Ultraprocessed Food Intake and Adiposity, Vascular Brain Injury, and Cognition in Middle-Aged Adults

Importance: Ultraprocessed foods (UPFs) account for a substantial and increasing proportion of dietary intake in Canada. Although UPFs are consistently associated with adiposity and cardiometabolic disease, their associations with subclinical vascular brain injury (VBI) and cognitive performance in midlife are unclear. Objective: To evaluate associations of UPF consumption with adiposity, magnetic resonance imaging (MRI)-defined VBI, and cognitive performance in middle-aged adults in Canada. Design, Setting, and Participants: This cross-sectional study included 8783 adults aged 35 to 69 years without cardiovascular disease who were enrolled in the Canadian Alliance for Healthy Hearts and Healthy Minds (CAHHM) and Prospective Urban and Rural Epidemiology-MIND (PURE-MIND) studies. Participants from CAHHM were recruited from January 1, 2014, to December 31, 2018, and participants from PURE-MIND were recruited from January 1, 2010, to December 31, 2018. Data analyses were conducted between July 16, 2024, and August 16, 2026. Exposures: UPF consumption assessed using previously validated semiquantitative food frequency questionnaires and expressed as servings per 2000 kcal/d. Main Outcomes and Measures: The main outcomes were body fat (BF) percentage (bioelectrical impedance), visceral adipose tissue (VAT) volume, hepatic fat fraction (HFF), VBI defined as covert brain infarcts or high white matter hyperintensities (HWMHs) (measured by MRI), and cognitive performance measured by the Montreal Cognitive Assessment (MOCA) and the Digital Symbol Substitution Test (DSST). Results: In this cross-sectional study of 8783 participants (mean [SD] age, 57.7 [8.7] years; 4917 females [56.6%]), those in the highest quartile of UPF intake had a BF percentage that was 1.7 (95% CI, 1.2-2.2) percentage points higher and a 5.7 (95% CI, 3.2-8.3) mL greater VAT volume compared with those in the lowest quartile, but no significant difference in HFF. Compared with the lowest quartile, the highest UPF quartile had higher odds of VBI (adjusted OR, 1.40; 95% CI, 1.10-1.77; P for trend = .009). No significant associations were observed between UPF intake and MOCA or DSST performance. Conclusions and Relevance: In this cross-sectional study of middle-aged adults in Canada, higher UPF intake was associated with greater adiposity and higher odds of MRI-defined VBI but not cognitive performance. Associations with VBI were sensitive to UPF exposure definition. Longitudinal studies are needed to establish temporality.