Black adults in US who consume ultra-processed foods at greater risk for hypertension

Black adults in the U.S. who consumed significant amounts of ultra-processed foods were at 55% increased risk for high blood pressure compared to white adults who ate a similar amount of ultra-processed foods, according to according to preliminary research to be presented at the American Heart Association's Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Conference 2021.

Ultra-processed foods (UPF) are ready-to-eat formulations of industrially formulated products, typically containing added flavors, colors, and other cosmetic additives, that have been extracted or refined from whole foods, and are typically high in salt, added sugar, and fat. These food products are inexpensive, heavily marketed, and are readily available with a long shelf life.

People experiencing food insecurity, the state of not having reliable access to enough affordable, nutritious food, are more likely to eat UPF. While there is growing evidence that UPF have little nutrients and contribute to energy imbalance, few studies have examined the impact of UPF on high blood pressure, a condition that can be affected by high salt intake and disproportionately affects people from diverse racial and ethnic groups.

"The increase in food insecurity over the past year as a result of the COVID-19 pandemic makes this research especially timely," says the study's lead author Carol R. Oladele, Ph.D., M.P.H., assistant professor at the Equity Research and Innovation Center of the Yale University School of Medicine in New Haven, Connecticut. Oladele explains that "people experiencing food insecurity are more likely to purchase and eat UPF because they cost less and have a longer shelf life. These foods may have become more central in the diet of population groups that were disproportionately affected by the pandemic."

For this analysis, researchers extracted data from the ongoing Reasons for Geographic and Racial Disparities in Stroke (REGARDS) study to examine the differences in UPF consumption among Black and white adults and its association with high blood pressure rates. REGARDS is a National Institutes of Health-sponsored study that enrolled more than 30,000 Black and white adults across the United States between 2003-2007.

The NOVA system, the international criteria developed by the Center for Epidemiological Studies in Health and Nutrition at the University of Sao Paulo in Brazil, defines the level of processing in foods from 1 (minimal processing) to 4 (ultra-processed). The United Nations-recognized system was used in this analysis to categorize the level of processing for foods consumed.

A total of nearly 6,000 participants (23% Black and 77% white, ages 45 and older) were included in the analysis, and researchers defined "incident hypertension" as a blood pressure reading higher than 140/90 mm Hg. (Note: the American Heart Association's 2017 hypertension guidelines define high blood pressure as ≥130/80 mm Hg).

Researchers used food consumption data from study participants to calculate total ultra-processed calories consumed and analyzed participants in quartiles of the least to the most ultra-processed foods consumed. The analysis found:

• Black adults who were in the top 25% of all participants for total ultra-processed food consumption were 55% more likely than white adults to have incident hypertension.
• More Black adults (27%) compared to white adults (24%) fell within the top 25% of all participants who consumed the most ultra-processed foods.
• Men and adults who had less education, lower levels of physical activity and household income below $35,000 annually were more likely to regularly consume ultra-processed foods.

"We believe that these results indicate the need for lifestyle interventions to address the inequities in access to affordable, healthy food," noted Oladele "Additionally, we suggest a reexamination of food policies to advance food justice in the U.S."