Higher ultra-processed food consumption may lead to type 2 diabetes: JAMA study

France: Ultra-processed foods (UPF) form an important part of Western diets. Because of their poorer nutritional quality, their consumption has been linked to multiple adverse health effects. Now, a recent study published in JAMA Internal Medicine has found that increased consumption of UPF in the diet can lead to type 2 diabetes (T2D). UPFs include canned vegetables, canned broth, salted nuts, canned fish, plain yoghurt, tofu, cheese, and smoked meats.

Type 2 diabetes mellitus is a major public health problem worldwide. It affected 425 million people in 2017, with an estimated projection of 629 million cases by 2045.

Ultra-processed foods are the foods that undergo multipole physical, biological, and/or chemical processes and generally contain food additives. UPF is widespread worldwide, especially in Western diets. Many studies have linked their consumption to have adverse health effects. This is because UPF undergoes several physical and chemical processes, possibly leading to the production of new compounds with potential cardiometabolic disruption properties.

UPF often have longer shelf-lives compared with non-UPF, particularly owing to the use of preservatives. Thus, they stay for long periods in their packaging, favoring potential migration of materials in contact with food, such as bisphenol A, associated with increased T2D risk in a recent meta-analysis of observational studies.

This population-based prospective cohort study by Bernard Srour, Université de Paris, SMBH Paris, France, and colleagues assessed the associations between consumption of UPF and risk of type 2 diabetes.

The study included 104 707 participants (21 800 [20.8%] men and 82 907 [79.2%] women) aged 18 years or older from the French NutriNet-Santé cohort (2009-2019). Dietary intake data were collected using repeated 24-hour dietary records (5.7 per participant on average), designed to register participants' usual consumption for more than 3500 different food items. These were categorized according to their degree of processing by the NOVA classification system.

Read Also: Ultra-processed foods lead to weight gain due to their higher calorie content

Key findings of the study include

• Absolute T2D rates in the lowest and highest UPF consumers were 113 and 166 per 100 000 person-years, respectively.


• Consumption of UPF was associated with a higher risk of T2D (multi-adjusted hazard ratio [HR] for an absolute increment of 10 in the percentage of UPF in the diet, 1.15; median follow-up, 6.0 years; 582 252 person-years; 821 incident cases).


• These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet, for other metabolic comorbidities (HR, 1.13), and weight change (HR, 1.13).


• The absolute amount of UPF consumption (grams per day) was consistently associated with T2D risk, even when adjusting for unprocessed or minimally processed food intake (HR for a 100 g/d increase, 1.05).

"Our results demonstrate that a higher proportion of UPF in the diet was associated with a higher risk of T2D. Even though these results need to be confirmed in other populations and settings, they provide evidence to support efforts by public health authorities to recommend limiting UPF consumption," concluded the authors.

The study, "Ultra-processed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort," is published in the JAMA Internal Medicine.

DOI: 10.1001/jamainternmed.2019.5942