associated with lower obesity-related cancer risk (HR: 0.98; 95% CI: 0.96, 0.99). For food subgroups, substituting ultra-processed (UP) dark/whole-grain and refined-grain breads with non-UP cooked cereal (e.g., oatmeal, oat bran, wheat germ) was associated with lower cancer risk: HR: 0.93 (0.86, 0.99) and HR: 0.93 (0.88, 0.98), respectively. Other pairwise substitutions for food subgroups were not significant.

Conclusions: Replacing UPF intake with unprocessed/minimally processed foods was associated with a small but significant lower risk of obesity-related cancers among US adults. Specifically, substituting UP bread with less processed cooked cereals was associated with lower cancer risk. Further research should identify specific replacements for UPF groups to inform dietary guidance for obesity-related cancer prevention.

Funding Sources: NIH/NCI