In this study, using the data from the Lifelines Biobank, we found that a higher overall intake of ultra-processed food is associated with a higher risk of incident type 2 diabetes (approximately 4-year follow-up), and this association is independent of the overall diet quality. However, this association differs per different ultra-processed food habitual consumption patterns. More specifically:
(1) The Warm Savory Snack Pattern (high intake of fried snacks, fries, and snack sauce, etc) and the Cold Savory Snack Pattern (also can be called as the Borrel Pattern, high intake of cheese, deli meat, and savory spreads for crackers or French bread, etc) were associated with a higher risk of incident type 2 diabetes;
(2) The Traditional Dutch Cuisine Pattern (high intake of main meal items typical for the Dutch culture, such as sliced bread, lunch meat, and gravy) was not associated with incident ttype 2 diabetes risk;
(3) The Sweet Snack Pattern (high intake of sweet biscuits/cookies, pastries, and chocolate) was, counterintuitively, inversely associated with incident type 2 diabetes risk.
In a post hoc analysis, we revealed that participants' diabetes risk at baseline may affect people's food choices. Especially, people with higher diabetes risk at baseline had lower adherence to the sweet snack pattern. In other words, awareness of high diabetes risk (e.g., family history of diabetes) may have driven participants to avoid products that are high in sugar. This may also be related to the layman’s term for type 2 diabetes, which is “suikerziekte" (sugar disease) in Dutch and several other languages. However, it should be noted that participants with higher diabetes risk at baseline were more likely to consume savory ultra-processed food, and these two savory ultra-processed food patterns were both associated with a higher risk of incident type 2 diabetes.
In conclusion, our results provide some new insights into the health effects of ultra-processed food. The positive associations of the two savory snack patterns suggest that savory ultra-processed food may be a suitable target for future public health prevention. Also, eating an otherwise healthy diet may not fully compensate for the detrimental effects of ultra-processed food (given the independent association). Therefore, in addition to promoting consumption of healthy food products, active discouragement of unhealthy food products such as savory ultra-processed food should be considered as part of future diabetes prevention strategies.
