Ultra-processed food consumption among adults with prediabetes and diabetes, 2001-2018

The American Diabetes Association recently recommended minimizing ultra-processed food consumption in persons with prediabetes or diabetes to reduce the risk of glycemic progression and clinical complications. We characterized trends in ultra-processed food consumption among these populations using nationally representative data.

We conducted serial cross-sectional analyses in adults ≥20 years with prediabetes or diabetes in the 2001-2018 National Health and Nutrition Examination Survey (NHANES). We defined prediabetes as HbA1c 5.7%-<6.5% and no self-reported diabetes diagnosis and diabetes as HbA1c ≥6.5% or self-reported diabetes diagnosis. We estimated the percent of total energy from ultra-processed food consumption (% kilocalories), as defined by Nova food classification system. We characterized the mean percent of total energy intake from ultra-processed food by diabetes status from 2001 to 2018 and assessed time trends with linear regression.

We included 16 024 adults (63.7% with prediabetes and 36.3% with diabetes). From 2001-2002 to 2017-2018, ultra-processed food consumption increased in adults with prediabetes (53.8 to 57.3% of kilocalories, p = 0.006) and diabetes (51.9 to 56.6% of kilocalories, p = 0.001). The proportion that consumed at least 75% of total kilocalories through ultra-processed food increased in persons with prediabetes (12.4 to 21.4%) and diabetes (8.9 to 20.5%). Younger adults (<45 years) and those without a college degree had the highest ultra-processed food consumption.

Patient education, nutritional interventions and nationwide policies are needed to reduce the growing consumption of ultra-processed food in persons with prediabetes and diabetes.