Background
Nutritional strategies for prevention and management of type 2 diabetes traditionally emphasize dietary patterns reflecting nutrient goals, but the health implications of ultra-processed food (UPF) for patients with type 2 diabetes remain unknown.
Objective
To evaluate the association of UPF intake with all-cause and cardiovascular disease (CVD) mortality amongst participants with type 2 diabetes from the Moli-sani Study in Italy (enrolment 2005-2010).
Design
This was a prospective observational cohort study on 1,065 individuals with type 2 diabetes at baseline, followed up for 11.6 y (median). Food intake was assessed by a 188-item FFQ. UPF was defined following the Nova classification and calculated as the ratio (weight ratio; %) between UPF (g/d) and total food eaten (g/d). Overall diet quality was assessed through the Mediterranean Diet Score (MDS). Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality.
Results
The average UPF consumption was 7.4% (±5.0%). In multivariable-adjusted COX analyses, greater UPF intake (Q4, ≥10.5% and ≥9% of total food eaten for females and males, respectively), as opposed to the lowest (Q1, UPF<4.7% and <3.7% for females and males, respectively), was associated with higher hazards of both all-cause (Hazard ratio (HR)=1.70; 95%CI 1.25-2.33) and CVD mortality (HR=2.64; 1.59-4.40); inclusion of the MDS into the model did not substantially alter the magnitude of these associations (HR=1.64; 1.19-2.25 and HR=2.55; 1.53-4.24, for all-cause and CVD mortality, respectively). A linear dose-response relationship of UPF intake with both all-cause and CVD mortality was also observed.
Conclusions
In participants with type 2 diabetes at study entry, higher UPF consumption was associated with reduced survival and higher CVD mortality rate, independent of diet quality. Besides prioritizing the adoption of a diet based on nutritional requirements, dietary guidelines for the management of type 2 diabetes should also recommend limiting UPF.
https://ajcn.nutrition.org/article/S0002-9165(23)66025-3/fulltext
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