Abstract
Background
It is unknown whether the association between ultra-processed food (UPF) intake and type 2 diabetes mellitus differs from other degrees of food processing. We examined the association between degree of food processing and incident type 2 diabetes mellitus.
Methods
This was a prospective cohort analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC). Dietary intake was assessed at baseline using dietary questionnaires and classified according to the Nova classification into unprocessed/minimally processed food (MPF), processed culinary ingredients (PCI), processed food (PF) and UPF. Type 2 diabetes mellitus cases were verified through multiple methods. Cox regression and statistical substitution analysis was used to estimate associations between MPF + PCI, PF and UPF intake and incident type 2 diabetes mellitus. To investigate heterogeneity in the association between UPF and incident type 2 diabetes mellitus, UPF sub-group analysis was conducted. Different reference groups were used in each analysis.
Findings
Over an average 10.9 years follow-up of 311,892 individuals, 14,236 type 2 diabetes mellitus cases were identified. Each 10% increment of total daily food intake from UPF (%g/day) was associated with 17% (95% confidence interval (95%CI): 1.14–1.19) higher incident type 2 diabetes mellitus. Each 10% increment in MPF + PCI or PF intake was associated with lower incident type 2 diabetes mellitus (MPF + PCI hazard ratio: 0.94 (95%CI: 0.92–0.96); PF hazard ratio: 0.92 (95%CI: 0.89–0.95)). Replacing UPF with MPF + PCI or PF was associated with lower incident type 2 diabetes mellitus. However, heterogeneity was observed across UPF sub-groups, with breads, biscuits and breakfast cereals, sweets and desserts, and plant-based alternatives associated with lower incident type 2 diabetes mellitus.
Interpretation
These findings support recommendations to focus on reducing intake of specific UPF for lowering type 2 diabetes mellitus risk.
It is unknown whether the association between ultra-processed food (UPF) intake and type 2 diabetes mellitus differs from other degrees of food processing. We examined the association between degree of food processing and incident type 2 diabetes mellitus.
Methods
This was a prospective cohort analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC). Dietary intake was assessed at baseline using dietary questionnaires and classified according to the Nova classification into unprocessed/minimally processed food (MPF), processed culinary ingredients (PCI), processed food (PF) and UPF. Type 2 diabetes mellitus cases were verified through multiple methods. Cox regression and statistical substitution analysis was used to estimate associations between MPF + PCI, PF and UPF intake and incident type 2 diabetes mellitus. To investigate heterogeneity in the association between UPF and incident type 2 diabetes mellitus, UPF sub-group analysis was conducted. Different reference groups were used in each analysis.
Findings
Over an average 10.9 years follow-up of 311,892 individuals, 14,236 type 2 diabetes mellitus cases were identified. Each 10% increment of total daily food intake from UPF (%g/day) was associated with 17% (95% confidence interval (95%CI): 1.14–1.19) higher incident type 2 diabetes mellitus. Each 10% increment in MPF + PCI or PF intake was associated with lower incident type 2 diabetes mellitus (MPF + PCI hazard ratio: 0.94 (95%CI: 0.92–0.96); PF hazard ratio: 0.92 (95%CI: 0.89–0.95)). Replacing UPF with MPF + PCI or PF was associated with lower incident type 2 diabetes mellitus. However, heterogeneity was observed across UPF sub-groups, with breads, biscuits and breakfast cereals, sweets and desserts, and plant-based alternatives associated with lower incident type 2 diabetes mellitus.
Interpretation
These findings support recommendations to focus on reducing intake of specific UPF for lowering type 2 diabetes mellitus risk.
| Originalsprog | Engelsk |
|---|---|
| Artikelnummer | 101043 |
| Tidsskrift | The Lancet Regional Health - Europe |
| Vol/bind | 46 |
| Antal sider | 15 |
| ISSN | 2666-7762 |
| DOI | |
| Status | Udgivet - 2024 |
Bibliografisk note
Funding Information:SJD is funded by a Medical Research Council grant (MR/N013867/1). RLB is funded by the National Institute for Health and Care Research, Sir Jules Thorn Charitable Trust and Rosetrees Trust. Funding IIG_FULL_2020_033 was obtained from World Cancer Research Fund (WCRF UK), as part of the World Cancer Research Fund International grant programme.
Funding Information:
The coordination of EPIC-Europe is financially supported by International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). Case ascertainment for type 2 diabetes in the EPIC study was done as part of the InterAct project that was supported by the: EU Sixth Framework Programme (FP6) (LSHM_CT_2006_037197) and the Medical Research Council Epidemiology Unit (MC_UU_00006/1).
Funding Information:
The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle G\u00E9n\u00E9rale de l\u2019Education Nationale, Institut National de la Sant\u00E9 et de la Recherche M\u00E9dicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), (The Netherlands); Health Research Fund (FIS) - Instituto de Salud Carlos III (ISCIII), Regional Governments of Andaluc\u00EDa, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology - ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Sk\u00E5ne and V\u00E4sterbotten (Sweden); Cancer Research UK (C8221/A29017 to EPIC-Oxford), Medical Research Council (MR/M012190/1 to EPIC-Oxford). The EPIC-Norfolk study received funding from Cancer Research UK (C864/A14136) and UK Medical Research Council (MR/N003284/1, MC-UU_12015/1 and MC_UU_00006/1) (United Kingdom). NGF, SJS and NJW are funded by the MRC Epidemiology Unit core support (MC_UU_00006/1 and MC_UU_00006/3). NGF and NJW acknowledge support from the National Institute of Health Research (NIHR*) Cambridge Biomedical Research Centre (NIHR203312) and NGF is an NIHR Senior Investigator (NIHR202397). *The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Funding Information:
International Agency for Research on Cancer.We thank all EPIC study participants and staff for their contribution to the study. We acknowledge Nicola Kerrison (EPIC-InterAct Data Manager, MRC Epidemiology Unit) for data management. Funding: SJD is funded by a Medical Research Council grant (MR/N013867/1). RLB is funded by the National Institute for Health and Care Research, Sir Jules Thorn Charitable Trust and Rosetrees Trust. Funding IIG_FULL_2020_033 was obtained from World Cancer Research Fund (WCRF UK), as part of the World Cancer Research Fund International grant programme. The coordination of EPIC-Europe is financially supported by International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). Case ascertainment for type 2 diabetes in the EPIC study was done as part of the InterAct project that was supported by the: EU Sixth Framework Programme (FP6) (LSHM_CT_2006_037197) and the Medical Research Council Epidemiology Unit (MC_UU_00006/1). The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave-Roussy, Mutuelle G\u00E9n\u00E9rale de l'Education Nationale, Institut National de la Sant\u00E9 et de la Recherche M\u00E9dicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di San Paolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), (The Netherlands); Health Research Fund (FIS) - Instituto de Salud Carlos III (ISCIII), Regional Governments of Andaluc\u00EDa, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology - ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Sk\u00E5ne and V\u00E4sterbotten (Sweden); Cancer Research UK (C8221/A29017 to EPIC-Oxford), Medical Research Council (MR/M012190/1 to EPIC-Oxford). The EPIC-Norfolk study received funding from Cancer Research UK (C864/A14136) and UK Medical Research Council (MR/N003284/1, MC-UU_12015/1 and MC_UU_00006/1) (United Kingdom). NGF, SJS and NJW are funded by the MRC Epidemiology Unit core support (MC_UU_00006/1 and MC_UU_00006/3). NGF and NJW acknowledge support from the National Institute for Health Research (NIHR\u2217) Cambridge Biomedical Research Centre (NIHR203312) and NGF is an NIHR Senior Investigator (NIHR202397). \u2217The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Disclaimer: Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization.
Publisher Copyright:
© 2024 The Author(s)