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

Ming-Jie Duan; Petra C Vinke; Gerjan Navis; Eva Corpeleijn; Louise H Dekker

doi:10.1186/s12916-021-02200-4

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

BMC Med. 2022 Jan 13;20(1):7. doi: 10.1186/s12916-021-02200-4.

Authors

Ming-Jie Duan^#¹, Petra C Vinke^#², Gerjan Navis³, Eva Corpeleijn², Louise H Dekker^{3

4}

Affiliations

¹ Department of Internal Medicine, Division Nephrology (AA52), University Medical Center Groningen, P.O. Box 30 001, 9700RB, Groningen, The Netherlands. m.duan@umcg.nl.
² Department of Epidemiology (FA40), University Medical Center Groningen, P.O. Box 30 001, 9700RB, Groningen, The Netherlands.
³ Department of Internal Medicine, Division Nephrology (AA52), University Medical Center Groningen, P.O. Box 30 001, 9700RB, Groningen, The Netherlands.
⁴ Aletta Jacobs School of Public Health, University of Groningen, P.O. Box 716, 9712GH, Groningen, The Netherlands.

^# Contributed equally.

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.

Keywords: Dietary pattern; Epidemiology; Nutrition; Type 2 diabetes; Ultra-processed food.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Diabetes Mellitus, Type 2* / epidemiology
Diet
Fast Foods
Female
Food Handling
Humans
Male
Prospective Studies