Food consumption by degree of food processing and risk of type 2 diabetes mellitus: a prospective cohort analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC)Research in context

Samuel J. Dicken; Christina C. Dahm; Daniel B. Ibsen; Anja Olsen; Anne Tjønneland; Mariem Louati-Hajji; Claire Cadeau; Chloé Marques; Matthias B. Schulze; Franziska Jannasch; Ivan Baldassari; Luca Manfredi; Maria Santucci de Magistris; Maria-Jose Sánchez; Carlota Castro-Espin; Daniel Rodríguez Palacios; Pilar Amiano; Marcela Guevara; Yvonne T. van der Schouw; Jolanda M.A. Boer; W.M. Monique Verschuren; Stephen J. Sharp; Nita G. Forouhi; Nicholas J. Wareham; Eszter P. Vamos; Kiara Chang; Paolo Vineis; Alicia K. Heath; Marc J. Gunter; Geneviève Nicolas; Elisabete Weiderpass; Inge Huybrechts; Rachel L. Batterham

The Lancet Regional Health. Europe (Nov 2024)

Food consumption by degree of food processing and risk of type 2 diabetes mellitus: a prospective cohort analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC)Research in context

Samuel J. Dicken,
Christina C. Dahm,
Daniel B. Ibsen,
Anja Olsen,
Anne Tjønneland,
Mariem Louati-Hajji,
Claire Cadeau,
Chloé Marques,
Matthias B. Schulze,
Franziska Jannasch,
Ivan Baldassari,
Luca Manfredi,
Maria Santucci de Magistris,
Maria-Jose Sánchez,
Carlota Castro-Espin,
Daniel Rodríguez Palacios,
Pilar Amiano,
Marcela Guevara,
Yvonne T. van der Schouw,
Jolanda M.A. Boer,
W.M. Monique Verschuren,
Stephen J. Sharp,
Nita G. Forouhi,
Nicholas J. Wareham,
Eszter P. Vamos,
Kiara Chang,
Paolo Vineis,
Alicia K. Heath,
Marc J. Gunter,
Geneviève Nicolas,
Elisabete Weiderpass,
Inge Huybrechts,
Rachel L. Batterham

Affiliations

Samuel J. Dicken: Centre for Obesity Research, Department of Medicine, University College London (UCL), London WC1E 6JF, UK; Corresponding author.
Christina C. Dahm: Department of Public Health, Aarhus University, Aarhus, Denmark
Daniel B. Ibsen: Department of Public Health, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark; Department of Nutrition, Sports and Exercise, University of Copenhagen, Frederiksberg, Denmark
Anja Olsen: Department of Public Health, Aarhus University, Aarhus, Denmark; Danish Cancer Institute, Copenhagen, Denmark
Anne Tjønneland: Danish Cancer Institute, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Denmark
Mariem Louati-Hajji: Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
Claire Cadeau: Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
Chloé Marques: Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
Matthias B. Schulze: Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
Franziska Jannasch: Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
Ivan Baldassari: Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
Luca Manfredi: Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH), Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, Orbassano (TO), Italy
Maria Santucci de Magistris: A.O.U. Federico II, Naples, Italy
Maria-Jose Sánchez: Escuela Andaluza de Salud Pública (EASP), Granada 18011, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada 18012, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain
Carlota Castro-Espin: Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L’Hospitalet de Llobregat, Barcelona, Spain; Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
Daniel Rodríguez Palacios: Department of Epidemiology, Murcia Regional Health Council-IMIB, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Pilar Amiano: Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain; BioGipuzkoa (BioDonostia) Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
Marcela Guevara: Instituto de Salud Pública y Laboral de Navarra, Pamplona 31003, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona 31008, Spain
Yvonne T. van der Schouw: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Jolanda M.A. Boer: National Institute for Public Health and the Environment, Bilthoven, the Netherlands
W.M. Monique Verschuren: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
Stephen J. Sharp: Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge Clinical School, Cambridge, UK
Nita G. Forouhi: Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge Clinical School, Cambridge, UK
Nicholas J. Wareham: Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge Clinical School, Cambridge, UK
Eszter P. Vamos: Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W12 0BZ, UK
Kiara Chang: Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W12 0BZ, UK
Paolo Vineis: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
Alicia K. Heath: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
Marc J. Gunter: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization (IARC-WHO), Lyon, France
Geneviève Nicolas: Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization (IARC-WHO), Lyon, France
Elisabete Weiderpass: International Agency for Research on Cancer, World Health Organization, Lyon, France
Inge Huybrechts: Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization (IARC-WHO), Lyon, France
Rachel L. Batterham: Centre for Obesity Research, Department of Medicine, University College London (UCL), London WC1E 6JF, UK; Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital (UCLH), London NW1 2BU, UK; National Institute for Health Research, Biomedical Research Centre, University College London Hospital (UCLH), London W1T 7DN, UK

Journal volume & issue: Vol. 46
p. 101043

Abstract

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Summary: Background: It is unknown whether the association between ultra-processed food (UPF) intake and type 2 diabetes mellitus differs from other degrees of food processing. We examined the association between degree of food processing and incident type 2 diabetes mellitus. Methods: This was a prospective cohort analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC). Dietary intake was assessed at baseline using dietary questionnaires and classified according to the Nova classification into unprocessed/minimally processed food (MPF), processed culinary ingredients (PCI), processed food (PF) and UPF. Type 2 diabetes mellitus cases were verified through multiple methods. Cox regression and statistical substitution analysis was used to estimate associations between MPF + PCI, PF and UPF intake and incident type 2 diabetes mellitus. To investigate heterogeneity in the association between UPF and incident type 2 diabetes mellitus, UPF sub-group analysis was conducted. Different reference groups were used in each analysis. Findings: Over an average 10.9 years follow-up of 311,892 individuals, 14,236 type 2 diabetes mellitus cases were identified. Each 10% increment of total daily food intake from UPF (%g/day) was associated with 17% (95% confidence interval (95%CI): 1.14–1.19) higher incident type 2 diabetes mellitus. Each 10% increment in MPF + PCI or PF intake was associated with lower incident type 2 diabetes mellitus (MPF + PCI hazard ratio: 0.94 (95%CI: 0.92–0.96); PF hazard ratio: 0.92 (95%CI: 0.89–0.95)). Replacing UPF with MPF + PCI or PF was associated with lower incident type 2 diabetes mellitus. However, heterogeneity was observed across UPF sub-groups, with breads, biscuits and breakfast cereals, sweets and desserts, and plant-based alternatives associated with lower incident type 2 diabetes mellitus. Interpretation: These findings support recommendations to focus on reducing intake of specific UPF for lowering type 2 diabetes mellitus risk. Funding: International Agency for Research on Cancer.

Published in The Lancet Regional Health. Europe

ISSN: 2666-7762 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: https://www.thelancet.com/journals/lanepe/home

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