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20 september 2024: Bron: The Lancet Regional Health Europa Online first d.d. September 16, 2024
Uit een langjarige observatiestudie blijkt dat mensen die veel ultra bewerkte voedingsmiddelen gebruiken in hun dagelijks voedingspatroon het risico op het krijgen van diabetes type 2 verhogen met 17 procent. Dat tonen de resultaten van een studie uitgevoerd in 8 Europese landen bij totaal 311.892 personen met een follow-up van 10,9 jaar.
De resultaten uit het abstract vertaalt in het Nederlands:
Gedurende een gemiddelde follow-up van 10,9 jaar van 311.892 personen werden 14.236 gevallen van diabetes type 2 geïdentificeerd. Elke toename van 10% van de totale dagelijkse voedselinname van ultra bewerkte voedingsmiddelen (UPF) (%g/dag) werd geassocieerd met 17% hogere incidentie van diabetes mellitus type 2 (95% betrouwbaarheidsinterval (95%BI): 1,14–1,19).
De wetenschappers ontdekten ook dat het verminderen van de hoeveelheid ultrabewerkt voedsel in het dagelijkse voedingspatroon, het risico op diabetes type 2 kan verlagen, aldus de onderzoekers in hun studieverslag.
Vervanging in het dagelijkse voedingspatroon van ultra bewerkte voedingsmiddelen (UPF) door onbewerkt/minimaal bewerkt voedsel (MPF), bewerkte culinaire ingrediënten (PCI), bewerkt voedsel (PF) werd geassocieerd met een lagere incidentie van diabetes type 2.
Het volledige studierapport is gratis in te zien. Klik op de titel van het abstract:
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)
Samuel J. Dickena samuel.dicken.20@ucl.ac.uk ∙ Christina C. Dahmb ∙ Daniel B. Ibsenb,c,d ∙ Anja Olsenb,e ∙ Anne Tjønnelande,f ∙ Mariem Louati-Hajjig∙ et al. Show more
Summary
Background
It is unknown whether the association between ultra-processed food (UPF) intake and type 2 diabetes mellitus differs from other degrees of food processing. We examined the association between degree of food processing and incident type 2 diabetes mellitus.
Methods
This was a prospective cohort analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC). Dietary intake was assessed at baseline using dietary questionnaires and classified according to the Nova classification into unprocessed/minimally processed food (MPF), processed culinary ingredients (PCI), processed food (PF) and UPF. Type 2 diabetes mellitus cases were verified through multiple methods. Cox regression and statistical substitution analysis was used to estimate associations between MPF + PCI, PF and UPF intake and incident type 2 diabetes mellitus. To investigate heterogeneity in the association between UPF and incident type 2 diabetes mellitus, UPF sub-group analysis was conducted. Different reference groups were used in each analysis.
Findings
Over an average 10.9 years follow-up of 311,892 individuals, 14,236 type 2 diabetes mellitus cases were identified. Each 10% increment of total daily food intake from UPF (%g/day) was associated with 17% (95% confidence interval (95%CI): 1.14–1.19) higher incident type 2 diabetes mellitus. Each 10% increment in MPF + PCI or PF intake was associated with lower incident type 2 diabetes mellitus (MPF + PCI hazard ratio: 0.94 (95%CI: 0.92–0.96); PF hazard ratio: 0.92 (95%CI: 0.89–0.95)). Replacing UPF with MPF + PCI or PF was associated with lower incident type 2 diabetes mellitus. However, heterogeneity was observed across UPF sub-groups, with breads, biscuits and breakfast cereals, sweets and desserts, and plant-based alternatives associated with lower incident type 2 diabetes mellitus.
Interpretation
These findings support recommendations to focus on reducing intake of specific UPF for lowering type 2 diabetes mellitus risk.
Funding
International Agency for Research on Cancer.
Research in context
Evidence before this study
PubMed was searched for peer-reviewed papers using: “ultra-processed food” AND “type 2 diabetes”, and: “Nova classification” AND “type 2 diabetes”, from conception until 28th May 2024 regarding prospective cohort associations between food processing according to the Nova classification and type 2 diabetes. Recent meta-analyses suggest increased risks of type 2 diabetes mellitus with greater UPF intake, with moderately convincing evidence for a dose–response association. However, less is known about whether the association between UPF intake and type 2 diabetes mellitus differs from other degrees of food processing.
Added value of this study
This is the first prospective study to examine the association between MPF + PCI, PF and UPF intake and incident type 2 diabetes mellitus. This study revealed contrasting associations between different degrees of food processing and incident type 2 diabetes mellitus, whereby replacing UPF with lower degrees of food processing was associated with lower incident type 2 diabetes mellitus. Importantly, this study identified that some UPF sub-groups were inversely associated with incident type 2 diabetes mellitus. Savoury snacks, animal-based products, ready-to-eat/heat mixed dishes and artificially- and sugar-sweetened beverages (ASB/SSB) were associated with higher incident type 2 diabetes mellitus, whereas breads, biscuits and breakfast cereals, sweets and desserts, and plant-based alternatives were associated with lower incident type 2 diabetes mellitus.
Implications of all the available evidence
The rising prevalence of type 2 diabetes mellitus is of concern across Europe, and worldwide. Our study provides important results that question the use of an overall UPF metric for public dietary guidance to reduce the risk of type 2 diabetes mellitus, and supports efforts to focus on reducing consumption of specific UPF.
Contributors
SJD, RLB, MJG, IH designed the analytical protocol, SJD performed the analyses and wrote the first draft of the manuscript. RLB, MJG and IH provided supervision. All authors were given the opportunity to comment on the analyses and provide comments on the manuscript. All authors have read and agreed to the final manuscript version.
Data sharing statement
This study used EPIC data provided by EPIC centres. Details on how to access EPIC data and biospecimens are available at: https://epic.iarc.fr/access/index.php.
Declaration of interests
SJD receives royalties from Amazon for a self-published book that mentions ultra-processed food, and payments from Red Pen Reviews. RLB is an employee of Eli Lilly and Company and reports honoraria from Novo Nordisk, Eli Lilly, Medscape, ViiV Healthcare Ltd and International Medical P and advisory board and consultancy work for Novo Nordisk, Eli Lilly, Pfizer, Gila Therapeutics Ltd, Epitomee Medical Ltd and ViiV Healthcare Ltd. All other authors declare no conflicts of interest.
Acknowledgements
We thank all EPIC study participants and staff for their contribution to the study. We acknowledge Nicola Kerrison (EPIC-InterAct Data Manager, MRC Epidemiology Unit) for data management.
Funding: SJD is funded by a Medical Research Council grant (MR/N013867/1). RLB is funded by the National Institute for Health and Care Research, Sir Jules Thorn Charitable Trust and Rosetrees Trust. Funding IIG_FULL_2020_033 was obtained from World Cancer Research Fund (WCRF UK), as part of the World Cancer Research Fund International grant programme.
The coordination of EPIC-Europe is financially supported by International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). Case ascertainment for type 2 diabetes in the EPIC study was done as part of the InterAct project that was supported by the: EU Sixth Framework Programme (FP6) (LSHM_CT_2006_037197) and the Medical Research Council Epidemiology Unit (MC_UU_00006/1).
The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave-Roussy, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di San Paolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), (The Netherlands); Health Research Fund (FIS) - Instituto de Salud Carlos III (ISCIII), Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology - ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (C8221/A29017 to EPIC-Oxford), Medical Research Council (MR/M012190/1 to EPIC-Oxford). The EPIC-Norfolk study received funding from Cancer Research UK (C864/A14136) and UK Medical Research Council (MR/N003284/1, MC-UU_12015/1 and MC_UU_00006/1) (United Kingdom). NGF, SJS and NJW are funded by the MRC Epidemiology Unit core support (MC_UU_00006/1 and MC_UU_00006/3). NGF and NJW acknowledge support from the National Institute for Health Research (NIHR∗) Cambridge Biomedical Research Centre (NIHR203312) and NGF is an NIHR Senior Investigator (NIHR202397). ∗The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Disclaimer: Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization.
Appendix ASupplementary data
Supplementary materials, Figs. S1–S7, and Tables S1–S15
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preventie, diabetes type 2, ultra bewerkte voedingmiddelen, Europese studie
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