Ultra-Processed Food Consumption and Risk of Type 2 Diabetes: Three Large Prospective U.S. Cohort Studies

Abstract

OBJECTIVE We examined the relationship between ultra-processed food (UPF) intake and type 2 diabetes (T2D) risk among 3 large U.S. cohorts, conducted a meta-analysis of prospective cohort studies, and assessed meta-evidence quality. RESEARCH DESIGN AND METHODS We included 71,871 women from the Nurses’ Health Study, 87,918 women from the Nurses’ Health Study II, and 38,847 men from the Health Professional Follow-Up Study. Diet was assessed using food frequency questionnaires and UPF was categorized per the NOVA classification. Associations of total and subgroups of UPF with T2D were assessed using Cox proportional hazards models. We subsequently conducted a meta-analysis of prospective cohort studies on total UPF and T2D risk, and assessed meta-evidence quality using the NutriGrade scoring system. RESULTS Among the U.S. cohorts (5,187,678 person-years; n = 19,503 T2D cases), the hazard ratio for T2D comparing extreme quintiles of total UPF intake (percentage of grams per day) was 1.46 (95% CI 1.39–1.54). Among subgroups, refined breads; sauces, spreads, and condiments; artificially and sugar-sweetened beverages; animal-based products; and ready-to-eat mixed dishes were associated with higher T2D risk. Cereals; dark and whole-grain breads; packaged sweet and savory snacks; fruit-based products; and yogurt and dairy-based desserts were associated with lower T2D risk. In the meta-analysis (n = 415,554 participants; n = 21,932 T2D cases), each 10% increment in total UPF was associated with a 12% (95% CI 10%–13%) higher risk. Per NutriGrade, high-quality evidence supports this relationship. CONCLUSION High-quality meta-evidence shows that total UPF consumption is associated with higher T2D risk. However, some UPF subgroups were associated with lower risk in the U.S. cohorts.

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

“…The systematic search identified 430 de-duplicated articles (fig 1). After applying the eligibility criteria, we included 14 meta-analysis studies with 45 distinct pooled analyses 1718404142434445464748495051…”

“…Each of the meta-analysis studies examined the non-dose-response associations between exposure to ultra-processed foods and adverse health outcomes. However, an additional analysis involving dose-response modelling of the ultra-processed food exposure variable was conducted in 13 pooled analyses across five meta-analysis studies 4042434751. The outcomes considered using this approach included all cause mortality and cardiovascular disease events, such as cardiovascular disease morbidity and mortality, associated with each increase in daily servings of ultra-processed food 43.…”

“…We found evidence of moderate (I 2 =50-74.9%) to high (I 2 ≥75%) heterogeneity in 13 (29%) and eight (18%) of the 45 discrete pooled analyses, respectively (supplementary table G). The 95% prediction intervals were statistically significant for seven (25%) of the 28 pooled analyses with three or more original research articles (supplementary table G), including direct associations of greater ultra-processed food exposure with higher risks of all cause mortality,43 cardiovascular disease related mortality,43 common mental disorder outcomes,50 Crohn’s disease,48 obesity,42 and type 2 diabetes (dose-response) 47. Additionally, we found evidence of excess significance bias in nine (32%) of the 28 pooled analyses with three or more original research articles listed in supplementary table G. This bias was evident in associations between higher ultra-processed food exposure and all cause mortality (dose-response and non-dose-response),43 hypertension,44 abdominal obesity,42 metabolic syndrome,45 non-alcoholic fatty liver disease,46 obesity (dose-response and non-dose-response),42 and type 2 diabetes 47.…”

Consuming less ultra-processed food is associated with inadequate protein intake among vegan dieters

“…[37][38][39] In fact, a recent study has shown that distinct subgroups of UPF are differently associated with type-2 diabetes risk, with subgroups such as fruit-and dairybased ultra-processed desserts even showing a risk reduction. 39 Another study found that although UPF consumption was associated with multimorbidity related to cancer and cardiometabolic diseases, this association was not seen in the subgroup of plantbased UPF, 40 suggesting that Nova may not capture possible nuance in "quality" among different UPF. In our study, textured soy protein was an important contributor to UPF consumption.…”

Diabetes mellitus: Is Pakistan the epicenter of the next pandemic?

“…5 Globalization of the Western diet in the form of ultraprocessed food in the last few years has led to obesity and DM. 6 The public's lack of awareness and oblivious attitude is a well-established factor in the escalation of the DM rate in Pakistan. 7 Unequal access to insulin, especially in low-and middle-income countries due to the lack of government policies on the selection of insulin, standardization of prices, and compensation, has created a gap in the effective management of DM.…”