Increased consumption of ultra-processed foods may be associated with higher mortality in diabetic patients

1. In this prospective cohort study, greater ultra-processed food intake was associated with higher hazards for both all-cause and cardiovascular disease (CVD) mortality in patients with type 2 diabetes.

2. Furthermore, a linear dose-response relationship existed between UPF consumption and all-cause and CVD mortality in this population.

Evidence Rating Level: 2 (Good)

Type 2 diabetes is a highly prevalent disease associated with increased mortality, especially from cardiovascular diseases (CVD). Diet significantly impacts the risk and progression of type 2 diabetes, and it is well known that higher consumption of ultra-processed foods (UPF) increases the risk of developing diabetes. However, whether consumption of UPF is detrimental in patients with diabetes is not well known. This study evaluated the association between UPF and all-cause and CVD mortality among patients with type 2 diabetes.

This prospective cohort study followed 1065 adult patients 35 years or older with type 2 diabetes living in Molise, Italy, for 11.6 years. Pregnant patients or those with type 1 diabetes or mental health and decision-making impairments were excluded. Food intake was determined through a 188-item food-frequency questionnaire, and UPF consumption was determined using the Nova classification. Overall diet quality was assessed using the Mediterranean Diet Score (MDS). The cohort was followed up for mortality from March 2005 to the end of December 2019. The primary outcomes measured were all-cause and CVD mortality, assessed by the Italian mortality registry.

The results demonstrated that greater UPF intake was associated with higher hazards for both all-cause and CVD mortality, independent of the overall diet quality. Sugary drinks, margarine, stock cubes, and biscuits were the individual UPFs associated with the highest mortality rates. The results also demonstrated a linear dose-response relationship between UPF consumption and all-cause and CVD mortality. However, this study was limited by the self-reported nature of food intake, which may have introduced bias. Nonetheless, these results suggested that UPFs are likely associated with increased mortality risk in patients with type 2 diabetes and should be considered when counseling such patients about lifestyle modifications.

Click to read the study in The American Journal of Clinical Nutrition

Image: PD

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