Abstract
BackgroundThe overall consumption of ultra-processed food (UPF) has previously been associated with type 2 diabetes. However, due to the substantial heterogeneity of this food category, in terms of their nutritional composition and product type, it remains unclear whether previous results apply to all underlying consumption patterns of UPF.MethodsOf 70,421 participants (35–70 years, 58.6% women) from the Lifelines cohort study, dietary intake was assessed with a food frequency questionnaire. UPF was identified according to the NOVA classification. Principal component analysis (PCA) was performed to derive UPF consumption patterns. The associations of UPF and adherence to UPF consumption patterns with incidence of type 2 diabetes were studied with logistic regression analyses adjusted for age, sex, diet quality, energy intake, alcohol intake, physical activity, TV watching time, smoking status, and educational level.ResultsDuring a median follow-up of 41 months, a 10% increment in UPF consumption was associated with a 25% higher risk of developing type 2 diabetes (1128 cases; OR 1.25 [95% CI 1.16, 1.34]). PCA revealed four habitual UPF consumption patterns. A pattern high in cold savory snacks (OR 1.16 [95% CI 1.09, 1.22]) and a pattern high in warm savory snacks (OR 1.15 [95% CI 1.08, 1.21]) were associated with an increased risk of incident type 2 diabetes; a pattern high in traditional Dutch cuisine was not associated with type 2 diabetes incidence (OR 1.05 [95% CI 0.97, 1.14]), while a pattern high in sweet snacks and pastries was inversely associated with type 2 diabetes incidence (OR 0.82 [95% CI 0.76, 0.89]).ConclusionsThe heterogeneity of UPF as a general food category is reflected by the discrepancy in associations between four distinct UPF consumption patterns and incident type 2 diabetes. For better public health prevention, research is encouraged to further clarify how different UPF consumption patterns are related to type 2 diabetes.
Highlights
The overall consumption of ultra-processed food (UPF) has previously been associated with type 2 diabetes
Overall consumption of ultra-processed food and risk of incident type 2 diabetes Table 2 shows the association between consumption of UPF and the risk of incident type 2 diabetes
In conclusion, this study illustrated that the heterogeneity of UPF as a general food category is reflected by the discrepancy in associations of four distinct UPF consumption patterns and incident type 2 diabetes
Summary
The overall consumption of ultra-processed food (UPF) has previously been associated with type 2 diabetes. Due to the substantial heterogeneity of this food category, in terms of their nutritional composition and product type, it remains unclear whether previous results apply to all underlying consumption patterns of UPF. Abundant evidence has shown that adherence to a healthy diet (such as the Mediterranean diet) is crucial to the prevention of type 2 diabetes [2] These dietary patterns studied generally focused on conventional food groups such as fruits and vegetables [3,4,5]. UPF forms a highly heterogeneous food category, especially in terms of their nutritional composition, product types, and contribution to a habitual diet It is unclear whether previous results that identify total intake of UPF as a single risk factor for type 2 diabetes do apply to all underlying consumption patterns that fall under this “umbrellaterm”
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