Unraveling the dietary impact: Associations between ultra-processed foods and prostate cancer in a two-decade study.

135 Background: Prostate cancer is a leading cause of cancer-related morbidity in men, and emerging research suggests that dietary patterns, particularly involving processed foods, may play a role in its development. This study aims to explore the association between NOVA-classified food consumption and prostate cancer. Methods: Data from the National Health and Nutrition Examination Survey (NHANES 1999-2018) was analyzed. A sensitivity analysis was performed. Men aged 20 and older with a diagnosis of prostate cancer (n=731) and without any cancer (n=20,972) were contrasted. The mean daily caloric intake from various NOVA food categories was analyzed using independent t-tests, then corrected using Benjamini-Hochberg (p<0.05). Subgroup analyses were conducted via Welch two-sample t-tests for age and BMI, while Chi-Square tests were used for race, education level, birth country, and military status. Results: Men with prostate cancer had a higher intake of the following NOVA group 4 ultra-processed foods: “cakes, cookies pies, pancakes” (p=0.031), “ice cream, ice pops, and frozen yogurts” (p<0.001), “sugared breakfast cereals” (p<0.001). They also had a higher intake of certain group 1 unprocessed or minimally processed foods: “roots and tubers” (p=0.019) and “fruits including juices” (p<0.001). Men without cancer had a higher intake of certain NOVA 1 unprocessed or minimally processed foods: meat/poultry (p<0.001), grains (p=0.002), pasta (p=0.025). They also ate more oils (NOVA 2 processed culinary ingredients, p=0.003), NOVA 3 processed foods like cheese (p<0.001), and many NOVA 4 foods like salty snacks (p=0.002), pizza (p<0.001), sandwiches/hamburgers (p=0.030), potato products (p<0.001), sauces/dressing/gravies (p=0.001), soft drinks (p<0.001), and sweetened beverages (p<0.001). Subgroups analyses revealed a greater association with prostate cancer for people with older age, Non-Hispanic Black and Non-Hispanic White races, being US-born, having a higher education, and serving in the military. Conclusions: To our knowledge, this is the largest study evaluating dietary behavior in the context of food processing and prostate cancer prevalence. We identified a high risk dietary pattern associated with industrially processed, calorically dense, and high glycemic index foods; conversely, a low risk dietary pattern was associated with minimally processed Mediterranean diets and, interestingly, highly processed Western diets.