Ultra-Processed Food Consumption and Risk of Type 2 Diabetes: Three Large Prospective U.S. Cohort Studies
Chen Z, Khandpur N, Desjardins C, Wang L, Monteiro CA, Rossato SL, Fung TT, Manson JE, Willett WC, Rimm EB, Hu FB, Sun Q, Drouin-Chartier JP
Diabetes care · 170 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Cohort study (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
- Intake measured by
- Food frequency questionnaire
Who paid for it
- Funding
- Independent funding
- Government
- Fonds de Recherche du Québec - Santé
- Government
- National Heart, Lung, and Blood Institute
- Government
- National Cancer Institute
- Government
- National Institute of Diabetes and Digestive and Kidney Diseases
- Government
- NHLBI NIH HHS
- Government
- NCI NIH HHS
- Government
- NIH
- Government
- NIDDK NIH HHS
- Grants
- National Cancer Institute (U01 CA167552); National Heart, Lung, and Blood Institute (U01 HL145386); National Cancer Institute (P01 CA087969); National Heart, Lung, and Blood Institute (R01-HL034594); National Cancer Institute (UM1 CA186107); National Heart, Lung, and Blood Institute (R01 HL035464); National Heart, Lung, and Blood Institute (R01-HL-088521); National Cancer Institute (U01 CA176726); National Institute of Diabetes and Digestive and Kidney Diseases (R01DK120870); National Cancer Institute (R01‐CA049449); National Cancer Institute (R01‐CA067262); National Heart, Lung, and Blood Institute (R01 HL060712)
Based on 8 listed funder(s).
Publication
- Published
- 2023-02-28 · Diabetes Care · vol. 46 · issue 7 · pp. 1335–1344
- Publisher
- American Diabetes Association
- Cited
- 250 citations · more than 100% of similar papers · 57.8× the field average
- Impact
- Top 10% most cited in its field
- References
- 37 works
- Access
- Free to read
- Research areas
- Consumer Attitudes and Food Labeling · Nutritional Studies and Diet · Culinary Culture and Tourism
- Keywords
- Medicine, Hazard ratio, Prospective cohort study, Type 2 diabetes, Cohort study, Nurses' Health Study, Meta-analysis, Environmental health, Diabetes mellitus, Refined grains, Proportional hazards model, Cohort, Lower risk, Confidence interval, Internal medicine, Whole grains, Food science, Endocrinology
- MeSH
- humans, fruit, diabetes mellitus, type 2, diet, cohort studies, follow-up studies, prospective studies, female, male, fast foods, food, processed
13 authors
From US, NL, BR, CA
- Zhangling Chen · correspondingHarvard University; Erasmus MC
- Neha KhandpurHarvard University; Universidade de São Paulo
- Clémence DesjardinsUniversité Laval; Institut sur la nutrition et les aliments fonctionnels (INAF)
- Lu Wang
- Carlos Augusto MonteiroUniversidade de São Paulo
- Sinara Laurini RossatoHarvard University; Universidade Federal de Uberlândia
Abstract
Objective
We examined the relationship between ultra-processed food (UPF) intake and type 2 diabetes (T2D) risk among 3 large U.S. cohorts, conducted a meta-analysis of prospective cohort studies, and assessed meta-evidence quality.
Research design and methods
We included 71,871 women from the Nurses' Health Study, 87,918 women from the Nurses' Health Study II, and 38,847 men from the Health Professional Follow-Up Study. Diet was assessed using food frequency questionnaires and UPF was categorized per the NOVA classification. Associations of total and subgroups of UPF with T2D were assessed using Cox proportional hazards models. We subsequently conducted a meta-analysis of prospective cohort studies on total UPF and T2D risk, and assessed meta-evidence quality using the NutriGrade scoring system.
Results
Among the U.S. cohorts (5,187,678 person-years; n = 19,503 T2D cases), the hazard ratio for T2D comparing extreme quintiles of total UPF intake (percentage of grams per day) was 1.46 (95% CI 1.39-1.54). Among subgroups, refined breads; sauces, spreads, and condiments; artificially and sugar-sweetened beverages; animal-based products; and ready-to-eat mixed dishes were associated with higher T2D risk. Cereals; dark and whole-grain breads; packaged sweet and savory snacks; fruit-based products; and yogurt and dairy-based desserts were associated with lower T2D risk. In the meta-analysis (n = 415,554 participants; n = 21,932 T2D cases), each 10% increment in total UPF was associated with a 12% (95% CI 10%-13%) higher risk. Per NutriGrade, high-quality evidence supports this relationship.
Conclusions
High-quality meta-evidence shows that total UPF consumption is associated with higher T2D risk. However, some UPF subgroups were associated with lower risk in the U.S. cohorts.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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