Ultra-processed Food and Incident Type 2 Diabetes: Studying the Underlying Consumption Patterns to Unravel the Health Effects of This Heterogeneous Food Category in the Prospective Lifelines Cohort

Overview

Journal BMC Med

Publisher Biomed Central

Specialty General Medicine

Date 2022 Jan 13

PMID 35022060

Authors

Ming-Jie Duan

Petra C Vinke

Gerjan Navis

Eva Corpeleijn

Louise H Dekker

Affiliations

Soon will be listed here.

Abstract

Background: The 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.

Methods: Of 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.

Results: During 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]).

Conclusions: The 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.

Citing Articles

Ultra-Processed Foods and Type 2 Diabetes Mellitus: What Is the Evidence So Far?.

Vallianou N, Evangelopoulos A, Tzivaki I, Daskalopoulou S, Adamou A, Michalaki Zafeiri G Biomolecules. 2025; 15(2).

PMID: 40001610 PMC: 11852733. DOI: 10.3390/biom15020307.

The Relationship Between Health Parameters, Body Size, Elements of Lifestyle, and Hand Grip Strength in a Group of Patients with Type 2 Diabetes, Aged 40-98, from Ulaanbaatar, Mongolia.

Jaalkhorol M, Cieslik A, Dashtseren M, Khairat A, Damdinbazar O, Ochirdorj G J Clin Med. 2025; 14(1.

PMID: 39797185 PMC: 11721179. DOI: 10.3390/jcm14010102.

Association between dietary patterns and chronic kidney disease in elderly patients with type 2 diabetes: a community-based cross-sectional study.

Cao L, Yu P, Zhang L, Yao Q, Zhou F, Li X Nutr J. 2025; 24(1):1.

PMID: 39754172 PMC: 11697753. DOI: 10.1186/s12937-024-01070-9.

Food consumption by degree of food processing and risk of type 2 diabetes mellitus: a prospective cohort analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC).

Dicken S, Dahm C, Ibsen D, Olsen A, Tjonneland A, Louati-Hajji M Lancet Reg Health Eur. 2024; 46:101043.

PMID: 39529810 PMC: 11551512. DOI: 10.1016/j.lanepe.2024.101043.

Enhanced Labeling to Promote Consumption of Nutrient Dense Foods and Healthier Diets.

Benbrook C, Mesnage R Foods. 2024; 13(21).

PMID: 39517161 PMC: 11544848. DOI: 10.3390/foods13213377.

References

Juul F, Vaidean G, Parekh N . Ultra-processed Foods and Cardiovascular Diseases: Potential Mechanisms of Action. Adv Nutr. 2021; 12(5):1673-1680. PMC: 8483964. DOI: 10.1093/advances/nmab049. View

Elizabeth L, Machado P, Zinocker M, Baker P, Lawrence M . Ultra-Processed Foods and Health Outcomes: A Narrative Review. Nutrients. 2020; 12(7). PMC: 7399967. DOI: 10.3390/nu12071955. View

Rico-Campa A, Martinez-Gonzalez M, Alvarez-Alvarez I, de Deus Mendonca R, de la Fuente-Arrillaga C, Gomez-Donoso C . Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ. 2019; 365:l1949. PMC: 6538973. DOI: 10.1136/bmj.l1949. View

Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N . Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9 edition. Diabetes Res Clin Pract. 2019; 157:107843. DOI: 10.1016/j.diabres.2019.107843. View

Ardisson Korat A, Willett W, Hu F . Diet, lifestyle, and genetic risk factors for type 2 diabetes: a review from the Nurses' Health Study, Nurses' Health Study 2, and Health Professionals' Follow-up Study. Curr Nutr Rep. 2015; 3(4):345-354. PMC: 4295827. DOI: 10.1007/s13668-014-0103-5. View

Dekker L, Rijnks R, Strijker D, Navis G . A spatial analysis of dietary patterns in a large representative population in the north of The Netherlands - the Lifelines cohort study. Int J Behav Nutr Phys Act. 2017; 14(1):166. PMC: 5719934. DOI: 10.1186/s12966-017-0622-8. View

Levy R, Rauber F, Chang K, Louzada M, Monteiro C, Millett C . Ultra-processed food consumption and type 2 diabetes incidence: A prospective cohort study. Clin Nutr. 2021; 40(5):3608-3614. DOI: 10.1016/j.clnu.2020.12.018. View

Ngwa J, Cabral H, Cheng D, Pencina M, Gagnon D, LaValley M . A comparison of time dependent Cox regression, pooled logistic regression and cross sectional pooling with simulations and an application to the Framingham Heart Study. BMC Med Res Methodol. 2016; 16(1):148. PMC: 5094095. DOI: 10.1186/s12874-016-0248-6. View

Almoraie N, Saqaan R, Alharthi R, Alamoudi A, Badh L, Shatwan I . Snacking patterns throughout the life span: potential implications on health. Nutr Res. 2021; 91:81-94. DOI: 10.1016/j.nutres.2021.05.001. View

10.

Fiolet T, Srour B, Sellem L, Kesse-Guyot E, Alles B, Mejean C . Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ. 2018; 360:k322. PMC: 5811844. DOI: 10.1136/bmj.k322. View

11.

Srour B, Fezeu L, Kesse-Guyot E, Alles B, Mejean C, Andrianasolo R . Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé). BMJ. 2019; 365:l1451. PMC: 6538975. DOI: 10.1136/bmj.l1451. View

12.

Monteiro C . Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutr. 2009; 12(5):729-31. DOI: 10.1017/S1368980009005291. View

13.

Monteiro C, Cannon G, Levy R, Moubarac J, Louzada M, Rauber F . Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019; 22(5):936-941. PMC: 10260459. DOI: 10.1017/S1368980018003762. View

14.

Li M, Shi Z . Ultra-Processed Food Consumption Associated with Overweight/Obesity among Chinese Adults-Results from China Health and Nutrition Survey 1997-2011. Nutrients. 2021; 13(8). PMC: 8399660. DOI: 10.3390/nu13082796. View

15.

Buijsse B, Boeing H, Drogan D, Schulze M, Feskens E, Amiano P . Consumption of fatty foods and incident type 2 diabetes in populations from eight European countries. Eur J Clin Nutr. 2014; 69(4):455-61. DOI: 10.1038/ejcn.2014.249. View

16.

von Eckardstein A, Schulte H, Assmann G . Risk for diabetes mellitus in middle-aged Caucasian male participants of the PROCAM study: implications for the definition of impaired fasting glucose by the American Diabetes Association. Prospective Cardiovascular Münster. J Clin Endocrinol Metab. 2000; 85(9):3101-8. DOI: 10.1210/jcem.85.9.6773. View

17.

Malik V, Popkin B, Bray G, Despres J, Hu F . Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. 2010; 121(11):1356-64. PMC: 2862465. DOI: 10.1161/CIRCULATIONAHA.109.876185. View

18.

MacDonald I . A review of recent evidence relating to sugars, insulin resistance and diabetes. Eur J Nutr. 2016; 55(Suppl 2):17-23. PMC: 5174139. DOI: 10.1007/s00394-016-1340-8. View

19.

Te Morenga L, Mallard S, Mann J . Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ. 2013; 346:e7492. DOI: 10.1136/bmj.e7492. View

20.

Aune D, Norat T, Romundstad P, Vatten L . Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Eur J Epidemiol. 2013; 28(11):845-58. DOI: 10.1007/s10654-013-9852-5. View