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Ultra-processed food consumption and risk of type-2 diabetes in the Melbourne Collaborative Cohort study
Priscila Machado1, Natalia Tolstova2, Melissa Lane3
1Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia; School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia; Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Sao Paulo, Brazil.
Background:
Prospective evidence on the association between ultra-processed food (UPF) consumption and type-2 diabetes, and the potential mediator role of body mass index (BMI), is lacking in Australia.
Objective:
To investigate the association between UPF consumption and incident type-2 diabetes in Australian adults, and to further examine the mediating role of BMI in this association.
Design:
Prospective study using the Melbourne Collaborative Cohort Study (MCCS) data.
Participants:
/Setting: Participants were recruited from the Melbourne metropolitan area between 1990-1994 (baseline), with follow-ups conducted in 1995-2002 and 2003-2007. A total of 25,214 participants aged 40-69 years, without diabetes at baseline, and who provided baseline dietary and follow-up diabetes data were included.
Main Outcome Measures:
Incidence of type-2 diabetes was assessed at follow-up 1 (self-report) and follow-up 2 (self-report, elevated plasma glucose (≥ 126 mg/dL fasting or ≥ 200 mg/dL non-fasting), or medication use).
Statistical Analyses Performed:
Adjusted Poisson regression models estimated Incidence Rate Ratios (IRRs) and 95% confidence intervals (CIs) for the risk of type-2 diabetes per 10% increase and by quartiles of UPF consumption (% total grams/day), using age as the time metric. Regression-based mediation analyses were employed to assess the mediation role of BMI.
Results:
During follow-up (mean: 11.6 ± 1.7 years), 1,734 cases of type-2 diabetes occurred. The direct association between each 10% increase in UPF consumption and type-2 diabetes was statistically significant (IRR: 1.16; 95%CI: 1.11, 1.21), yet spline analyses indicated evidence of non-linearity. Participants in the highest quartile of UPF consumption had a 40% higher risk of type-2 diabetes (IRRhighxlow category = 1.40, 95%CI: 1.22, 1.60; p<0.001). BMI significantly mediated 18% of the association.
Conclusions:
In this large cohort of Australian adults, higher UPF consumption was associated with an increased risk of type-2 diabetes, with BMI as an important mediator.
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