Ultra-processed food and mortality among long-term cancer survivors from the Moli-sani Study: prospective findings and analysis of biological pathways

Background: Ultra-processed food (UPF) intake may influence outcomes in long-term cancer survivors. This study examined the relationship between post-diagnostic UPF consumption and mortality and assessed whether chronic disease biomarkers explain this association. Methods: We longitudinally analysed 802 men and women with a previous cancer diagnosis (any site) recruited in the Moli-sani Study (2005-2010). Food intake data was collected at baseline, and assessed an average of 8.4 years after diagnosis. UPF was defined according to the Nova classification and calculated as a weight ratio. The Mediterranean Diet Score (MDS) was used to assess overall diet quality. Inflammatory, metabolic, and cardiovascular biomarkers were analysed as potential explanatory factors on the basis of change-in-estimate. Results: During a median follow-up of 14.6 years, a total of 281 deaths occurred. Multivariable (including the MDS)-adjusted HRs of higher UPF consumption for all-cause and cancer mortality, were 1.48 (95%CI 1.07-2.03 for highest vs. lowest third) and 1.57 (95%CI 1.00-2.47), respectively. Taken together, inflammation markers and resting heart rate levels attenuated the associations of UPF with all-cause mortality by approximately 40%. Conclusions: Higher consumption of UPFs after cancer diagnosis was associated with increased all-cause and cancer mortality rates, irrespective of diet quality. Part of these associations was explained by elevated levels of inflammation markers and resting heart rate. Impact: These findings contribute to the growing body of evidence linking UPFs to adverse health outcomes in cancer survivors. Further research is needed to identify specific mechanisms underlying this relationship and to explore potential dietary interventions for improving long-term survival.