Abstract MP73: Ultra-processed Food Intake And All-cause And Cause-specific Mortality In Subjects With Type 2 Diabetes: Longitudinal Findings From The Moli-sani Study

Abstract

Introduction: Excessive consumption of ultra-processed food (UPF) is associated with increased risk of mortality and disease in general populations but its health impact for individuals with type 2 diabetes is poorly defined. Hypothesis: We assessed the hypothesis of an association between elevated UPF intake and all-cause and cause-specific mortality among subjects with type 2 diabetes. We expect that elevated sugar content of UPF is on the pathway of this relation and that established risk factors might act as potential biological mechanisms linking UPF to mortality. Methods: Longitudinal analysis on 1,068 men and women (mean age 65±10 y) with type 2 diabetes, at the moment of their enrolled in the Moli-sani Study( between 2005 and 2010), and followed for 10.7 y (median). Food intake was assessed, at enrolment, by a 188-item food frequency questionnaire. UPF was defined using the NOVA classification according to degree of processing, and categorized as quartiles of the ratio (%) between UPF (g/d) and total food consumed (g/d). The possible mediating effects of 18 inflammatory, metabolic, cardiovascular and renal biomarkers were evaluated on the basis of percentage changes and associated p values. Results: Study participants reported a median UPF intake of 6.3% (interquartile range: 4.1-9.4%). Food mostly contributing to the total of UPF eaten were processed meat (22.4%), crispbread/rusks (16.6%), non-homemade pizza (11.2%), and cakes/pies/pastries (8.8%). In multivariable-adjusted COX analyses, higher intake of UPF (Q4, ≥9.4% of total food eaten), as opposed to the lowest (Q1, UPF<4.1%), was associated with higher hazards of all-cause (Hazard ratio [HR]=1.72; 95%CI 1.22-2.41) and CVD mortality (HR=2.15; 1.23-3.77). A linear dose-response relationship of 1% increment in UPF intake with all-cause and CVD mortality was also observed. Elevated sugar content of UPF explained about 30% of these associations. Altered levels of serum creatinine accounted for 9.6% and 12.6% of the relation between UPF with all-cause and CVD mortality, respectively. Conclusions: An increased dietary share of UPF was associated with higher hazards of all-cause and CVD mortality among individuals with type 2 diabetes, possibly through the high sugar content of these products. Creatinine, as a marker of renal function, was likely on the pathway between UPF and mortality.