Ultra-Processed Foods and Type 2 Diabetes: Results from the EPIC Cohort
A major cohort study
published in The Lancet Regional Health – Europe in September 2024
has added strong new evidence to the growing concern that diets high in ultra-processed foods (UPFs) are associated with increased risk of type 2 diabetes (T2D). Using data from 312,557 adults across eight European countries in the EPIC (European Prospective Investigation into Cancer and Nutrition) cohort, the researchers tracked health outcomes over a median follow-up of 10.7 years (mean 11.2 years). During this time, 11,986 new cases of T2D were recorded.
According to the authors, each 10% increase in the proportion of UPFs in the total diet (by weight) was associated with a 16% higher risk of developing type 2 diabetes
“Public health actions aiming to reduce consumption of specific UPFs, especially sugary and artificially sweetened beverages and ready-to-eat/heat savoury products, could contribute to the prevention of type 2 diabetes.”
What Are Ultra-Processed Foods?
Ultra-processed foods (UPFs) are industrial formulations that contain little or no whole food, often including additives such as sweeteners, colorings, emulsifiers, and flavor enhancers.
These foods are classified as NOVA Group 4, which refers to foods processed primarily for convenience, shelf life, and sensory appeal, rather than nutritional purpose.
Examples include sugary drinks, artificially sweetened beverages, packaged snacks, reconstituted meats, and ready-to-eat meals. Their widespread consumption has raised global concerns due to associations with obesity, cardiovascular disease, cancer, and now, type 2 diabetes.
Study Design and Scope
The analysis used data from 312,557 adults (out of 340,555 initially assessed) across Denmark, France, Germany, Italy, the Netherlands, Spain, Sweden, and the UK. Participants were free of type 2 diabetes at baseline and completed detailed dietary questionnaires. UPF intake was calculated as a percentage of total food intake by weight, categorized according to the NOVA classification.
Participants were followed for a median of 10.7 years, during which 11,986 new diagnoses of T2D were recorded through registries and validated procedures. The study used multivariable Cox proportional hazards models, adjusting for a wide range of confounders: age, sex, energy intake, BMI, education, physical activity, smoking, alcohol, and family history of diabetes.
Key Findings
- Each 10% increase in UPF intake by weight was associated with a 16% increased risk of developing T2D (HR 1.16; 95% CI 1.12–1.20).
- The strongest positive associations were observed for:
- Sugary beverages
- Artificially sweetened beverages
- Ready-to-eat savory meals and snacks
- Industrial bread showed a small but significant association (HR 1.05, p = 0.03).
- No significant associations were found for sweetened dairy products or desserts.
In substitution models:
- Replacing 10% of UPFs with minimally processed foods (e.g., fruits, vegetables, milk, plain yogurt) was associated with a 14% lower risk of T2D (HR 0.86; 95% CI 0.83–0.89).
- Replacing UPFs with moderately processed foods (e.g., cheese, canned vegetables, nuts) led to a 9% reduction (HR 0.91; 95% CI 0.88–0.94).
The authors emphasize that the association is driven by specific subcategories of UPFs rather than the entire group.
Biological Plausibility
The link between UPFs and type 2 diabetes may be explained by several mechanisms. UPFs tend to have high energy density, added sugars, unhealthy fats, and salt, which together promote weight gain and insulin resistance. They are often low in fiber, leading to faster glucose absorption and reduced satiety. Additives such as emulsifiers and artificial sweeteners may affect gut microbiota and glucose metabolism. Additionally, the high palatability and convenience of UPFs can encourage overconsumption.
Public Health Implications
The findings support the need for specific dietary recommendations and public health actions targeting ultra-processed food consumption. Notably, the authors call for:
- Policy interventions that incorporate food processing level into dietary guidelines and labeling systems
- Public messaging that distinguishes between more and less harmful UPFs
- Strategic reductions in key subgroups such as sugary drinks and savory packaged meals
“Public health actions aimed at reducing consumption of specific UPFs could contribute to the prevention of type 2 diabetes.”
Practical Recommendations
To lower type 2 diabetes risk, individuals should consider both food quality and degree of processing in their choices.
- Limit intake of sugary or artificially sweetened beverages, salty snacks, and convenience meals
- Choose minimally or moderately processed alternatives like fresh fruits, vegetables, legumes, and whole grains
- Read labels and reduce reliance on foods with long ingredient lists or synthetic additives
