Skip the Chips to Reduce Risk of Diabetes
Chips or cherries? Regular choices can prevent or promote the risk of developing diabetes. A new study out of University College London finds that swapping out ultra-processed foods with healthier options can reduce your risk of this chronic metabolic disease.
The recent research was published in The Lancet Regional Health -- Europe along with experts at the University of Cambridge and Imperial College London. It evaluated the association between the degree of food processing and type 2 diabetes risk, along with which UPF posed the most risk.
The researchers assessed UPF consumption and health outcomes in nearly 312,000 subjects from eight European countries over 10-plus years. During this time, over 14,000 individuals developed type 2 diabetes.
They discovered that for every 10% increase in UPF consumption in a person’s diet, a 17% increase in type 2 diabetes risk was observed. This chance of developing diabetes could be reduced by eating less processed food.
The “Wurst” of UPF
Savory snacks like chips and animal-based snacks like meat sticks, ready-made meals, and sugar-sweetened and artificially-sweetened drinks posed the highest risk for the development of diabetes. Attention should focus on reducing these foods and beverages.
The Nova classification system was used in evaluating the level of processing. This system divides foods into four groups: unprocessed or minimally processed foods (MPF) including eggs, milk, and fruit; processed culinary ingredients (PCI) like butter, oil, and salt; processed foods (PF) like canned fish, beer, and cheese; and ultra-processed foods such as ready-to-eat/heat mixed dishes, salty snacks, sweets, and desserts.
It’s unclear what the exact association between UPF and type 2 diabetes is, but factors such as overconsumption and weight gain are likely. A previous study suggests that increased abdominal fat accounted for roughly half of the connection.
NOVA
According to Samuel Dicken, first author of the study from UCL Division of Medicine, "We know that ultra-processed foods are associated with a higher risk of certain diseases such as type 2 diabetes. As expected, our findings confirm this link and show that every 10% increase in the diet from UPF increases the risk of developing type 2 diabetes considerably.
"Most studies to date only consider UPF as a whole, but we also suspect that there may be different risks associated with different types of UPF, and the risks of other processing groups have not been well researched. Our analysis goes a step further than previous studies, by looking at all four processing groups in the Nova classification to gauge the impact on type 2 diabetes risk when we substitute UPF with less processed foods, as well as looking at nine UPF subgroups.
"The good news is that replacing UPF with less processed foods was associated with a reduced type 2 diabetes risk."
Data from EPIC
Researchers from UCL evaluated data from the EPIC study. This research investigates the connection between diet, lifestyle, and environmental factors and the incidence of chronic diseases in over half a million Europeans over time.
To better understand how the level of food processing impacts type 2 diabetes risk, an additional evaluation of the data was done to separate UPS into nine subgroups. In addition to how consuming UPF affects an individual’s risk of developing type 2 diabetes, substitution modeling of the data was done to potentially see how replacing UPF would impact the risk of type 2 diabetes.
Substituting 10% of UPF in the diet with 10% of MPF/PCI reduced type 2 diabetes risk by 14%, according to the results. Swapping 10% of UPF in the diet with 10% of PF reduced diabetes risk by 18%.
The researchers believe this may be because 30-50% of PF intake in this study came from beer and wine, which have been linked with a lower risk of type 2 diabetes in a past EPIC study. PF also includes salted nuts, artisanal breads, and canned fruits and vegetables.
A higher incidence of type 2 diabetes was noted with savory snacks, animal-based products, ready meals, and sugar-sweetened and artificially-sweetened beverages were associated with higher incidence of type 2 diabetes.
High intake of these less healthy foods added to overall type 2 diabetes risk. Sweetened drinks alone accounted for almost 40% of their UPF intake and 9% of their diet overall in the top 25% of UPF consumers, where UPF made up 23.5% of their total diet.
An Ultra-processed Surprise
Ironically, UPF breads, biscuits and breakfast cereals, sweets and desserts, and plant-based alternatives were linked with lower incidence of type 2 diabetes.
Senior author of the study Professor Rachel Batterham from UCL Division of Medicine, notes: "The UPF subgroup analysis in this study has been revealing and confirms that not all foods categorized as UPF are alike in terms of the health risks associated with them.
"Breads and cereals, for example, are a staple of many people's diets. Based on our results, I think we should treat them differently to savory snacks or sugary drinks in terms of the dietary advice we provide." As this is an observational study, it only measures associations and not causes.
A current study is being done by UCL researchers to evaluate the impact of UPF versus MPF diets meeting healthy diet guidance. This will further confirm the study results. The results of this study should be published in 2025.
Future Research
A report was published in 2023 by the UK Scientific Advisory Committee on Nutrition (SACN) about the available scientific evidence on UPFs. It noted that higher intake of processed foods, especially UPFs, was linked with an increased risk of health conditions such as obesity, chronic illnesses including type 2 diabetes, and depression. The report also increased awareness of the need for more research to understand the cause of these associations.
"The findings from this study add to the growing body of research that links consumption of UPF with higher risk of certain chronic diseases including obesity, cardiometabolic diseases, and some cancers. While such a study cannot determine causal relationships, it does suggest that reducing consumption of some UPF and replacing them with unprocessed, whole foods, might lower the risk of type 2 diabetes. Further research to understand mechanisms and potential causal pathways is now needed”, states Professor Marc Gunter, an author of the study from Imperial College London and one of the coordinators of the EPIC study.
1 The nine subgroups of UPF include:
Breads, biscuits, and breakfast cereals
Sauces, spreads, and condiments
Sweets and desserts
Savory snacks
Plant-based alternatives
Animal-based products
Ready-to-eat/heat mixed dishes
Artificially and sugar-sweetened beverages
Alcoholic drinks
Other ultra-processed foods
For clients at risk for diabetes or other chronic diseases, weight management, regular physical activity and reduction of sugary drinks, animal-based products, and savory snacks may be the simplest advice to give.
Lisa Andrews, MEd, RD, LD
Reference:
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. 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, 2024; 101043 DOI: 10.1016/j.lanepe.2024.101043