Association between higher consumption of ultra-processed foods and risk of diabetes and its complications: A systematic review & updated meta-analysis

Abstract

Background & aims

Recent epidemiologic studies on the association between higher consumption of ultra-processed foods (UPFs) and risk of incident diabetes have reported conflicting results in populations worldwide. We conducted an updated systematic review and meta-analysis to quantify the magnitude of this association.

Methods

PubMed and Embase databases were systematically searched (from 2009 to November 14, 2024) for prospective cohort studies reporting data on the association between UPF intake (defined by the NOVA classification) and the risk of incident diabetes or its complications in adults (>18 years). Meta-analysis was performed using random-effects modelling to obtain pooled hazard ratios (HRs) with 95 % confidence intervals (CIs), and the GRADE approach was applied to evaluate the certainty of evidence.

Results

We included 14 prospective cohort studies with a total of 692,508 participants. The highest UPF consumption was significantly associated with an increased risk of diabetes (n = 9 studies; HR 1.24, 95 % CI 1.14 to 1.34, I² = 69 %) compared with the lowest UPF intake (very low certainty of evidence). Subgroup analysis showed that studies published in 2024 had a smaller effect size compared with earlier studies. There were no significant differences between subgroups based on study location, duration of follow-up, method and frequency of dietary intake assessment, and risk of bias. Sensitivity analyses did not change these findings. Each 10 % increase in total UPF consumption was associated with a 13 % (n = 4 studies; HR 1.13, 95 % CI 1.08 to 1.18, I² = 37 %) increased risk of diabetes. Preliminary data from 4 cohort studies also suggest that high UPF consumption may be associated with complications in diabetic patients, including microvascular/cardiovascular disease, chronic kidney disease, and mortality.

Conclusion

UPF consumption is associated with a higher risk of incident diabetes and may contribute to its complications. Urgent public health efforts should prioritize the reduction of UPF consumption.