Ultra-Processed Food Intake and Impairment Across Multiple Cognitive Domains in Nationally Representative Older U.S. Adults

Heejin Lee^1*Elizabeth Ludwig-Borycz²Claire T McEvoy³Euridice Martinez Steele^4,5Neha Khandpur^1,5,6Steven G. Heeringa⁷Lindsay H. Ryan⁷Kenneth M. Langa^8,9Julia Wolfson^10,11Cindy W. Leung¹

• ¹Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, United States
• ²Center for Global Health Equity, University of Michigan, Ann Arbor, United States
• ³Centre for Public Health, Institute for Global Food Security, Queen’s University Belfast, Belfast, United Kingdom
• ⁴Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
• ⁵Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, Sao Paulo, Brazil
• ⁶Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
• ⁷Institute for Social Research, University of Michigan, Ann Arbor, United States
• ⁸Institute for Social Research, University of Michigan,, Ann Arbor, United States
• ⁹Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, United States
• ¹⁰Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
• ¹¹Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States

Ultra-processed food (UPF) consumption, which accounts for more than 50% of energy intake in the US, has steadily increased among older adults over the past decade. UPF consumption is associated with overall cognitive decline, but few studies have examined the associations between UPF consumption and individual cognitive domains. In this study, we examined associations between UPF consumption and impairment in executive function, memory, language, visuospatial, and orientation using data from the longitudinal and nationally representative Health and Retirement Study (HRS). Data were drawn from HRS participants who took part in both the 2013 Health Care and Nutrition Study (HCNS) and the 2016 Harmonized Cognitive Assessment Protocol (HCAP) and who did not have dementia or memory problems at baseline (2012) (n=1,408). Dietary intake was assessed using the food frequency questionnaire from 2013 HCNS. UPF was classified using the Nova categorization. The percentage of energy intake from UPF was grouped into sex-specific quintiles (Q). Cognitive impairment was assessed from the 2016 HCAP based on cognitive domain scores, defined as >1.5 SDs below the mean or a T-score=35. Weighted multivariate-logistic regression was used to estimate the associations between UPF consumption and cognitive outcomes. In the analytic sample, mean UPF intake was 42.3% energy/day. After adjustment for baseline sociodemographic and health characteristics, higher UPF consumption showed a marginally significant trend toward greater impairment in executive function (Q4 vs Q1, OR 2.08, 95% CI 1.16-3.74; Q5 vs Q1, OR 1.73 95% CI 0.97-3.09; P-trend=0.052). UPF consumption was not significantly associated with impairment in other cognitive domains. Our findings highlight a potential association between high UPF intake and executive functioning impairment among older US adults.