Ultraprocessed food consumption is associated with all-cause and cardiovascular mortality in participants with type 2 diabetes independent of diet quality: a prospective observational cohort study

Jul 28, 2023The American journal of clinical nutrition

Ultraprocessed food linked to higher death risk, including heart-related, in people with type 2 diabetes regardless of overall diet quality

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Abstract

The average ultraprocessed food (UPF) consumption among participants with type 2 diabetes was 7.4% of total food intake.

Higher UPF intake (≥10.5% for females and ≥9% for males) was associated with increased hazards of all-cause mortality (hazard ratio: 1.70) and cardiovascular disease (CVD) mortality (hazard ratio: 2.64).
Participants consuming the lowest amounts of UPF (<4.7% for females and <3.7% for males) had significantly lower mortality risks.
The associations between UPF intake and mortality were not substantially altered by adjusting for overall diet quality, as measured by the Mediterranean Diet Score.
A linear dose-response relationship was observed, indicating that higher UPF intake correlates with higher risks of both all-cause and CVD mortality.

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BACKGROUND: Nutritional strategies for prevention and management of type 2 diabetes traditionally emphasize dietary patterns reflecting nutrient goals, but the health implications of ultraprocessed food (UPF) for patients with type 2 diabetes remain unknown.

OBJECTIVES: This study aimed to evaluate the association of UPF intake with all-cause and cardiovascular disease (CVD) mortality among participants with type 2 diabetes from the Moli-sani Study in Italy (enrollment 2005-2010).

METHODS: This was a prospective observational cohort study on 1065 individuals with type 2 diabetes at baseline, followed up for 11.6 y (median). Food intake was assessed by a 188-item food-frequency questionnaire. UPF was defined following the Nova classification and calculated as the ratio (weight ratio; %) between UPF (g/d) and total food eaten (g/d). Overall diet quality was assessed through the Mediterranean Diet Score (MDS). Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality.

RESULTS: The average UPF consumption was 7.4% (±5.0%). In multivariable-adjusted Cox analyses, greater UPF intake (Q4, ≥10.5% and ≥9% of total food eaten for females and males, respectively), as opposed to the lowest (Q1, UPF <4.7% and <3.7% for females and males, respectively), was associated with higher hazards of both all-cause (HR: 1.70; 95% CI: 1.25, 2.33) and CVD mortality (HR: 2.64; 95% CI: 1.59, 4.40); inclusion of the MDS into the model did not substantially alter the magnitude of these associations (HR: 1.64; 95% CI: 1.19, 2.25 and HR: 2.55; 95% CI: 1.53, 4.24 for all-cause and CVD mortality, respectively). A linear dose-response relationship of UPF intake with both all-cause and CVD mortality was also observed.

CONCLUSIONS: In participants with type 2 diabetes at study entry, higher UPF consumption was associated with reduced survival and higher CVD mortality rate, independent of diet quality. Besides prioritizing the adoption of a diet based on nutritional requirements, dietary guidelines for the management of type 2 diabetes should also recommend limiting UPF.

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Ultraprocessed food consumption is associated with all-cause and cardiovascular mortality in participants with type 2 diabetes independent of diet quality: a prospective observational cohort study

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