Ultraprocessed foods may raise mortality risk in patients with type 2 diabetes

Key takeaways:

• Researchers observed a linear dose-response relationship of ultraprocessed food intake with mortality.
• A healthy diet may not be enough to overcome the negative effects of ultraprocessed foods.

Ultraprocessed food intake was associated with higher cardiovascular and all-cause mortality rates for people with type 2 diabetes, regardless of the nutritional quality of the rest of their diet, according to recent study results.

For patients with type 2 diabetes, dietary recommendations “almost exclusively prioritize” consuming nutritionally balanced foods and promote dietary patterns that emphasize food groups, like the Mediterranean Diet, regardless of food-processing levels, Marialaura Bonaccio, PhD, an epidemiologist at the Istituto di Ricovero e Cura a Carattere Scientifico Neuromed of Pozzilli, and colleagues wrote in The American Journal of Clinical Nutrition.

Previous research has shown that ultraprocessed food (UPF) consumption is linked to worse health outcomes — poor cardiovascular fitness and premature mortality, for example — but not much is yet known about whether UPF-heavy diets are “as hazardous for health” among patients with diabetes as they are for general populations, the researchers wrote.

“UPFs are usually nutrient-poor, high in calories, added sugar, sodium and unhealthy fats,” they wrote. “It is therefore conceivable that an elevated intake of these products may exacerbate health risk among individuals with type 2 diabetes who are already more exposed to [a] higher risk of premature mortality mainly because of the numerous diabetes-related complications.”

Bonaccio and colleagues conducted a prospective observational cohort study to evaluate the connections between UPF consumption and mortality among 1,065 participants with type 2 diabetes who completed a 188-item food frequency questionnaire.

"Over an average follow-up of 12 years, we observed that a diet rich in ultraprocessed foods exposed people with diabetes to a greater risk of death,” Bonaccio said in a press release. “Participants reporting a higher consumption of ultraprocessed foods had 60% increased risk of dying from any cause, compared to people consuming less of these products. The risk of mortality from cardiovascular diseases, which is a leading cause of death for people with diabetes, was more than doubled."

Compared with the lowest UPF intake (less than 4.7% of total food eaten), greater intake (more than 9% of total food eaten) was linked to higher hazards of both CVD (HR = 2.64; 95% CI, 1.59-4.4) and all-cause mortality (HR = 1.7; 95% CI, 1.25-2.33). Bonaccio and colleagues also reported observing a linear dose-response relationship of UPF intake with both CVD and all-cause mortality.

Notably, the associations persisted regardless of diet quality, indicating that a healthy diet may not be enough to overcome the negative effects of ultraprocessed foods (HR for CVD mortality = 2.55; 95% CI, 1.53-4.24; HR for all-cause mortality = 1.64; 95% CI, 1.19-2.25), according to the researchers.

Licia Iacoviello, PhD, director of the department of hygiene at the University of Insubria of Varese and Como, said in the release that one of the study’s most interesting findings is that “the increased risk linked to ultraprocessed foods was observed even when participants reported a good adherence to the Mediterranean Diet.”

“These findings suggest that if the dietary share of ultraprocessed foods is high, the potential advantages of a healthful Mediterranean Diet risk to be overlooked,” Iacoviello said in the release.

References:

• For people with diabetes, healthy eating is not enough if their diet is rich in ultra-processed foods. https://www.eurekalert.org/news-releases/996450. Published July 26, 2023. Accessed July 26, 2023.
• Bonaccio M, et al. Am J Clin Nutr. 2023;doi:10.1016/j.ajcnut.2023.07.004.