Higher consumption of ultra-processed foods is associated with increased risk of fracture among adults: findings from China Health and Nutrition Survey

Background: Although the consumption of ultra-processed foods (UPFs) has been shown to increase the risk of many diet-related chronic diseases, its potential association with fracture risk remains unexplored in Chinese adults. 

Methods: This study used data from a cohort of 13,194 adults who participated at least twice of the China Nutrition and Health Survey (CNHS) between 1997 and 2011 (six waves in total), during which information on fractures was collected. Dietary intake was assessed at each survey using a 3-day 24-hour dietary recall method. UPF consumption was calculated as the total intake of foods classified as NOVA group 4. Fracture was self-reported at each survey. Multilevel mixed-effects logistic regression models, accounting for repeated measures, were used to assess the association, adjusting for covariates including sociodemographic, socioeconomic, health, behavioural, and dietary factors. 

Results: Mean per capita UPF consumption increased from 11.3 g in 1997 to 41.5 g in 2011. The total number of participants reported having fracture was 1,471 with 1,057 reported incident fractures during the follow-up. The prevalence of fracture was 2.6% in 1997 and 5.3% in 2011. The adjusted odds ratios (95% CI) for fracture for those with mean UPF consumption of 1–49 g/day, 50–99 g/day, and ≥ 100 g/day were 1.45 (1.25–1.69), 1.62 (1.28–2.04), and 1.66 (1.22–2.24), respectively, compared with non-consumers (p for trend < 0.001). There was significant interaction between UPF and residence with the positive association being significant in rural areas but not in urban areas. 

Conclusion: Higher UPF consumption was associated with increased risk of fractures, especially in rural areas. Dietary guidelines should integrate this evidence to address the evolving food environment in China and its potential impact on musculoskeletal health.