Ultra-processed foods (UPFs) consumption, characterized by high levels of sugars, unhealthy fats, and additives, yet low in nutrients, has increased significantly in recent decades(1). Previous studies have demonstrated the link between UPF consumption and Type 2 diabetes (T2D) (2). Considering the variation in these food categories across studies and the scarcity of large-scale studies focusing on specific UPF subgroups, this study aims to explore the prospective association between UPFs, their subgroups, and the incidence of T2D in a UK based cohort study.

A total of 7,774 participants aged 40-69 years without T2D (69% men and 31% women) from the Whitehall II cohort, who had dietary intake data at baseline (1993/1994) and follow-up data on T2D incidence available, were included in the analyses. Food intake was assessed using a validated 127-item food frequency questionnaire (FFQ). We applied the NOVA classification to categorize FFQ items into four classes based on the level of processing. The intake of UPFs per day was calculated as a percentage of the total daily food intake in grams to account for UPFs that do not provide energy. The incidence of T2D was evaluated from 1993/1994 to 2007/2009 through self- reports and oral glucose tolerance test results. Multivariate Cox regression models were employed to assess the prospective association between UPFs consumption (in quintiles) and T2D risk, adjusting for socioeconomic factors, family history of T2D, lifestyle characteristics, total energy intake, and indicators of nutritional quality.

During the 15-year follow-up, 954 cases of T2D were confirmed. In multivariable models adjusted for family history of T2D, socioeconomic, and lifestyle factors, the highest UPF consumption quintile [mean 33% of total daily intake (grams)] was associated with an increased risk of T2D [HR: 1.35, 95% CI: 1.06-1.71] compared to the lowest quintile [mean 9.6% of total daily intake (grams)]. Adjustment for total energy intake slightly increased the risk of T2D [HR: 1.46, 95% CI: 1.12-1.91]. Additional adjustments for sugar, sodium, and fat intake further increased the risk of T2D [HR: 1.51, 95% CI: 1.15-1.98]. Among UPFs subgroups, only the intake of soft drinks was significantly associated with an increased risk of T2D [HR: 1.02, 95% CI: 1.01-1.08], whereas no significant associations were found for other UPFs subgroups. Similar results were found after multiple imputation of missing values.

In UK midlife adults, higher UPF consumption tends to be prospectively associates with an increased risk of T2D, with notable variations across UPFs subgroups. These findings suggest that the association between UPFs intake and T2D might be independent of nutritional quality and energy intake, indicating that food processing itself could be a contributing factor. This study provides evidence to support efforts to limit UPF consumption as a strategy to alleviate the population burden of T2D.
References:
1. Monteiro CA, Moubarac JC, Cannon G, Ng SW & Popkin B (2013) Obesity Reviews14(S2), 21–8.
2. Moradi S, Kermani MAH, Bagheri R et al. (2021) Nutrients13(12), 4410.
3. Monteiro CA, Cannon G, Levy RB  et al. (2019). Public Health Nutr22. 936–41.

Ultra-processed foods (UPFs) consumption, characterized by high levels of sugars, unhealthy fats, and additives, yet low in nutrients, has increased significantly in recent decades(1). Previous studies have demonstrated the link between UPF consumption and Type 2 diabetes (T2D) (2). Considering the variation in these food categories across studies and the scarcity of large-scale studies focusing on specific UPF subgroups, this study aims to explore the prospective association between UPFs, their subgroups, and the incidence of T2D in a UK based cohort study.

A total of 7,774 participants aged 40-69 years without T2D (69% men and 31% women) from the Whitehall II cohort, who had dietary intake data at baseline (1993/1994) and follow-up data on T2D incidence available, were included in the analyses. Food intake was assessed using a validated 127-item food frequency questionnaire (FFQ). We applied the NOVA classification to categorize FFQ items into four classes based on the level of processing. The intake of UPFs per day was calculated as a percentage of the total daily food intake in grams to account for UPFs that do not provide energy. The incidence of T2D was evaluated from 1993/1994 to 2007/2009 through self- reports and oral glucose tolerance test results. Multivariate Cox regression models were employed to assess the prospective association between UPFs consumption (in quintiles) and T2D risk, adjusting for socioeconomic factors, family history of T2D, lifestyle characteristics, total energy intake, and indicators of nutritional quality.

During the 15-year follow-up, 954 cases of T2D were confirmed. In multivariable models adjusted for family history of T2D, socioeconomic, and lifestyle factors, the highest UPF consumption quintile [mean 33% of total daily intake (grams)] was associated with an increased risk of T2D [HR: 1.35, 95% CI: 1.06-1.71] compared to the lowest quintile [mean 9.6% of total daily intake (grams)]. Adjustment for total energy intake slightly increased the risk of T2D [HR: 1.46, 95% CI: 1.12-1.91]. Additional adjustments for sugar, sodium, and fat intake further increased the risk of T2D [HR: 1.51, 95% CI: 1.15-1.98]. Among UPFs subgroups, only the intake of soft drinks was significantly associated with an increased risk of T2D [HR: 1.02, 95% CI: 1.01-1.08], whereas no significant associations were found for other UPFs subgroups. Similar results were found after multiple imputation of missing values.

In UK midlife adults, higher UPF consumption tends to be prospectively associates with an increased risk of T2D, with notable variations across UPFs subgroups. These findings suggest that the association between UPFs intake and T2D might be independent of nutritional quality and energy intake, indicating that food processing itself could be a contributing factor. This study provides evidence to support efforts to limit UPF consumption as a strategy to alleviate the population burden of T2D.
References:
1. Monteiro CA, Moubarac JC, Cannon G, Ng SW & Popkin B (2013) _Obesity Reviews_14(S2), 21–8.
2. Moradi S, Kermani MAH, Bagheri R et al. (2021) _Nutrients_13(12), 4410.
3. Monteiro CA, Cannon G, Levy RB  et al. (2019). _Public Health Nutr_22. 936–41.

OC145 - Prospective association between ultra-processed food consumption and incidence of type II diabetes: the UK Whitehall II cohort study

Unique to the new Congress (previously the Summer Conference) is that you will have greater opportunity to engage with more nutrition science than ever before. In 2024 the core programme will be delivered by the Irish Section of The Nutrition Society, supported by the Science Committee. The theme of these symposia will be ‘new data – focused approaches and challenges’. Outside of the core programme you will have the chance to hear the latest research from the Society’s partner organisations, universities, the private sector and more, on a diverse range of research.