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Cited by 259

The DOI matches its Crossref record; 11 of the 11 references it cites were found in a registry or an index.

Ultra-Processed Food Consumption and Risk of Type 2 Diabetes: Three Large Prospective U.S. Cohort Studies

Chen, Zhangling, Khandpur, Neha, Desjardins, Clémence, Wang, Lu, Monteiro, Carlos A., Rossato, Sinara L., Fung, Teresa T., Manson, JoAnn E., Willett, Walter C., Rimm, Eric B., Hu, Frank B., Sun, Qi, Drouin-Chartier, Jean-Philippe·2023·Diabetes Care
DOI 10.2337/dc22-1993

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Abstract

OBJECTIVE: We examined the relationship between ultra-processed food (UPF) intake and type 2 diabetes (T2D) risk among 3 large U.S. cohorts, conducted a meta-analysis of prospective cohort studies, and assessed meta-evidence quality. RESEARCH DESIGN AND METHODS: We included 71,871 women from the Nurses’ Health Study, 87,918 women from the Nurses’ Health Study II, and 38,847 men from the Health Professional Follow-Up Study. Diet was assessed using food frequency questionnaires and UPF was categorized per the NOVA classification. Associations of total and subgroups of UPF with T2D were assessed using Cox proportional hazards models. We subsequently conducted a meta-analysis of prospective cohort studies on total UPF and T2D risk, and assessed meta-evidence quality using the NutriGrade scoring system. RESULTS: Among the U.S. cohorts (5,187,678 person-years; n = 19,503 T2D cases), the hazard ratio for T2D comparing extreme quintiles of total UPF intake (percentage of grams per day) was 1.46 (95% CI 1.39–1.54). Among subgroups, refined breads; sauces, spreads, and condiments; artificially and sugar-sweetened beverages; animal-based products; and ready-to-eat mixed dishes were associated with higher T2D risk. Cereals; dark and whole-grain breads; packaged sweet and savory snacks; fruit-based products; and yogurt and dairy-based desserts were associated with lower T2D risk. In the meta-analysis (n = 415,554 participants; n = 21,932 T2D cases), each 10% increment in total UPF was associated with a 12% (95% CI 10%–13%) higher risk. Per NutriGrade, high-quality evidence supports this relationship. CONCLUSIONS: High-quality meta-evidence shows that total UPF consumption is associated with higher T2D risk. However, some UPF subgroups were associated with lower risk in the U.S. cohorts.

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Crossref · 10.2337/dc22-1993

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  • Combined analysis of seven cohorts showed a direct non-dose-response association between greater ultra-processed food exposure and higher risk of incident type 2 diabetes (odds ratio 1.40, 95% confidence interval 1.23 to 1.59; credibility class II; GRADE very low).

    “non-dose-response odds ratio 1.40, 1.23 to 1.59; class II; very low”

    From Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses (2024) · cites this paper as [47]

  • Combined analysis of seven cohorts showed a direct dose-response association between greater ultra-processed food exposure and higher risk of incident type 2 diabetes (risk ratio 1.12, 95% confidence interval 1.11 to 1.13; credibility class I; GRADE moderate).

    “The combined analysis of seven cohorts showed direct associations between greater exposure to ultra-processed foods and higher risk of incident type 2 diabetes (dose-response risk ratio 1.12, 1.11 to 1.13; class I; moderate”

    From Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses (2024) · cites this paper as [47]

  • While certain subcategories of ultra-processed foods further showed higher risk, others were inversely associated, such as ultra-processed cereals, dark/wholegrain bread, packaged sweet and savoury snacks, fruit based products and yoghurt, and dairy based desserts.

    “while certain subcategories of ultra-processed foods further showed higher risk, others were inversely associated, such as ultra-processed cereals, dark/wholegrain bread, packaged sweet and savoury snacks, fruit based products and yoghurt, and dairy based desserts.”

    From Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses (2024) · cites this paper as [47]

  • A meta-analysis by Chen and colleagues (2023), included in the review, established a clear link between overall consumption of ultra-processed foods and a higher risk of type 2 diabetes, consistently observed across multiple cohorts.

    “A meta-analysis by Chen and colleagues (2023), included in our review, established a clear link between overall consumption of ultra-processed foods and a higher risk of type 2 diabetes, consistently observed across multiple cohorts.”

    From Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses (2024) · cites this paper as [47]

  • These methodological challenges are all liable to compromise the validity and precision of estimates.

    “These challenges are all liable to compromise the validity and precision of estimates.220,221”

    From Ultra-processed foods and human health: the main thesis and the evidence (2025) · cites this paper as [221]

Citations

Cites

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Research works printed but not linked: 26

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Metadata

Authors
Chen, Z., Khandpur, N., Desjardins, C., Wang, L., Monteiro, C. A., Rossato, S. L., Fung, T. T., Manson, J. E., Willett, W. C., Rimm, E. B., Hu, F. B., Sun, Q., & Drouin-Chartier, J.-P.
Affiliations
  • 1Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
  • 5Centre Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Québec, Canada
  • 7Friedman School of Nutrition Science and Policy, Boston, MA
  • 3Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
  • 10Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2023-02-28
Volume
46
Issue
7
Pages
1335-1344
ISSN
  • 0149-5992
  • 1935-5548
DOI
10.2337/dc22-1993
Cited by
259
References
11
Language
en
Licence
www.diabetesjournals.org/journals/pages/license (vor)
Funders
  • Fonds de Recherche du Québec - Santé
  • NIH

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