Ultra-processed food and incident type 2 diabetes: studying the underlying consumption patterns to unravel the health effects of this heterogeneous food category in the prospective Lifelines cohort

Abstract Background The overall consumption of ultra-processed food (UPF) has previously been associated with type 2 diabetes. However, due to the substantial heterogeneity of this food category, in terms of their nutritional composition and product type, it remains unclear whether previous results apply to all underlying consumption patterns of UPF. Methods Of 70,421 participants (35–70 years, 58.6% women) from the Lifelines cohort study, dietary intake was assessed with a food frequency questionnaire. UPF was identified according to the NOVA classification. Principal component analysis (PCA) was performed to derive UPF consumption patterns. The associations of UPF and adherence to UPF consumption patterns with incidence of type 2 diabetes were studied with logistic regression analyses adjusted for age, sex, diet quality, energy intake, alcohol intake, physical activity, TV watching time, smoking status, and educational level. Results During a median follow-up of 41 months, a 10% increment in UPF consumption was associated with a 25% higher risk of developing type 2 diabetes (1128 cases; OR 1.25 [95% CI 1.16, 1.34]). PCA revealed four habitual UPF consumption patterns. A pattern high in cold savory snacks (OR 1.16 [95% CI 1.09, 1.22]) and a pattern high in warm savory snacks (OR 1.15 [95% CI 1.08, 1.21]) were associated with an increased risk of incident type 2 diabetes; a pattern high in traditional Dutch cuisine was not associated with type 2 diabetes incidence (OR 1.05 [95% CI 0.97, 1.14]), while a pattern high in sweet snacks and pastries was inversely associated with type 2 diabetes incidence (OR 0.82 [95% CI 0.76, 0.89]). Conclusions The heterogeneity of UPF as a general food category is reflected by the discrepancy in associations between four distinct UPF consumption patterns and incident type 2 diabetes. For better public health prevention, research is encouraged to further clarify how different UPF consumption patterns are related to type 2 diabetes.

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Associations of ultra-processed food and its consumption patterns with incident type 2 diabetes

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.437 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Duan ◽

P C Vinke ◽

G J Navis ◽

E Corpeleijn ◽

L H Dekker

Keyword(s):

Type 2 Diabetes ◽

Diabetes Risk ◽

Consumption Patterns ◽

Processed Foods ◽

Inverse Association ◽

Processed Food ◽

Incident Type ◽

Increased Risk ◽

Incident Type 2 Diabetes

Abstract Background To study the associations of the consumption of ultra-processed food (UPF) and its underlying habitual consumption patterns with incident type 2 diabetes (T2D) in a large population-based cohort. Methods In 70 421 participants (35-70 years, 58.6% women) from the Lifelines cohort study, dietary intake was assessed with a food frequency questionnaire. Principal component analysis (PCA) was performed to derive UPF consumption patterns. UPF was related to incident diabetes with adjustments for confounders, including overall diet quality. Results During a median follow-up of 41 months, the intake of UPF was associated with higher risk of type 2 diabetes (1128 cases, OR for a 10% increment in UPF intake 1.33 [95% CI 1.26, 1.41]), and remained significant after adjustment for confounders. PCA revealed four habitual UPF consumption patterns. A pattern high in cold savory snacks (OR 1.16 [95% CI 1.09, 1.22]) and a pattern high in warm savory snacks (OR 1.15 [95% CI 1.08, 1.21]) were associated with an increased diabetes risk; a pattern high in traditional Dutch cuisine was not associated with diabetes risk (OR 1.05 [95% CI 0.97, 1.14]); while a pattern high in sweet snacks and pastries was inversely associated with diabetes risk (OR 0.82 [95% CI 0.76, 0.89]). There was a clear inverse association between diabetes risk at baseline and the sweet snacks and pastries pattern (β = -0.104 [95% CI -0.113, -0.094]). Conclusions A higher consumption of UPF was associated with higher risk of type 2 diabetes. For consumption patterns, this association was most pronounced for the patterns that were high in savory snacks. Our findings emphasize that in addition to promoting the consumption of healthy food products, discouraging the consumption of UPF, specifically savory snacks, should be considered as part of future diabetes prevention strategies. Key messages Ultra-processed foods intake was associated with increased risk of type 2 diabetes. Consumption patterns of ultra-processed foods should be the focus for future policies.

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Associations of Ultra-Processed Food and Its Underlying Consumption Patterns With Incident Type 2 Diabetes: The Lifelines Cohort Study

Current Developments in Nutrition ◽

10.1093/cdn/nzab038_014 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 402-402

Author(s):

Ming-Jie Duan ◽

Petra C Vinke ◽

Gerjan Navis ◽

Eva Corpeleijn ◽

Louise Dekker

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Principal Component ◽

Diabetes Risk ◽

Consumption Patterns ◽

Inverse Association ◽

Processed Food ◽

Incident Type ◽

Incident Type 2 Diabetes

Abstract Objectives Although consumption of ultra-processed food (UPF) has previously been associated with adverse health outcomes, it is unclear how the consumption of UPF and its underlying habitual consumption patterns are associated with incident type 2 diabetes. Methods In 70 421 participants (35–70 years, 58.6% women) from the Lifelines cohort study, dietary intake was assessed with a food frequency questionnaire. Principal component analysis (PCA) was performed to derive UPF consumption patterns. UPF was related to incident diabetes with adjustments for confounders, including overall diet quality. Results During a median follow-up of 41 months, the intake of UPF was associated with higher risk of type 2 diabetes (1128 cases, OR for a 10% increment in UPF intake 1.33 [95% CI 1.26, 1.41]), and remained significant after adjustment for confounders (OR 1.25 [95% CI 1.16, 1.34]). PCA revealed four habitual UPF consumption patterns. A pattern high in cold savory snacks (OR 1.16 [95% CI 1.09, 1.22]) and a pattern high in warm savory snacks (OR 1.15 [95% CI 1.08, 1.21]) were associated with an increased diabetes risk; a pattern high in traditional Dutch cuisine was not associated with diabetes risk (OR 1.05 [95% CI 0.97, 1.14]); while a pattern high in sweet snacks and pastries was inversely associated with diabetes risk (OR 0.82 [95% CI 0.76, 0.89]). There was a clear inverse association between diabetes risk at baseline and the sweet snacks and pastries pattern (β = −0.104 [95% CI − 0.113, −0.094]). Conclusions A higher consumption of UPF was associated with higher risk of type 2 diabetes. For consumption patterns, this association was most pronounced for the patterns that were high in savory snacks. Our findings emphasize that in addition to promoting the consumption of healthy food products, discouraging the consumption of UPF, specifically savory snacks, should be considered as part of future diabetes prevention strategies. Funding Sources This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 754425.

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Deciphering the Plasma Proteome of Type 2 Diabetes

10.2337/figshare.12896426 ◽

2020 ◽

Author(s):

Ada Admin ◽

Mohamed A. Elhadad ◽

Christian Jonasson ◽

Cornelia Huth ◽

Rory Wilson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Growth Hormone Receptor ◽

Smoking Status ◽

Underlying Disease ◽

Sex Hormone Binding Globulin ◽

Health Study ◽

Study Cohort ◽

Incident Type ◽

Incident Type 2 Diabetes

With an estimated prevalence of 463 million affected, type 2 diabetes represents a major challenge to health care systems worldwide. Analyzing the plasma proteomes of individuals with type 2 diabetes may illuminate hitherto unknown functional mechanisms underlying disease pathology. We assessed the associations between type 2 diabetes and >1000 plasma proteins in the KORA (Cooperative health research in the Region of Augsburg) F4 cohort (n=993, 110 cases), with subsequent replication in the HUNT3 (Third wave of the Nord-Trøndelag Health Study) cohort (n=940, 149 cases). We computed logistic regression models adjusted for age, sex, BMI, smoking status and hypertension. Additionally, we investigated associations with incident type 2 diabetes and performed two-sample bi-directional Mendelian randomization (MR) analysis to prioritize our results. Association analysis of prevalent type 2 diabetes revealed 24 replicated proteins, of which eight are novel. Proteins showing association with incident type 2 diabetes were aminoacylase-1, growth hormone receptor, and insulin-like growth factor binding protein-2. Aminoacylase-1 was associated with both prevalent and incident type 2 diabetes. MR analysis yielded nominally significant causal effects of type 2 diabetes on cathepsin Z and rennin, both known to have roles in the pathophysiological pathways of cardiovascular disease, and of sex hormone-binding globulin on type 2 diabetes. In conclusion, our high-throughput proteomics study replicated previously reported type 2 diabetes-protein associations, and identified new candidate proteins possibly involved in the pathogenesis of type 2 diabetes.

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Deciphering the Plasma Proteome of Type 2 Diabetes

10.2337/figshare.12896426.v1 ◽

2020 ◽

Author(s):

Ada Admin ◽

Mohamed A. Elhadad ◽

Christian Jonasson ◽

Cornelia Huth ◽

Rory Wilson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Growth Hormone Receptor ◽

Smoking Status ◽

Underlying Disease ◽

Sex Hormone Binding Globulin ◽

Health Study ◽

Study Cohort ◽

Incident Type ◽

Incident Type 2 Diabetes

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Abstract MP05: Leisure-Time Running and Incident Type 2 Diabetes

Circulation ◽

10.1161/circ.131.suppl_1.mp05 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Duck-chul Lee ◽

Carl J. Lavie ◽

Timothy S. Church ◽

Xuemei Sui ◽

Steven N. Blair

Keyword(s):

Type 2 Diabetes ◽

Lower Risk ◽

Leisure Time ◽

Cox Regression ◽

Smoking Status ◽

Physical Activities ◽

Incident Type ◽

Incident Type 2 Diabetes

Introduction: There is still little evidence on the dose-response relation between leisure-time running and incident type 2 diabetes (T2D). Hypothesis: We examined the hypothesis that running reduces the risk of developing T2D. Methods: Participants were 19,347 adults aged 18 to 100 years (mean age, 44) who received an extensive preventive medical examination during 1974-2006 in the Aerobics Center Longitudinal Study. Participants were free of cardiovascular disease, cancer, and T2D at baseline. Running and other physical activities were assessed on the medical history questionnaire by self-reported leisure-time activities during the past 3 months. We defined T2D as fasting glucose ≥126 mg/dl, insulin use, or physician-diagnosis during follow-up medical examinations. Cox regression was used to quantify the association between running and T2D after adjusting for baseline age, sex, examination year, body mass index, smoking status, heavy alcohol drinking, abnormal electrocardiogram, hypertension, hypercholesterolemia, and levels of other physical activities. Results: During an average follow-up of 6.5 years, 1,015 adults developed T2D. Approximately 30% of adults participated in leisure-time running. Runners had a 29% lower risk of developing T2D compared with non-runners. The hazard ratios (95% confidence intervals) of T2D were 0.97 (0.74-1.27), 0.66 (0.49-0.89), 0.62 (0.45-0.85), 0.78 (0.58-1.03), and 0.57 (0.42-0.79) across quintiles (Q) of running time (minutes/week); 0.99 (0.76-1.30), 0.60 (0.44-0.82), 0.72 (0.55-0.94), 0.65 (0.47-0.90), and 0.63 (0.47-0.86) across Q of running distance (miles/week); 1.08 (0.83-1.40), 0.67 (0.50-0.90), 0.70 (0.53-0.93), 0.61 (0.45-0.83), and 0.53 (0.36-0.76) across Q of running frequency (times/week); 0.95 (0.73-1.24), 0.70 (0.52-0.94), 0.62 (0.45-0.84), 0.73 (0.55-0.97), and 0.58 (0.42-0.80) across Q of total amount of running (MET-minutes/week); and 0.95 (0.71-1.28), 0.76 (0.59-0.99), 0.59 (0.42-0.83), 0.66 (0.51-0.85), and 0.62 (0.43-0.90) across Q of running speed (mph), respectively, compared with no running after adjusting for confounders including levels of other physical activities. Conclusions: Participating in leisure-time running is associated with markedly lower risk of developing T2D in adults. Except for those in the very lowest Q for running doses, even relatively low running doses (starting with Q 2) were associated with marked reductions in T2D risk over time, supporting the prescription of running to reduce T2D.

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Abstract MP037: Plasma Organochlorine Concentration and Risk of Diabetes: the Nurses' Health Study

Circulation ◽

10.1161/circ.125.suppl_10.amp037 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Hongyu Wu ◽

Kimberly A Bertrand ◽

Anna L Choi ◽

Frank B Hu ◽

Francine Laden ◽

...

Keyword(s):

Type 2 Diabetes ◽

Polychlorinated Biphenyl ◽

Plasma Concentrations ◽

Diabetes Risk ◽

Health Study ◽

Blood Draw ◽

Incident Type ◽

Increased Risk ◽

Incident Type 2 Diabetes

Background: Animal experiments have suggested that exposure to persistent organic pollutants (POPs) may lead to increased risk of type 2 diabetes. Although recent human studies supported this hypothesis, evidence from prospective investigations is sparse. Objective: To examine the associations of plasma POP concentrations with risk of incident type 2 diabetes in a prospective setting among US women. Methods: Study population was comprised of participants from two independent nested case-control studies in the Nurses’ Health Study, in which major polychlorinated biphenyl (PCB 118, 138, 153, and 180), p-p'- dichlorodiphenyldichloroethylene (DDE), dichlorodiphenyltrichloroethane (DDT), and hexachlorobenzene (HCB) were measured. A non-parametric approach was used to derive standardized scores for plasma concentrations of lipid-adjusted POPs within each study to minimize between-study variation of the POP measurements. Risk of incident type 2 diabetes during the follow-up period (1990-2008) across the tertiles of the scores was examined. Results: Of 1,120 participants, we identified 48 incident type 2 diabetes cases. After adjusting for covariates assessed at blood draw in 1990, including smoking status, body mass index, and total fish intake, plasma HCB concentration was positively associated with type 2 diabetes risk: odds ratio (OR) (95% confidence interval [CI]) was 2.77 (1.17, 6.55, P for trend =0.022) comparing the highest vs. lowest tertile. Other POPs were not significantly associated with diabetes: the ORs (95% CI) were 1.10 (0.51, 2.34, P for trend =0.81) for p-p'-DDE, 0.93 (0.44, 1.95, P for trend =0.86) for DDT, and 0.88 (0.39, 1.97, P for trend =0.76) for sum of the 4 major PCBs, comparing the extreme tertiles. Conclusion: The significant association of plasma HCB concentration with diabetes risk supports a role of POP exposure in the etiology of type 2 diabetes. More prospective data are warranted to confirm these findings.

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The Risk of Incident Type 2 Diabetes in a Korean Metabolically Healthy Obese Population: The Role of Systemic Inflammation

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2014-3885 ◽

2015 ◽

Vol 100 (3) ◽

pp. 934-941 ◽

Cited By ~ 42

Author(s):

Chang Hee Jung ◽

Min Jung Lee ◽

Yu Mi Kang ◽

Jung Eun Jang ◽

Jaechan Leem ◽

...

Keyword(s):

Type 2 Diabetes ◽

Systemic Inflammation ◽

Incident Type ◽

Metabolically Healthy Obese ◽

Increased Risk ◽

Incident Type 2 Diabetes ◽

Healthy Obese ◽

Metabolically Healthy ◽

Inflammation Group

Abstract Objective: This study sought to investigate whether the metabolically healthy obese (MHO) phenotype is associated with an increased risk of incident type 2 diabetes in a Korean population and, if so, whether systemic inflammation affects this risk in MHO individuals. Design and Methods: The study population comprised 36 135 Koreans without type 2 diabetes. Participants were stratified by body mass index (cutoff value, 25.0 kg/m2) and metabolic health state (assessed using Adult Treatment Panel-III criteria). High-sensitive C-reactive protein (hsCRP) was used as a surrogate marker of systemic inflammation. Subjects were classified into low (ie, hsCRP < 0.5 mg/L) and high (ie, hsCRP ≥ 0.5 mg/L) systemic inflammation groups. Results: During a median followup of 36.5 months (range, 4.8–81.7 mo), 635 of the 36 135 individuals (1.8%) developed type 2 diabetes. The MHO group had a significantly higher risk of incident type 2 diabetes (multivariate-adjusted hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.16–2.11) than the metabolically healthy nonobese (MHNO) group. However, the risk of the MHO group varied according to the degree of systemic inflammation. Compared with the MHNO/low systemic inflammation group, the risk of type 2 diabetes in the MHO/low systemic inflammation group was not significantly elevated (multivariate-adjusted HR, 1.61; 95% CI, 0.77–3.34). However, the MHO/high systemic inflammation group had an elevated risk of incident type 2 diabetes (multivariate-adjusted HR, 3.73; 95% CI 2.36–5.88). Conclusions: MHO subjects show a substantially higher risk of incident type 2 diabetes than MHNO subjects. The level of systemic inflammation partially explains this increased risk.

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Incident type 2 diabetes and risk of fracture: a comparative cohort analysis using UK primary care records

10.2337/figshare.13034150.v1 ◽

2020 ◽

Author(s):

Gabrielle S Davie ◽

Kingshuk Pal ◽

Elizabeth Orton ◽

Edward G Tyrrell ◽

Irene Petersen

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Lifestyle Changes ◽

Health Improvement ◽

Prevalence Rates ◽

Risk Of Fracture ◽

Incident Type ◽

Increased Risk ◽

Incident Type 2 Diabetes

Objective To estimate risk of fracture in men and women with recent diagnosis of type 2 diabetes compared to individuals without diabetes. Research Design and Methods In this cohort study we used routinely-collected UK primary care data from The Health Improvement Network. In adults (>35 years) diagnosed with type 2 diabetes between 2004-2013 fractures sustained until 2019 were identified and compared to fractures sustained in individuals without diabetes. Multivariable models estimated time to first fracture following diagnosis of diabetes. Annual prevalence rates included at least one fracture in a given year. Results Among 174,244 individuals with incident type 2 diabetes and 747,290 without diabetes, there was no increased risk of fracture among males with diabetes (adjusted hazards ratio (aHR) 0.97 (95%CI 0.94, 1.00)) and a small reduced risk among females (aHR 0.94, (95%CI 0.92, 0.96)). In those aged 85 years and over those in the diabetes cohort were at significantly lower risk of incident fracture (Males: aHR 0.85, 95%CI 0.71, 1.00; Females: aHR 0.85, 95%CI 0.78, 0.94). For those in the most deprived areas, aHRs were 0.90 (95%CI 0.83, 0.98) for males and 0.91 (95%CI 0.85, 0.97) for females. Annual fracture prevalence rates, by sex, were similar for those with and without type 2 diabetes. Conclusion We found no evidence to suggest a higher risk of fracture following diagnosis of type 2 diabetes. After a diagnosis of type 2 diabetes individuals should be encouraged to make positive lifestyle changes, including undertaking weight-bearing physical activities that improve bone health.

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Serum creatinine levels and risk of incident type 2 diabetes mellitus or dysglycemia in middle-aged Japanese men: a retrospective cohort study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2017-000492 ◽

2018 ◽

Vol 6 (1) ◽

pp. e000492 ◽

Cited By ~ 6

Author(s):

Mamoru Takeuchi ◽

Hironori Imano ◽

Isao Muraki ◽

Yuji Shimizu ◽

Mina Hayama-Terada ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Serum Creatinine ◽

Incident Type ◽

Increased Risk ◽

Incident Type 2 Diabetes ◽

Fasting Plasma Glucose Concentration

ObjectiveTo assess the association between low serum creatinine levels and an increased risk of type 2 diabetes mellitus and dysglycemia.Research design and methodsWe conducted a retrospective cohort study of 3313 Japanese male workers aged 30–55 years, who underwent annual health check-ups during 2001–2008 and showed no type 2 diabetes mellitus, and underwent follow-up examinations until March 2013. Dysglycemia was defined as a fasting plasma glucose concentration of ≥110 mg/dL (6.1 mmol/L), or a non-fasting plasma glucose concentration of ≥140 mg/dL (7.8 mmol/L). A Cox proportional model was used to calculate HRs and 95% CIs for developing type 2 diabetes mellitus or dysglycemia.ResultsDuring the median 6.7-year follow-up, there were 207 cases of incident type 2 diabetes mellitus and 596 cases of incident dysglycemia, including 115 cases of type 2 diabetes mellitus among the subjects with normal glucose concentrations at baseline. After adjustment for age, body mass index and known diabetes risk factors, the multivariable HR of type 2 diabetes mellitus for the lowest category of serum creatinine (<0.7 mg/dL) vs the highest category (0.9–1.1 mg/dL) was 1.9 (95% CI 1.2 to 2.9; P for trend 0.03). The multivariable HRs of dysglycemia for the lowest category of serum creatinine versus the highest category was 1.5 (95% CI 1.1 to 1.9; P for trend 0.01).ConclusionsLow serum creatinine levels were associated with an increased risk of type 2 diabetes mellitus and dysglycemia.

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Erythrocyte n-6 polyunsaturated fatty acids, gut microbiota and incident type 2 diabetes: a prospective cohort study

10.2337/figshare.12624821 ◽

2020 ◽

Author(s):

Zelei Miao ◽

Jie-sheng Lin ◽

Yingying Mao ◽

Geng-dong Chen ◽

Fang-fang Zeng ◽

...

Keyword(s):

Type 2 Diabetes ◽

Gut Microbiota ◽

Health Study ◽

Diabetes Incidence ◽

Incident Type ◽

Β Diversity ◽

Α Diversity ◽

Incident Type 2 Diabetes

OBJECTIVE To examine the association of erythrocyte n-6 polyunsaturated fatty acid (PUFA) biomarkers with incident type 2 diabetes and explore the potential role of gut microbiota in the association. RESEARCH DESIGN AND METHODS We evaluated 2,731 participants without type 2 diabetes recruited between 2008-2013 in the Guangzhou Nutrition and Health Study, China. Type 2 diabetes cases were identified with clinical and biochemical information collected at follow-up visits. Using stool samples collected during the follow-up in the subset (n=1,591), 16S rRNA profiling was conducted. Using multivariable-adjusted Poisson or linear regression, we examined associations of erythrocyte n-6 PUFA biomarkers with incident type 2 diabetes, and diversity and composition of gut microbiota. RESULTS Over 6.2 years of follow-up, 276 type 2 diabetes cases were identified (risk=0.10). Higher levels of erythrocyte <a>γ-linolenic acid</a> (GLA), but not linoleic or arachidonic acid, were associated with higher type 2 diabetes incidence. Comparing the top to the bottom quartile groups of GLA levels, relative risk was 1.72 (95% confidence intervals: 1.21, 2.44) adjusted for potential confounders. Baseline GLA was inversely associated with gut microbial richness and diversity (α-diversity, both p<0.05) during follow-up, and significantly associated with microbiota β-diversity (p=0.002). α-diversity acted as a potential mediator in the association between GLA and type 2 diabetes (p<0.05). Seven genera (Butyrivibrio, Blautia, Oscillospira, Odoribacter, S24-7 other, Rikenellaceae other, and Clostridiales other) were enriched in quartile 1 of GLA, and in participants without type 2 diabetes. CONCLUSIONS Relative concentrations of erythrocyte GLA were positively associated with incident type 2 diabetes in a Chinese population and also with gut microbial profiles. These results highlight that gut microbiota may play an important role linking n-6 PUFA metabolism and type 2 diabetes etiology.

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