Ultra-Processed Food Consumption and Increased Risk of Metabolic Syndrome in Adults: The ELSA-Brasil

Diabetes Care. 2023 Feb 1;46(2):369-376. doi: 10.2337/dc22-1505.


Objective: To investigate the association between ultra-processed food (UPF) consumption and the incidence of metabolic syndrome (MetS).

Research design and methods: From 2008 to 2010, we enrolled 15,105 adults, aged 35-74 years, who were employees from six public education and research institutions to assemble the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We used a food frequency questionnaire to assess UPF consumption (measured in grams per day) at baseline. We then assessed the outcomes of those returning to visits between 2012 and 2014 and between 2017 and 2019. We defined incident MetS by the presence of at least three of the following five abnormalities: high fasting glucose level, high triglyceride level, low HDL cholesterol level, high blood pressure, and abdominal obesity, after excluding those meeting such criteria at baseline. We also excluded those who had missing data or an implausible energy intake, leaving 8,065 participants in the study.

Results: The median age was 49 years, 59% of participants were women, and the median consumption of UPFs was 366 g/day. After 8 years, there were 2,508 new cases of MetS. In robust Poisson regression, adjusting for sociodemographics, behavioral factors, and energy intake, we found a 7% (relative risk [RR] 1.07; 95% CI 1.05-1.08) higher risk of incident MetS for an increase of 150 g/day in UPF consumption. Similarly, those in the fourth quartile (compared with the first quartile) had a 33% increased risk (RR 1.33; 95% CI 1.20-1.47). Further adjustment for BMI attenuated these associations (for 150 g/day increases in UPF consumption and for the fourth quartile compared to the first one, respectively, RR = 1.04, 95% CI 1.02-1.06; RR = 1.19, 95% CI 1.07-1.32).

Conclusions: Greater consumption of UPFs is associated with an increased risk of MetS. These findings have important implications for diabetes and cardiovascular disease prevention and management.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brazil / epidemiology
  • Diet / adverse effects
  • Fast Foods
  • Female
  • Food, Processed
  • Humans
  • Longitudinal Studies
  • Male
  • Metabolic Syndrome* / epidemiology
  • Metabolic Syndrome* / etiology
  • Middle Aged