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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Claims the paper makes
32 Own result · 14 Not checked yet · 7 Own method · 4 Own interpretation
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
plaincorrelationaln = 821 ·- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
- 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
plainn = 821- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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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
“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
plaincorrelationaln = 821- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- 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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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 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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- 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
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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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
“| 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
plaindirect- Asserted: passes — The authors put it forward as true.
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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
“| 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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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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
“| 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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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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
“| 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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- 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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It 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
plainn = 821- Asserted: passes — The authors put it forward as true.
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It 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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It 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
plaincorrelationaln = 707- Asserted: passes — The authors put it forward as true.
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It 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
plainn = 707- Asserted: passes — The authors put it forward as true.
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Probably 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
plainn = 707- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It 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
plaincorrelationaln = 707- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It 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]
plainn = 186- Asserted: passes — The authors put it forward as true.
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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]
hedgedn = 20- Asserted: passes — The authors put it forward as true.
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It 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
plain- Asserted: passes — The authors put it forward as true.
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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]
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably 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
plain- Asserted: passes — The authors put it forward as true.
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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
hedged- Asserted: passes — The authors put it forward as true.
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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
hedged- Asserted: passes — The authors put it forward as true.
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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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably 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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably 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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably 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
plain- Asserted: passes — The authors put it forward as true.
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Probably 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]
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It 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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably 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
plaindirect- Asserted: passes — The authors put it forward as true.
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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
plain- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
Probably 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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably 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
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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
“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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably 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
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It 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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It 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]
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It 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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably 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.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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]
Citations
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Cited by
Sorted by citations
Items 301–400 of 458
Whyte, K., Contento, I. R., Wolf, R. L., Guerra, L. A., Martinez, E., Pi-Sunyer, X., & Gallagher, D. (2022) · PubMed Central · doi:10.34763/jmotherandchild.20212504.d-21-00025 · Cited by 6
Silva, F. M., Giatti, L., da Fonseca, M. D. J. M., Brant, L. C. C., Diniz, M. D. F. H. S., Molina, M. D. C. B., Matos, S. M. A., Vigo, Á., & Barreto, S. M. (2023) · International Journal of Food Sciences and Nutrition · doi:10.1080/09637486.2023.2267797 · Cited by 7
“…shown the association of UPF with cardiometabolic risk factors and the incidence of some specific NCDs, such as CVD (Srour et al. 2019), diabetes (Srour et al. 2020), and hypertension (Mendonça et al. 2017; Scaranni et al. 2021), indicating the biological plausibility of the association with NCD…”
BackgroundMethodInfluentialMendoza-Herrera, K., Barquera, S., & Tobias, D. K. (2025) · Diabetologia · doi:10.1007/s00125-025-06358-x · Cited by 4
“In addition, these results were not explained by overall diet quality and intakes of sugar, sodium, saturated fat or other nutrients [34].”
InfluentialThe battle over “food addiction”
Lustig, R. H. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1621742 · Cited by 4
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“These approaches are associated with improved metabolic regulation and lower inflammatory markers in observational studies and dietary intervention trials [118,119].”
Ultra-processed foods, lifestyle management, and cardiovascular diseases
Guasti, L., Bonaccio, M., Abreu, A., Asteggiano, R., Bes‐Rastrollo, M., Christodorescu, R., de Gaetano, G., Ferrini, M., Marques-Vidal, P. M., Pathak, A., et al. (2026) · European Heart Journal · doi:10.1093/eurheartj/ehag226 · Cited by 5
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Koop, J., Fedde, S., Hägele, F. A., Beunink, C., Müller, M. J., & Bosy‐Westphal, A. (2024) · Public Health Nutrition · doi:10.1017/s1368980024001836 · Cited by 4
“24) in HP ( Nutritional value and health impacts of high-protein ultra-processed foods The lower sugar and saturated fat content of HP compared to NP UPF might contribute to a lower UPF-associated risk for non-alcoholic fatty liver disease (12) , type 2 diabetes (25) and CVD (26) .”
O’Connell, C. P., Hong, H. G., Abar, L., Khandpur, N., Steele, E. M., Liao, L. M., Sinha, R., Trabert, B. L., & Loftfield, E. (2025) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2025.05.024 · Cited by 5
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Self-citationAncka-Iglesias, C. V., Flores-Albino, Y. A., Calizaya-Milla, Y. E., & Saintila, J. (2022) · Nutrición clínica y dietética hospitalaria/Nutrición clínica, dietética hospitalaria · doi:10.12873/421ancka · Cited by 5
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Nutritional Determinants of Type 2 Diabetes Mellitus in the European Union: A Systematic Review
Díaz-Benavides, D. A., Muhlis, A. N. A., Chamouni, G., Charles, R., Nigatu, D. T., Khadra, J. B., Israel, F. E. A., Shehab, B., Tarek, G. L., Sharshekeeva, A., et al. (2025) · Nutrients · doi:10.3390/nu17223507 · Cited by 5
“A broad consensus indicates that higher intake of these foods is associated with higher risk [46,47,77,78].”
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“From a dietary-processing perspective, such patterns may influence glycemic regulation through characteristics including high glycemic load, low fiber content, reduced satiety, and food additives that may affect gut and metabolic pathways [47,48].”
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“This convergence positions HPA–HPG crosstalk as a mechanistic bridge through which sleep loss and UPF-related stress signaling directly constrain testosterone synthesis. induce insulin resistance and significantly increase the risk of developing T2DM [103, 104].”
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Can differentiated value-added tax rates promote healthier diets? The case of Costa Rica
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Self-citationFuster, V. P., Pérez, A., Carretero‐Gómez, J., Caixàs, A., Gómez‐Huelgas, R., & Pérez‐Martínez, P. (2021) · Clínica e Investigación en Arteriosclerosis · doi:10.1016/j.arteri.2020.11.005 · Cited by 5
Estresse no Trabalho e Associação ao Consumo de Ultraprocessados por Servidores Universitários
Farias, B. D. O., Cavalcante, A. C. M., Sampaio, R. M. M., Teixeira, M. Y. P., Sampaio, H. A. D. C., & Machado, S. P. (2021) · Revista Psicologia Organizações e Trabalho · doi:10.5935/rpot/2021.3.20828 · Cited by 4
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Online food delivery systems: barriers to achieving public health nutrition in the Philippines
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“The consumption of ultra-processed foods has been associated in recent prospective studies with increased risks of all-cause mortality and chronic diseases such as cancer, CVD, hypertension and dyslipidemia(5).”
BackgroundRodrigues, L. S., da Silva, J. A. R., Júnior, J. D. B. L., Silva, A. G. M. E., Rodrigues, T. C. G. D. C., da Silva, W. C., da Silva, T. C., de Castro, V. C. G., Alfaia, C. M., de Almeida, A. M., et al. (2023) · Animals · doi:10.3390/ani13243785 · Cited by 3
“PUFA have been listed as agents for the prevention and treatment of chronic neurological diseases, cancer, inflammatory diseases, obesity and diabetes mellitus [54–56].”
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da Silva, B. F., Neta, A. D. C. P. D. A., Rodrigues, R. E. D. A., de Araújo, J. M., Moreira, P. V. L., Ferreira, F. E. L. D. L., Vianna, R. P. D. T., Neto, J. M. D. S., Carli, E. D., & de Lima, R. L. F. C. (2024) · Scientific Reports · doi:10.1038/s41598-024-59991-8 · Cited by 3
Hochverarbeitete Lebensmittel und ihre Bedeutung für die Genese ernährungsmitbedingter Erkrankungen
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“[19] Srour B, Fezeu LK, Kesse-Guyot E et al.”
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“The NutriNet-Sant´e cohort also found an association between higher UPF consumption and an increased risk of cardiovascular disease [30], cancers [50], T2D [34], all-cause mortality [29], overweight and obesity [28].”
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“The transition from traditional to modern lifestyles over the past century has also been accompanied by decreased daily physical activity, which is, in itself, a risk factor for the development of obesity and prediabetes [7].”
Bauer, J., Ayala, F. O., Marcadenti, A., Machado, R. H. V., Bersch-Ferreira, Â. C., Moreira, M. F. S., Beretta, M. V., Feóli, A. M. P., & Busnello, F. M. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22081275 · Cited by 3
“However, there is growing evidence indicating that the consumption of UPF is associated with various negative outcomes, including T2DM [13,38,39].”
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Ultra-processed food intake is associated with low diet quality in young adult college students
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“…to previous studies higher UPF intake was associated with a lower intake of healthy food items and nutrients including fruits and vegetables, 33,66 dietary fiber, and protein, 45,67 and higher intake of less healthy items like processed meats, 35 saturated and trans fats, 20,68 sodium,…”
Mendoza-Herrera, K., Monge‐Rojas, R., Vargas-Quesada, R., & Mattei, J. (2025) · Nutrition Research · doi:10.1016/j.nutres.2025.02.002 · Cited by 2
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“High-calorie diets rich in processed foods and sugary beverages exacerbate insulin resistance and dyslipidemia, both of which accelerate the onset of T2DM [11].”
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Ultra-Processed: The Search of Positioning From the Food Industry Regulatory Authorities
Rego, R. A. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.906561 · Cited by 2
“Since then, there has been a crescent trend (27) in the development of scientific studies seeking to prove this affirmation, which was successively relating several industrialized food categories to low-quality diets (28), obesity, excessive calorie consumption and weight gain (29–31), diabetes type 2 (32, 33), heart…”
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Ultra-processed foods and colorectal neoplasia: is there a link?
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Self-citationImpact of Technology on Daily Food Habits and Their Effects on Health
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“In the French NutriNet-Santé cohort, 5 which included individuals over 18 years of age from all weight classes, high UPF consumption was associated with an increased risk of type 2 diabetes.”
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“Furthermore, high UPF consumption was associated with an increased risk of diabetes [13, 15–17], cardiovascular disease [18, 19], cancer risk and cancer mortality [20], and all-cause mortality [21–23].”
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“Over the past decade, scientific interests and public awareness of the relationship between food consumption and human health, as well as food consumption and the environment have risen substantially [16,38,40,41].”
Ultra processed food consumption and nutrients adequacy among cancer survivors in Lebanon
Helou, R. E., Srour, B., Hadla, R., Azar, R. N., Mahfoud, Z. R., Touvier, M., Temraz, S. N., & Jabbour, J. (2026) · BMC Public Health · doi:10.1186/s12889-026-26547-6 · Cited by 1
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“These ambiguities cause misclassification errors that bias results toward no effect and can lead to differential errors if linked to health status, brand use, or cultural food preferences [15,25–27].”
InfluentialFridén, M., Mai, M., Olsen, A., Dahm, C. C., & Ibsen, D. B. (2026) · BMC Medicine · doi:10.1186/s12916-026-05028-y · Cited by 4
“Risk of bias in the outcome was scored with some concern in the studies by Srour 2020 [32] and Moslehi 2024 [34].”
InfluentialEffect of Ultra Processed Foods on Cancer Risk and Strategies for Risk Mitigation
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“UPFs are also associated with insulin resistance and type 2 diabetes [ 13 , 32 ] which are associated with multiple cancers, including liver, pancreatic, and endometrial [ 33 ].”
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“Therefore, the increased consumption of UPFs also has a negative impact on health and is associated with obesity [9], type 2 diabetes [10], cardiovascular diseases [11], cancer [12], and an increase in the risk of all-cause mortality [13,14].”
Fuster, V. P., Pérez, A., Carretero‐Gómez, J., Caixàs, A., Gómez‐Huelgas, R., & Pérez‐Martínez, P. (2020) · Revista Clínica Española · doi:10.1016/j.rce.2020.10.009 · Cited by 1
Interactions of Food With the Microbiota of the Digestive Tract
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Un système alimentaire pour la santé, la planète et la sécurité alimentaire : c’est possible !
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Advancing Indonesia's Rice Industry: Embracing Tayyib Principles Beyond Halal
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Risk Factors for Type II Diabetes: The Role of Ultra-processed Foods
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Approachable ways to educate patients about reducing environmental health risks
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Kalorienreduktion ist ein Gesundheitsplus, aber wie und welche?
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Les aliments ultratransformés, un concept utile, mais mal utilisé
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Andrade, G. C. (2021) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/t.5.2021.tde-08092021-104715
Optimizing Diet in Patients with Diabetes
Shah, M. (2021) · Wiley eBooks · doi:10.1002/9781119603207.ch10
Вырожденные задачи синтеза систем управления линейными дискретными объектами
Львович, Б. А. (2009) · Проблемы управления
Lacombe, J., Guo, K., Bonneau, J., Faubert, D., Gioanni, F., Vivoli, A., Muir, S. M., Hezzaz, S., Poitout, V., & Ferron, M. (2022) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2022.05.13.491370
“rich but nutrient-poor food is one possible contributor to the current T2D pandemic (Srour et al., 2020).”
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“All food items were classified according to the NOVA classification (6,28) as previously extensively described (29).”
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“The consumption of processed, especially ultra-processed food and drinks, is an emerging topic in nutrition science and has recently been associated with numerous adverse health outcomes, including cardiovascular disease [32, 34], cancer [16], and metabolic disorders [31, 33].”
BackgroundMetabolism disrupting chemicals in the development of human diseases
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EFEITO DA OFICINA DE CULINÁRIA SOBRE A ACEITAÇÃO DE PRODUTOS ALIMENTÍCIOS ADICIONADOS DE BETERRABA
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An Analysis of Foods Promoted in Bronx Supermarket Circulars Based on the Degree of Processing
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“7,8 Given the association of UPFs with health outcomes, researchers have attempted to delineate the relationship between the extent and severity of food processing on health outcomes.”
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Entre existir e resistir: experiências de consumo de travestis e mulheres trans
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Interesterified Palm Oil Leads to Slight Variation in Intestinal Microbiota Of MicePreprint
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Interesterified palm oil leads to distinct variation in the intestinal microbiota of mice
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Auf der Überholspur zu Diabetes durch stark verarbeitete Lebensmittel
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“Ähnliche Ergebnisse wurden auch in aktuellen europäischen Studien festge-stellt,darunterderfranzösischenNutriNet-Kohorte, die trotz kürzerem Follow-up die Assoziation auch nach BMI-Korrektur be-stätigte [3, 6, 8].”
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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
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