The DOI matches its Crossref record; 83 of the 89 references it cites were found in a registry or an index, and 1 are not checked yet; none of the 26 sources its claims cite is checked for support yet.
Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort
Open accessAbstract
Importance: Ultraprocessed foods (UPF) are widespread in Western diets. Their consumption has been associated in recent prospective studies with increased risks of all-cause mortality and chronic diseases such as cancer, cardiovascular diseases, hypertension, and dyslipidemia; however, data regarding diabetes are lacking. Objective: To assess the associations between consumption of UPF and risk of type 2 diabetes (T2D). Design, Setting, and Participants: In this population-based prospective cohort study, 104 707 participants aged 18 years or older from the French NutriNet-Santé cohort (2009-2019) were included. Dietary intake data were collected using repeated 24-hour dietary records (5.7 per participant on average), designed to register participants' usual consumption for more than 3500 different food items. These were categorized according to their degree of processing by the NOVA classification system. Main Outcomes and Measures: Associations between UPF consumption and risk of T2D were assessed using cause-specific multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors). Results: A total of 104 707 participants (21 800 [20.8%] men and 82 907 [79.2%] women) were included. Mean (SD) baseline age of participants was 42.7 (14.5) years. Absolute T2D rates in the lowest and highest UPF consumers were 113 and 166 per 100 000 person-years, respectively. Consumption of UPF was associated with a higher risk of T2D (multi-adjusted hazard ratio [HR] for an absolute increment of 10 in the percentage of UPF in the diet, 1.15; 95% CI, 1.06-1.25; median follow-up, 6.0 years; 582 252 person-years; 821 incident cases). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet, for other metabolic comorbidities (HR, 1.13; 95% CI, 1.03-1.23), and for weight change (HR, 1.13; 95% CI, 1.01-1.27). The absolute amount of UPF consumption (grams per day) was consistently associated with T2D risk, even when adjusting for unprocessed or minimally processed food intake (HR for a 100 g/d increase, 1.05; 95% CI, 1.02-1.08). Conclusions and Relevance: In this large observational prospective study, a higher proportion of UPF in the diet was associated with a higher risk of T2D. Even though these results need to be confirmed in other populations and settings, they provide evidence to support efforts by public health authorities to recommend limiting UPF consumption. Trial Registration: ClinicalTrials.gov Identifier: NCT03335644.
Checked 2026-10-10 · 1 reference not checked yet
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Written from the paper’s full text.
TL;DR
In the French NutriNet-Santé prospective cohort, higher ultraprocessed food (UPF) consumption was associated with increased type 2 diabetes (T2D) risk. The association persisted after adjustment for diet quality, metabolic comorbidities, and weight change.
Key findings
- Among 104,707 participants, 821 incident T2D cases occurred over 582,252 person-years (median follow-up 6.0 years).
- Each 10-point increment in the percentage of UPF in the diet was associated with T2D risk: Model 1 HR, 1.15 (95% CI, 1.06-1.25); after further adjustment for metabolic comorbidities, HR, 1.13 (95% CI, 1.03-1.23); after adjustment for weight change, HR, 1.13 (95% CI, 1.01-1.27).
- Absolute UPF consumption was also associated with T2D risk: HR for a 100 g/d increase, 1.05 (95% CI, 1.02-1.08), even when adjusting for unprocessed/minimally processed food intake.
- The proportion of unprocessed/minimally processed foods was inversely associated with T2D risk: HR for a 10-point increment, 0.91 (95% CI, 0.84-0.98). Absolute T2D rates were 113 and 166 per 100,000 person-years in the lowest and highest UPF consumers, respectively.
Methods
- Population-based prospective cohort study using the French NutriNet-Santé cohort (2009-2019); 104,707 adults aged 18 years or older were included (21,800 men [20.8%] and 82,907 women [79.2%]; mean [SD] baseline age, 42.7 [14.5] years).
- Dietary intake was collected with repeated validated web-based 24-hour dietary records (5.7 per participant on average) covering more than 3500 food items; foods were categorized by degree of processing using the NOVA classification.
- Cause-specific multivariable Cox proportional hazard models with age as timescale and left truncation assessed UPF proportion and T2D incidence, treating T2D and death as competing events; models adjusted for sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors, with multiple imputation for missing data.
Limitations
- The paper states that T2D case ascertainment exhaustiveness could not be guaranteed, with about 20% of T2D cases estimated to be underdiagnosed in France, likely reducing statistical power and potentially underestimating associations.
- The paper states that causation cannot be established from this single observational study and residual confounding cannot be entirely ruled out; NOVA misclassification and the broad, heterogeneous UPF category are also noted as limitations.
- The paper states that participants were younger, more often women, more educated, and had healthier dietary habits than the general French population, with lower T2D incidence, which may have limited statistical power, especially for stratified analyses such as in men.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Consumption of UPF was associated with a higher risk of T2D (multi-adjusted hazard ratio [HR] for an absolute increment of 10 in the percentage of UPF in the diet, 1.15; 95% CI, 1.06-1.25;median follow-up, 6.0 years; 582 252 person-years; 821 incident cases).”
- Also stated in: § Results · plain
“Ultraprocessed food intake was associated with an increased T2D risk (Model 1: HR for a 10-point increment in the percentage of UPF in the diet, 1.15; 95% CI, 1.06-1.25;P = .001).”
- Also stated in: § Discussion · plain
“In this large cohort, UPF consumption was associated with increased T2D risk.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“During follow-up (582 252 person-years; median follow-up time, 6.0 years; interquartile range [IQR], 2.8-8.4 years), 821 incident T2D cases were detected.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Results
Strength:plain· not yet calibratedn = 821Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet, for other metabolic comorbidities (HR, 1.13; 95% CI, 1.03-1.23),and for weight change (HR, 1.13; 95% CI, 1.01-1.27).”
- Also stated in: § Results · plain
“The associations remained significant after further adjust- ments for Model 2, 3, 4, and 5 covariates (Table 3).”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The proportion of unprocessed/minimally processed foods in the diet was inversely associated with T2D risk (HR for a 10-point increment, 0.91; 95% CI, 0.84-0.98;P = .01;[Model 1 covariates]).”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The absolute amount of UPF consumption (grams per day) was consistently associated with T2D risk, even when adjusting for unprocessed or minimally processed food intake (HR for a 100 g/d increase, 1.05; 95% CI, 1.02-1.08).”
- Also stated in: § Results · plain
“The absolute amount of UPF consumption in grams per day was consistently associated with T2D risk, even when ad- justing for the absolute amount (in g/d) of unprocessed/ minimally processed food intake (HR for a 100 g/d increase in UPF consumption, 1.05; 95% CI, 1.02-1.08; P = .003).”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These results suggest an association between UPF consumption and T2D risk.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Conclusions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“| Sodium intake, mg/1000 kcal/d | 1479.10 (369.21) | 6.97 (1.20) | <.001 |”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Conclusions
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“| Alcohol intake, g/1000 kcal/d | 3.91 (5.53) | -0.50 (0.02) | <.001 |”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Conclusions
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“| Whole grains, g/1000 kcal/d | 18.96 (24.36) | -3.14 (0.08) | <.001 |”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Conclusions
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“| Fiber, g/1000 kcal/d | 10.72 (3.57) | -0.78 (0.01) | <.001 |”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Conclusions
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- It may state two separate claims as one. 21
- Probably not a substantial claim. 12
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The proportions of UPF in beverages, sugary products, fats/ sauces, and dairy products were more specifically associated with increased T2D risk (eTable 2 in the Supplement).”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Absolute incidence rates for T2D in the whole population were 132 per 100 000 personyears; age and sex corrected absolute rates were 113, 125, 143 and 166 per 100 000 person-years in the first quarter (lowest con-sumers), second, third, and fourth quarter (highest consumers) of the proportion of UPF intake in the diet, respectively.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although HRs were in the same direction, this association was significant in women only, but statistical power was reduced for men (eTable 1 in the Supple- ment).”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Higher consumption of UPF was associated with higher FSAm-NPS DI scores (reflecting a poorer nutritional quality of the diet), higher intakes of energy, SFA, sodium and sugar, lower intakes of fiber and alcohol, higher consumptions of sugary drinks and red and processed meats, and lower consumptions of whole grains, yogurt, nuts, and fruits and vegetables (Table 2).”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Results
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The mean weight contribution of UPF to the diet was 17.3%.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Results
Strength:plain· not yet calibratedn = 707Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A total of 104 707 participants (21 800 [20.8%] men and 82 907 [79.2%] women) were included.Mean (SD) baseline age of participants was 42.7 (14.5) years.”
- Also stated in: § Results · plain
“A total of 104 707 participants (21 800 [20.8%] men and 82 907 [79.2%] women) were included.Mean (SD) baseline age of participants was 42.7 (14.5) years.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Abstract
Strength:plain· not yet calibratedn = 707Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, UPF proportions were higher in younger participants, obese individuals, those with lower physical activity levels, and current smokers (Table 1).”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Results
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Furthermore, T2D incidence was lower (186 cases per 100 000 personyears in our sample after standardization vs 289 per 100 000 in the French population 78 ), thereby limiting statistical power, especially for some stratified analyses (eg, in men).”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Limitations
What the sources say
- Not checked yetcites [78]
Strength:plain· not yet calibratedn = 186Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Only 1304 participants had a null follow-up and were excluded.Some of them may have had T2D that was not detected thereafter.However, this should represent a small number of missed cases (<20 cases considering T2D incidence in France 78 ) and, owing to the prospective design, the resulting potential misclassification bias was most likely nondifferential and rather resulted in an underestima-tion”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Limitations
What the sources say
- Not checked yetcites [78]
Strength:hedged· not yet calibratedn = 20Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The NutriNet-Santé web-based selfadministered 24-hour dietary records have been tested and validated against an interview by a trained dietitian, 47 and against blood and urinary biomarkers.48,49”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Dietary Data and Food Processing Categorization
What the sources say
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Even if a causal link between UPF and chronic diseases cannot be established so far, the accumulation of consistent data leads public health authorities in several countries such as France 82 or Brazil 83 to recommend privileging the consumption of unprocessed/minimally processed foods, and limiting the consumption of UPF in the name of the precautionary principle.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Conclusions
What the sources say
- Not checked yetcites [82]
- Not checked yetcites [83]
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Participants were asked to declare major health events though the yearly health questionnaire, through a specific health check-up questionnaire every 3 months, or at any time through a specific interface on the study website.They were also asked to declare all currently taken medications and treatments via the check-up and yearly questionnaires.In addition, data are linked to medico-administrative”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Case Ascertainment
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Even though we used a multisource case ascertainment approach, exhaustiveness could not be guaranteed.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Limitations
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Third, misclassification bias in the NOVA cannot be ruled out; however, this would have led to a nondifferential measurement error (in cases and noncases), and potentially biasing toward the null hypothesis.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Limitations
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Of note, energy balance and overweight are both associated with T2D risk.3”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Discussion
What the sources say
- Not checked yetcites [3] source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Many food groups, mostly ultraprocessed (eg, processed meat, and sugary sweetened beverages) are recognized T2D risk factors.3”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Discussion
What the sources say
- Not checked yetcites [3] source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Associations between UPF consumption and risk of T2Dwere assessed using cause-specific multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors).”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Multiple imputation for missing data was performed using the multivariate imputation by chained equations (MICE) method.53”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Statistical Analyses
What the sources say
- Not checked yetcites [53] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“About 20% of T2D cases are estimated to be underdiagnosed in France.78 This probably resulted in a loss of statistical power.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Limitations
What the sources say
- Not checked yetcites [78]
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In particular, the exposure to bisphenol-A (BPA), a hydrophobic substance of very high concern, 66 having endocrine disrupting properties, as well as high BPA serum concentrations, have been associated with increased T2D risk in recent meta-analyses.29,67”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Discussion
What the sources say
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Overall, UPF usually have a lower nutritional quality 35 because they are on average richer in sodium, energy, fat, sugar, and poorer in fiber [12][13][14][15][16][17][18][19][20]25 and often exhibit a higher glycemic index.61”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Discussion
What the sources say
- Not checked yetcites [35]
- Not checked yetcites [12][13][14][15][16][17][18][19][20]25
- Not checked yetcites [61] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Fourth, the ultraprocessed category covers diverse products; this exploratory approach was not designed to focus on a specific food category or to isolate a particular process/additive.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“It was approved by the relevant institutional review boards (Inserm and Cnil).Participants provided electronic informed consent.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Study Population and Data Collection
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“To our knowledge, although UPF consumption was previously found to be associated with increased risks of cancer, 31 cardiovascular diseases, 35 mortality, 32,36 depressive symptoms, 33,37 and metabolic disorders (obesity, 40 hypertension, 41 and dyslipidemia 39 ), no prior prospective epidemiological study had evaluated their association with T2D risk.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Discussion
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The Cox model assumptions were verified (eFigures 2 and 3 in the Supplement).”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Statistical Analyses
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Second, causation could not be established from this single observational study and residual confounding cannot be entirely ruled out.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Limitations
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Consistently, in a 1-month randomized clinical trial, 63 an ultraprocessed diet vs an unprocessed one led to an increased energy intake, which was highly correlated with weight gain.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Discussion
What the sources say
- Not checked yetcites [63] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Finally, compared with the general French population, participants to this study were younger, more often women, with higher educational levels 80 and healthier dietary habits.81 This might have underestimated the associations owing to a narrower range of UPF intake.”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Limitations
What the sources say
- Not checked yetcites [80]
- Not checked yetcites [81]
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Moreover, 2 meta-analyses observed associations between T2D risk and the intakes of nonnutritive sweeteners and artificially sweetened beverages.28,66”
§ Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort > Discussion
What the sources say
- Not checked yetcites [28]
- Not checked yetcites [66] source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
No prior large-scale prospective study had evaluated the association between UPF consumption and T2D risk before this study.
“However, no such large-scale prospective study has been conducted regarding T2D.”
“no prior prospective epidemiological study had evaluated their association with T2D risk.”
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“The level of processing per se as an independent risk factor, comes from a randomised controlled trial finding that an ultra-processed diet relative to an unprocessed one causes excessive calorie intake and weight gain 57 , and three cohort studies showing an association between UPF consumption and weight gain, obesity, type-2 diabetes or hypertension risk, which remains significant after”
From Ultra‐processed foods and the nutrition transition: global, regional and national trends, food systems transformations and political economy drivers (2020) · cites this paper as [40]
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“Studies show that the consumption of UPF is also associated with the emergence of non-communicable diseases and conditions such as obesity and cardiometabolic events (2,5 – 7) .”
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“Evidence demonstrates that high UPF intake is associated with an increased risk of weight gain [12,13], type 2 diabetes mellitus (T2DM) [14], cardiovascular disease [15], all types of cancer [16], and all-cause mortality [17–19].”
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“27 Although most of the previous research involved observational studies, some randomized controlled trials researched UPFs and health outcomes.”
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“Notably, findings from a French prospective study reveal that high ultra-processed foods consumption is linked to a 12% higher risk of CVDs [29] and a 15% higher risk of diabetes after 5–6 years [30].”
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Self-citationUltra-Processed Foods and Type 2 Diabetes Mellitus: What Is the Evidence So Far?
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“Snour et al. were the fi rst to explore the association between UPF consumption and the risk of T2DM [12]. the risk of T2DM [12].”
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Baraldi, L. G., Steele, E. M., Louzada, M. L. D. C., & Monteiro, C. A. (2021) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2021.02.011 · Cited by 17
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“general recommendation is to avoid or restrict the consumption of UPF [62] since several studies have reported that their consumption is related to health alterations, including obesity and overweight development [63], diabetes mellitus [64], dyslipidemia [65], metabolic syndrome, heart disease, hypertension, and canc…”
BackgroundHosseinpour‐Niazi, S., Malmir, H., Mirmiran, P., Shabani, M., Hasheminia, M., & Azizi, F. (2024) · Nutrition & Metabolism · doi:10.1186/s12986-024-00831-x · Cited by 12
“…cholesterol, fiber, fruit, and vegetable intake most studies, the association between UPF and MetS, as well as its components such as type 2 diabetes and hypertension, has been adjusted for fruit and vegetable consumption as a confounding factor [10, 17, 18], although not in all of them [9, 19–21].”
BackgroundResultThe Gift of Data: Industry-Led Food Reformulation and the Obesity Crisis in Europe
Campbell, N., Browne, S., Claudy, M., Mialon, M., Herçberg, S., Goiana-da-Silva, F., & Finucane, F. M. (2020) · Journal of Public Policy & Marketing · doi:10.1177/0743915620983842 · Cited by 13
“Highest on this list of systemic drivers is commercial influence on the public policy process (Swinburn et al. 2019).”
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“[46] demonstrate through clinical trials that greater consumption of ultra-processed foods are associated with higher risk of Type 2 diabetes.”
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“Type 2 diabetes (T2D) affected 425 million people worldwide in 2017, and it is estimated to affect 629 million people by 2045 (1).”
BackgroundRodrigues, L. S., da Silva, J. A. R., da Silva, W. C., da Silva, É. B. R., Belo, T. S., Sousa, C. E. L., Rodrigues, T. C. G. D. C., Silva, A. G. M. E., Prates, J. A. M., & Júnior, J. D. B. L. (2024) · Animals · doi:10.3390/ani14111618 · Cited by 12
“As a result, a dedication to improving production systems and animal husbandry practices can help to strengthen the nutritional quality and overall sustainability of food derived from water buffaloes, making them important contributors to the future of varied and nutritious food supplies.”
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“In terms of type 2 diabetes (T2D) risk, prospective studies from western countries consistently demonstrated a positive association between UPF and T2D occurrence [11–15].”
BackgroundUltra-Processed Foods and the Impact on Cardiometabolic Health: The Role of Diet Quality
Wang, X., & Sun, Q. (2024) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2024.0659 · Cited by 22
Juul, F., Lin, Y., Deierlein, A. L., Vaidean, G. D., & Parekh, N. (2021) · British Journal Of Nutrition · doi:10.1017/s000711452100060x · Cited by 16
“multiple chronic conditions including obesity, type 2 diabetes, hypertension, cardiovascular disease (CVD) and cancer (5-9) .”
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“However, this is not incompatible with the fact that some of these additives could contribute to explaining part of the association between ultra-processed foods and elevated risk of type 2 diabetes 31,32 .”
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“Obesity, weight gain [72–74], and UPF consumption are risk factors for type 2 diabetes [30], affecting over 30 million people in the US, with approximately 98 million suffering from prediabetes [75].”
BackgroundFood policies: balancing health and market in the era of ubiquitous ultra-processed foods
Ferretti, F. F., & Malorgio, G. (2024) · Agricultural and Food Economics · doi:10.1186/s40100-024-00329-3 · Cited by 10
“…the risk of developing one or more non-communicable diseases (NCDs), primarily cardiovascular diseases (such as heart attacks and stroke), type 2 diabetes, chronic kidney and liver diseases, certain types of cancers, and even common mental health disorders (Srour et al. 2020; Cordova et al. 2023).”
Ultra-processed foods and type 2 diabetes: more fundamental research is needed
Janssen, J. A. M. J. L. (2024) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2024.101084 · Cited by 10
“8 However, for most additives present in our food, human data on long-term health impacts are still lacking.”
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“Meanwhile, an increasing number of observational studies have previously suggested that ultra-processed foods contribute to increasing the risk of hypertension [41], type 2 diabetes [42], and cardiovascular diseases [33].”
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“UPFs consumption has been linked to an increased risk of developing obesity [13–17] and type-2 diabetes [18].”
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“Higher intake of ultra-processed foods is associated with a concomitant decrease in disease-preventing vegetable intake [26,45] and increased risk of wheezing or asthma in teens [46,47], depression [48,49], mortality [50–53] and chronic diet-related diseases such as metabolic syndrome [54–57], obesity [23,58–62], type…”
BackgroundAssociation of Ultra-Processed Food Consumption With Risk of Dementia: A Prospective Cohort StudyPreprint
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Pemmican, an endurance food: Past and present
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“Similarly, reducing ultra processed foods may give benefits beyond weight reduction, and also reduce the incidence of diabetes [81, 82].”
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Brewerton, T. D., Dennis, K., & Wiss, D. A. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01017-9 · Cited by 11
“UPFs have been shown to promote binge eating [67, 68] and higher body weights [69–72], as well as worsen depression [73–77], type-2 diabetes [78, 79], cardiovascular disease [80–84], and chronic kidney disease [85].”
BackgroundLane, M. M., Lotfaliany, M., Machado, P. P., Jacka, F. N., Mohebbi, M., O'Neil, A. E., Werneck, A. O., Monteiro, C. A., Loughman, A., Rocks, T., et al. (2023) · Preprints.org · doi:10.20944/preprints202308.1110.v1 · Cited by 8
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“However, observational studies have shown an association between UPF consumption and overweight, obesity, or metabolic disorders [6,24,25].”
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“Type 2 diabetes mellitus is associated with a diet that is rich in sweets, soft drinks, snacks, nuggets, and other ultra-processed foods [7]; hypertension has a strong connection with salt intake [9]; and cardiovascular diseases have strong connections with fatty foods.”
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“However, the complexity of ML algorithms often hampers their understandability, posing challenges to medical decision-making [38].”
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“…associated with various non-communicable diseases (Cordova et al., 2023; Lane et al., 2024), such as type 2 diabetes (Llavero-Valero et al., 2021; Srour et al., 2020), cardiovascular disease (Bonaccio et al., 2021; Srour et al., 2019), hypertension (Jardim et al., 2021; Prescott et al., 2024;…”
Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus
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Investigation of direct and indirect association of ultra‐processed food intake and periodontitis
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What should we advise MAFLD patients to eat and drink?
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Relationship Between Dietary Self-Efficacy and Religiosity Among Seventh-Day Adventists in Peru
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Processed Foods – Getting Back to The Basics
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Classification and identification of risk factors for type 2 diabetes
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“However, the complexity of ML algorithms often limits their interpretability, making it challenging to apply them effectively in medical decision-making 35 .”
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Ultra-Processed Foods and Cardiometabolic Health: A Review of Current Evidence
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“However, every 10% increase in UPF consumption has been found to increase T2DM by %15 (OR: 1.15; 95% CI: 1.06–1.25) [ 165 ].”
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“Overnutrition is recognized as a main driver of the chronic metabolic inflammation associated with the development of obesity and related metabolic disorders [3,5,8,51,52].”
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Self-citationA study on the consumer behavior and attitude toward low-sodium convenience store foods
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Cenário e perspectivas do sistema alimentar brasileiro frente à pandemia de Covid-19
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Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus
Fuster, V. P., Pérez, A., Carretero‐Gómez, J., Caixàs, A., Gómez‐Huelgas, R., & Pérez‐Martínez, P. (2021) · Endocrinología Diabetes y Nutrición (English ed ) · doi:10.1016/j.endien.2020.10.008 · Cited by 10
The impact of food addiction behaviours on the treatment of overweight students
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“These chronic diseases include diabetes, hypertension, and cancer (11,12,13) .”
BackgroundNutritional recommendations in the prevention and treatment of atherogenic dyslipidemia
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The degree of food processing contributes to sugar intakes in families with preschool-aged children
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Newest Updates to Health Providers on the Hazards of Ultra-Processed Foods and Proposed Solutions
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Ultra‐Processed food intake and risk of Helicobacter pylori infection: A case–control study
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“…relationship between UPFs consumption and irritable bowel syndrome and dyspepsia (Schnabel et al., 2018), weight gain (Hall et al., 2019), cardiovascular disease (Srour et al., 2019), type 2 diabetes mellitus (Srour et al., 2020), and inflammatory diseases (Srour et al., 2022) has been reported.”
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Differential association of dietary scores with the risk of type 2 diabetes by metabotype
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“Extensive studies have demonstrated the role of UPF in promoting the development of T2DM [ 14 , 15, 53–56]; however, they largely overlooked individual factors such as genetics and metabolism, which led to a one-size-fits-all approach in dietary guidelines.”
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Association of ultra-processed foods consumption with increased liver steatosis in U.S. adults
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Padrões alimentares e doenças crônicas em inquérito com adultos na Amazônia
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Tendencias en el consumo de alimentos ultra procesados y salud pública: Un estudio cienciométrico
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Health risk factors among adult individuals with and without diabetes in Brazil: Vigitel (2020–2023)
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Fuster, V. P., Pérez, A., Carretero‐Gómez, J., Caixàs, A., Gómez‐Huelgas, R., & Pérez‐Martínez, P. (2021) · Endocrinología Diabetes y Nutrición · doi:10.1016/j.endinu.2020.10.009 · Cited by 7
Metadata
- Authors
- Srour, B., Fezeu, L. K., Kesse-Guyot, E., Allès, B., Debras, C., Druesne-Pecollo, N., Chazelas, E., Deschasaux, M., Hercberg, S., Galan, P., Monteiro, C. A., Julia, C., & Touvier, M.
- Affiliations
- Inserm (FR)
- Paris 13 University, Inserm, Inra, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center–University of Paris (CRESS), 93017 Bobigny, France
- Universidade de São Paulo (BR)
- Corresponding author
- Srour, Bernard
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2020-02-01
- Volume
- 180
- Issue
- 2
- Pages
- 283
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC6990737
- OpenAlex
- W2995681102
- Semantic Scholar
- c2346ec140c10417145d08b337da652a351745b0
- Cited by
- 465
- References
- 89
- Citations by year
- 2026: 45 · 2025: 69 · 2024: 80 · 2023: 53 · 2022: 85 · 2021: 96 · 2020: 34
- FWCI
- 49.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Consumer Attitudes and Food Labeling
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Keywords
- ultra-processed foods, type 2 diabetes, NOVA classification, diabetes risk, NutriNet-Santé cohort, diet quality, weight change, metabolic comorbidities, cancer
- MeSH terms
- Adult, Diabetes Mellitus, Type 2, Diet, Female, Food Handling, France, Humans, Male, Middle Aged, Prospective Studies, Cohort Studies, Proportional Hazards Models
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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