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)

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

doi:10.1016/j.lanepe.2024.101043

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)

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. BoerW. 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

^*Corresponding author for this work

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6 Citations (Scopus)

Abstract

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.

Original language	English
Article number	101043
Journal	The Lancet Regional Health - Europe
Volume	46
Number of pages	15
ISSN	2666-7762
DOIs	https://doi.org/10.1016/j.lanepe.2024.101043
Publication status	Published - Nov 2024

Keywords

Diet
Europe
Food processing
Nova classification
Type 2 diabetes mellitus
Ultra-processed food

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Dicken, S. J., Dahm, C. C., Ibsen, D. B., Olsen, A., Tjønneland, A., Louati-Hajji, M., Cadeau, C., Marques, C., Schulze, M. B., Jannasch, F., Baldassari, I., Manfredi, L., Santucci de Magistris, M., Sánchez, M. J., Castro-Espin, C., Palacios, D. R., Amiano, P., Guevara, M., van der Schouw, Y. T., ... Batterham, R. L. (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). The Lancet Regional Health - Europe, 46, Article 101043. https://doi.org/10.1016/j.lanepe.2024.101043

@article{17dd041fa2984b9ca9ada4d70881a7ad,

title = "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)",

abstract = "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.",

keywords = "Diet, Europe, Food processing, Nova classification, Type 2 diabetes mellitus, Ultra-processed food",

author = "Dicken, {Samuel J.} and Dahm, {Christina C.} and Ibsen, {Daniel B.} and Anja Olsen and Anne Tj{\o}nneland and Mariem Louati-Hajji and Claire Cadeau and Chlo{\'e} Marques and Schulze, {Matthias B.} and Franziska Jannasch and Ivan Baldassari and Luca Manfredi and {Santucci de Magistris}, Maria and S{\'a}nchez, {Maria Jose} and Carlota Castro-Espin and Palacios, {Daniel Rodr{\'i}guez} and Pilar Amiano and Marcela Guevara and {van der Schouw}, {Yvonne T.} and Boer, {Jolanda M.A.} and Verschuren, {W. M.Monique} and Sharp, {Stephen J.} and Forouhi, {Nita G.} and Wareham, {Nicholas J.} and Vamos, {Eszter P.} and Kiara Chang and Paolo Vineis and Heath, {Alicia K.} and Gunter, {Marc J.} and Genevi{\`e}ve Nicolas and Elisabete Weiderpass and Inge Huybrechts and Batterham, {Rachel L.}",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s)",

year = "2024",

month = nov,

doi = "10.1016/j.lanepe.2024.101043",

language = "English",

volume = "46",

journal = "The Lancet Regional Health - Europe",

issn = "2666-7762",

publisher = "Elsevier",

}

Dicken, SJ, Dahm, CC , Ibsen, DB , Olsen, A, Tjønneland, A, Louati-Hajji, M, Cadeau, C, Marques, C, Schulze, MB, Jannasch, F, Baldassari, I, Manfredi, L, Santucci de Magistris, M, Sánchez, MJ, Castro-Espin, C, Palacios, DR, Amiano, P, Guevara, M, van der Schouw, YT, Boer, JMA, Verschuren, WMM, Sharp, SJ, Forouhi, NG, Wareham, NJ, Vamos, EP, Chang, K, Vineis, P, Heath, AK, Gunter, MJ, Nicolas, G, Weiderpass, E, Huybrechts, I & Batterham, RL 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)', The Lancet Regional Health - Europe, vol. 46, 101043. https://doi.org/10.1016/j.lanepe.2024.101043

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). / Dicken, Samuel J.; Dahm, Christina C.; Ibsen, Daniel B. et al.
In: The Lancet Regional Health - Europe, Vol. 46, 101043, 11.2024.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Food consumption by degree of food processing and risk of type 2 diabetes mellitus

T2 - a prospective cohort analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC)

AU - Dicken, Samuel J.

AU - Dahm, Christina C.

AU - Ibsen, Daniel B.

AU - Olsen, Anja

AU - Tjønneland, Anne

AU - Louati-Hajji, Mariem

AU - Cadeau, Claire

AU - Marques, Chloé

AU - Schulze, Matthias B.

AU - Jannasch, Franziska

AU - Baldassari, Ivan

AU - Manfredi, Luca

AU - Santucci de Magistris, Maria

AU - Sánchez, Maria Jose

AU - Castro-Espin, Carlota

AU - Palacios, Daniel Rodríguez

AU - Amiano, Pilar

AU - Guevara, Marcela

AU - van der Schouw, Yvonne T.

AU - Boer, Jolanda M.A.

AU - Verschuren, W. M.Monique

AU - Sharp, Stephen J.

AU - Forouhi, Nita G.

AU - Wareham, Nicholas J.

AU - Vamos, Eszter P.

AU - Chang, Kiara

AU - Vineis, Paolo

AU - Heath, Alicia K.

AU - Gunter, Marc J.

AU - Nicolas, Geneviève

AU - Weiderpass, Elisabete

AU - Huybrechts, Inge

AU - Batterham, Rachel L.

PY - 2024/11

Y1 - 2024/11

N2 - 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.

AB - 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.

KW - Diet

KW - Europe

KW - Food processing

KW - Nova classification

KW - Type 2 diabetes mellitus

KW - Ultra-processed food

UR - http://www.scopus.com/inward/record.url?scp=85204066269&partnerID=8YFLogxK

U2 - 10.1016/j.lanepe.2024.101043

DO - 10.1016/j.lanepe.2024.101043

M3 - Journal article

AN - SCOPUS:85204066269

SN - 2666-7762

VL - 46

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 101043

ER -

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)

Abstract

Keywords

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