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Ultraprocessed foods (UPF) are widespread in Western diets. Their consumption has been associated in recent prospective studies with increased risks of all-cause mortality and chronic diseases such as cancer, cardiovascular diseases, hypertension, and dyslipidemia; however, data regarding diabetes is lacking.
To assess the associations between consumption of UPF and risk of type 2 diabetes (T2D).
Design, Setting, and Participants
In this population-based prospective cohort study, 104 707 participants aged 18 years or older from the French NutriNet-Santé cohort (2009-2019) were included. 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.
Main Outcomes and Measures
Associations between UPF consumption and risk of T2D were assessed using cause-specific multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors).
A total of 104 707 participants (21 800 [20.8%] men and 82 907 [79.2%] women) were included. Mean (SD) baseline age of participants was 42.7 (14.5) years. 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; 95% CI, 1.06-1.25; 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; 95% CI, 1.03-1.23), and for weight change (HR, 1.13; 95% CI, 1.01-1.27). 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; 95% CI, 1.02-1.08).
Conclusions and Relevance
In this large observational prospective study, 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.
Disclosure statements are available on the authors' profiles:
Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective CohortJAMA Intern Med 2019 Dec 16;[EPub Ahead of Print], B Srour, LK Fezeu, E Kesse-Guyot, B Allès, C Debras, N Druesne-Pecollo, E Chazelas, M Deschasaux, S Hercberg, P Galan, CA Monteiro, C Julia, M Touvier
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This study adds to the rapidly growing body of evidence that consuming foods defined as ultraprocessed adversely affect health. Ultraprocessed foods are distinguished from other processed foods by requiring industrial production, bearing no resemblance to the foods from which they were derived, containing ingredients not found in home kitchens, such as color, flavor, and texture additives, and loaded with added sugars, salt, and fat. Like this one, other studies link diets high in ultraprocessed foods to obesity, type 2 diabetes, heart disease, and even to mortality. Although most such studies have been observational, one involved a direct clinical trial. Kevin Hall and colleagues recruited 20 volunteers and placed them on an unprocessed/processed diet for 2 weeks and a diet based on ultraprocessed foods for another 2 weeks. The diets were equivalent in calories, sugars, fat (as measured), and in palatability (by report). Study participants were permitted to eat as much as desired of each diet. The stunning result: on the ultraprocessed diet, the participants an average of 500 more calories a day than on the unprocessed/processed diet. Not surprisingly, they gained weight—1 pound a week (as would be predicted from the calorie increase). The study participants were unaware that they were eating more calories, and why they did so is not known. Even so, the take-home lesson is obvious: if you want to maintain or lose weight and avoid or manage type 2 diabetes, avoiding ultraprocessed foods is a good way to start.