“Let things taste the way they are.”
― Alice Waters, chef, author, and owner of Chez Panisse
We’ve all seen the images: overweight kids addicted to video games 24/7, chubby teenagers glued to their cell phones and walking into lampposts, and adults lost for days in the virtual rabbit holes of their computer screens. Invariably, these images are populated in the background by ever-present neon-colored snacks, greasy fast food wrappers, and soft drink containers the size of small water towers.
This 1-2 combination of inactivity and ultra-processed food (over) consumption has become an indelible watermark on our 21st-century lifestyle. This circumstantial evidence implicating ultra-processed foods (UPFs) as a risk factor in the continuing explosion of chronic disability and disease in the United States and many other Westernized countries continues to mount.
This week’s study spotlight is the fourth US prospective cohort study to take a closer look at the link between ultra-processed food consumption and the risk of developing type II diabetes in the United States. Diabetes is a leading cause of death and disability worldwide, and dietary intake is a key modifiable risk factor for diabetes. The question is whether an increased consumption of ultra-processed food is associated with an increased risk of developing type II diabetes.
- The review examined the data from the Atherosclerosis Risk in Communities (ARIC) study.
- The cohort consisted of 13,172 participants without diabetes at baseline, and the median follow-up was 21 years.
- Dietary intake was assessed with a 66-item semiquantitative food frequency questionnaire, and food was categorized using the NOVA classification system.
- The participants were divided into quartiles based on the average servings of ultra-processed food per day.
- The highest quartile consumed 8.4 servings of ultra-processed food per day, on average, and had a 13% increased risk of developing diabetes compared to the lowest quartile of ultra-processed food consumers.
- Each serving of ultra-processed food was associated with a 2% higher risk of developing diabetes.
- Specific groups of ultra-processed foods such as sugar and artificially sweetened beverages, ultra-processed meats, and sugary snacks were associated with the highest risk of developing diabetes at 29%, 21%, and 16%, respectively, versus the lowest quartile of consumers.
The Caveat:
This study is the fourth prospective cohort study to demonstrate an association between the amount of ultra-processed food consumed and the risk of developing type II diabetes in Americans. In addition to diabetes, high consumption of ultra-processed foods is linked to obesity, metabolic syndrome (prediabetes), and cardiovascular disease, all of which are intricately linked to the pro-inflammatory pathophysiology of type II diabetes. Despite these and many other warning signs, the issue of UPFs is still not addressed in the current US Diabetes Standards of Care Guidelines.[1] Considering that for the average American adult, UPFs constitute almost 70% of their diet, this has the potential to be a serious and consequential omission.
This is because the flipside of the findings is that a reduced risk of developing type II diabetes was associated with increased consumption of whole, authentic, and minimally processed foods, raising the question of whether dietary changes can impact the natural history of type II diabetes. This particular study demonstrated a dose-response relationship (the hallmark of many a drug) with approximately a 2% increased risk of developing type II diabetes associated with each serving of ultra-processed food. Importantly, this analysis demonstrated that there is no “safe minimum or threshold.” Every serving of ultra-processed foods, according to this study, correlated to an increased risk.
Interestingly, there did, however, seem to be a difference in the magnitude of risk associated with certain groups of ultra-processed foods. Specifically, sugar and artificially sweetened beverages, ultra-processed meats, and sugary snacks were particularly associated with an increased risk of developing type II diabetes. This is in agreement with previous US-based studies, which also reported a higher risk of diabetes associated with sugar and artificially sweetened beverages and ultra-processed meat products.[2] The findings are in general agreement with European-based studies, which have shown anywhere from “a 15-55% increased risk of diabetes associated with greater ultra-processed food consumption.”[3],[4],[5]
Unsurprisingly, higher consumption of UPFs correlated with the consumption of less fruits, vegetables, and fiber. In general, diet is a zero-sum game. Eating more of one particular type of food, in this case UPFs, generally results in the consumption of less of other types of foods: a phenomenon known as displacement. The caveat here, as in all observational studies, is to remember that correlation does not equal causation. With that being said, as Bertrand Russell noted, “Facts have to be discovered by observation, not by reasoning.”
[1] (American Diabetes Association Professional Practice Committee, 2024)
[2] (Chen, 2023)
[3] (Levy, 2021)
[4] (Llavero-Valero, 2021)
[5] (Srour, 2020)
The Study:
Additional resources:
American Diabetes Association Professional Practice Committee (2024) 3. Prevention or delay of diabetes and associated comorbidities: Standards of care in diabetes-2024. Diabetes Care 47(Suppl 1):S43–S51. https://doi.org/10.2337/dc24-S003.
