Wellness
Replacing ultra-processed foods in diet reduces type 2 diabetes risk
People who eat more ultra-processed foods (UPF) are at increased risk of developing type 2 diabetes, but this risk can be lowered by consuming less processed foods instead, a new study has found.
The study investigated the relationship between the degree of food processing and type 2 diabetes risk, including which kinds of UPF were most high-risk.
The team analysed UPF intake and health outcomes for 311,892 individuals from eight European countries over 10.9 years on average, during which time 14,236 people developed type 2 diabetes.
They found that every 10 per cent increase in the amount of ultra-processed foods in a person’s diet is linked with a 17 per cent increase in type 2 diabetes risk, but this risk can be lowered by consuming less-processed foods instead.
The highest risk UPF groups were savoury snacks, animal-based products such as processed meats, ready meals, and sugar-sweetened and artificially-sweetened beverages, suggesting that particular attention should be paid to these foods to help tackle ill-health.
The degree of processing in foods is most often assessed using the Nova classification, which divides foods into four groups: unprocessed or minimally processed foods (MPF) such as eggs, milk, and fruit; processed culinary ingredients (PCI) such as salt, butter and oil; processed foods (PF) like tinned fish, beer and cheese; and ultra-processed foods such as ready-to-eat/heat mixed dishes, savoury snacks, sweets and desserts.
The exact causes of the link between UPF and type 2 diabetes are unconfirmed, though several factors are thought to be at play including overconsumption and weight gain. In a previous study, backed up by new analysis in this study, increased body fat accounted for around half the association.
Samuel Dicken, first author of the study from UCL Division of Medicine, said: “We know that ultra-processed foods are associated with a higher risk of certain diseases such as type 2 diabetes. As expected, our findings confirm this link and show that every 10 per cent increase in the diet from UPF increases the risk of developing type 2 diabetes considerably.
“Most studies to date only consider UPF as a whole, but we also suspect that there may be different risks associated with different types of UPF, and the risks of other processing groups have not been well researched.
“Our analysis goes a step further than previous studies, by looking at all four processing groups in the Nova classification to gauge the impact on type 2 diabetes risk when we substitute UPF with less processed foods, as well as looking at nine UPF subgroups.
“The good news is that replacing UPF with less processed foods was associated with a reduced type 2 diabetes risk.”
In the study, researchers from UCL analysed data from the EPIC study, which has investigated the relationship between diet, lifestyle, and environmental factors, and the incidence of chronic diseases in more than half a million Europeans over time.
Additional analysis on the data was performed to separate UPF into nine subgroups1 in order to better understand how level of processing affects type 2 diabetes risk.
Alongside analysing how eating UPF affected a person’s risk of developing type 2 diabetes, the researchers performed substitution modelling on the data to see how, theoretically, replacing one Nova food group with another would affect type 2 diabetes risk.
The results showed that substituting 10 per cent of UPF in the diet with 10 per cent of MPF/PCI reduced type 2 diabetes risk by 14 per cent.
Substituting 10 per cent of UPF in the diet with 10 per cent of PF reduced diabetes risk by 18 per cent. The authors say this may be down to the fact that 30 to 50 per cent of PF intake in this study came from beer and wine, which have been associated with a lower risk of type 2 diabetes in a previous EPIC study. PF also includes salted nuts, artisanal breads, and preserved fruits and vegetables.
Analysis of the nine UPF subgroups showed that savoury snacks, animal-based products, ready meals, and sugar-sweetened and artificially-sweetened beverages were associated with higher incidence of type 2 diabetes.
High proportions of these less healthy foods contributed to overall type 2 diabetes risk. In the top 25 per cent of UPF consumers, where UPF made up 23.5 per cent of their total diet, sweetened beverages alone accounted for nearly 40 per cent of their UPF intake and 9 per cent of their diet overall.
However, UPF breads, biscuits and breakfast cereals, sweets and desserts, and plant-based alternatives were associated with lower incidence of type 2 diabetes.
Professor Rachel Batterham, senior author of the study from UCL Division of Medicine, said: “The UPF subgroup analysis in this study has been revealing and confirms that not all foods categorised as UPF are alike in terms of the health risks associated with them.
“Breads and cereals, for example, are a staple of many people’s diets. Based on our results, I think we should treat them differently to savoury snacks or sugary drinks in terms of the dietary advice we provide.”
The authors say that, due to the observational nature of the study, it can only measure associations rather than causal effects.
The UCL team are currently conducting a trial to assess the impact of UPF versus MPF diets meeting healthy diet guidance, which will further clarify the results of this study. The results of this trial are expected to be published in 2025.
In 2023, the UK Scientific Advisory Committee on Nutrition (SACN) reviewed the available scientific evidence on UPFs and published a report stating that increased consumption of processed foods, particularly UPFs, was associated with an increased risk of health issues such as obesity, chronic diseases like type 2 diabetes, and depression.
The report also highlighted the need for additional research to understand the cause of these associations.
Professor Marc Gunter, an author of the study from Imperial College London and one of the coordinators of the EPIC study, said: “The findings from this study add to the growing body of research that links consumption of UPF with higher risk of certain chronic diseases including obesity, cardiometabolic diseases and some cancers.
“While such a study cannot determine causal relationships, it does suggest that reducing consumption of some UPF and replacing them with unprocessed, whole foods, might lower risk of type 2 diabetes. Further research to understand mechanisms and potential causal pathways is now needed.”
The study was led by researchers at UCL and was published in The Lancet Regional Health – Europe in collaboration with experts at the University of Cambridge and Imperial College London,
Gut-friendly foods such as kimchi and kombucha may carry hidden risks for heart health when eaten in excess, the British Heart Foundation (BHF) has warned.
The charity said foods marketed as prebiotic, probiotic or otherwise good for the gut can support the microbiome, but some may also be high in salt or sugar, which can raise the risk of cardiovascular disease.
Products highlighted by the British Heart Foundation included kimchi, kombucha, fruit yoghurts, smoothies and sauerkraut. It said there is no harm in including them as part of a healthy diet, but advised people to check labels for added salt and sugar and eat them in moderation.
Tracy Parker, the charity’s nutrition lead, said: “We encourage everyone to choose foods that can keep their gut microbiome healthy. The benefits are clear, and we are continuing to improve our understanding of how a gut-friendly diet may help our hearts.
“A lot of these products can contain high levels of salt or sugar though, so it is important to be aware of the potential drawbacks.
“By ensuring you check package labels for added salt and sugars, and eat each in moderation, you can make sure the risks do not outweigh the benefits for your heart health.”
Fermented foods such as kimchi and sauerkraut are rich in probiotics, the healthy bacteria produced during fermentation that can help support a diverse and healthy gut microbiome.
However, both are traditionally made using a lot of salt, which can raise blood pressure if eaten frequently or in large quantities. High blood pressure is known to increase the risk of heart attack and stroke.
Kombucha, a fermented tea, also contains probiotics and can be a healthier alternative to fizzy drinks, but many commercial and shop-bought versions contain added sugar.
Eating too much sugar can lead to weight gain, which can increase the risk of heart attack, stroke and other cardiovascular disease.
Fruit yoghurts can contain probiotic live bacteria cultures, but may also be high in sugar and have fewer live cultures than plain versions.
The charity said plain yoghurt with live and active cultures on the label can be a lower-sugar option, with whole fruit added at home for sweetness.
Smoothies made with whole fruits provide prebiotic fibre, which feeds beneficial gut bacteria and supports digestive health.
They can also provide vitamins and antioxidants, especially when made with a variety of plant-based ingredients.
But blending breaks down the structure of fruit, releasing free sugars that behave like added sugars in the body and can cause faster rises in blood sugar levels.
Regularly consuming too much sugar can lead to weight gain, which can increase the risk of developing type 2 diabetes, heart disease and kidney disease.
The charity said only one 150ml serving of any smoothie counts towards five-a-day, and suggested adding nuts or seeds for extra protein and fibre to help keep blood sugar levels more stable.
The BHF also noted that some shop-bought sauerkraut is pasteurised, which removes most of the live bacteria.
It advised checking the label, eating small portions and choosing unpasteurised products for those seeking the probiotic benefits.
The charity said beneficial gut bacteria produce short-chain fatty acids during digestion, which are linked to reduced inflammation, better metabolism and better heart and circulatory health.
These good bacteria also help digest polyphenols, natural plant chemicals thought to have antioxidant properties and which may help lower blood pressure.
By contrast, harmful gut bacteria, which thrive on diets high in fat and red meat, produce chemicals that can cause problems in the heart and blood vessels by increasing inflammation and altering how cholesterol is processed in the body.
Beneficial bacteria thrive on varied diets high in prebiotics, non-digestible fibres found in foods such as wholegrains, oats, beans, lentils, bananas and onions.
People with diabetes may have undiagnosed heart failure that could be detected by a simple screening blood test, research suggests.
The TARTAN-HF trial found that one in four patients with diabetes who had at least one other risk factor for heart failure had undiagnosed heart failure detected through screening with a blood test and ultrasound scanning of the heart.
Experts said the findings show the extent of unrecognised heart failure in people with diabetes, and how the condition can be detected using a widely available blood test called NT-proBNP, which measures how much strain the heart is under.
They suggest a heart failure screening programme for diabetics could improve diagnosis rates, lead to earlier treatment and potentially reduce the risk of hospitalisation and death.
The study, involving 700 patients, was led by the University of Glasgow in collaboration with AstraZeneca, Roche Diagnostics, Us2.ai, NHS Greater Glasgow and Clyde and NHS Lanarkshire.
Dr Kieran Docherty, clinical senior lecturer at the University of Glasgow’s School of Cardiovascular and Metabolic Health, said: “Our results from the landmark TARTAN-HF trial identified heart failure in a large proportion of people living with diabetes, emphasising the need for a heart failure screening strategy in this group of patients.
“We know that many of the symptoms and signs of heart failure are non-specific, and may go unrecognised as potentially being due to heart failure for a long time.
“The strategy used in our trial is simple and easy to implement in clinical practice, and will aid in the early identification of heart failure in people with diabetes, and facilitate the initiation of medications that we know improve outcomes in patients with heart failure.”
The study, which began more than three years ago, involved more than 700 people with diabetes from the two health board areas who had at least one other risk factor for heart failure.
They were randomly assigned either to receive heart failure screening or to continue with their usual care.
Researchers found screening uncovered a large number of previously unrecognised cases of heart failure. Around one in four, or 24.9 per cent, of those screened were found to have the condition within six months, compared with 1 per cent in the group continuing their usual care.
The study, involving patients with type 1 and type 2 diabetes, found almost all of the participants found to have heart failure had preserved ejection fraction, which can be difficult to detect without dedicated testing.
The findings of the TARTAN-HF trial were presented at the American College of Cardiology conference taking place from 28 to 30 March in New Orleans in the US.
Dr Edward Piper, medical director at AstraZeneca UK, said: “Delayed diagnosis and treatment of heart failure in people with type 2 diabetes contributes to poor long-term outcomes. TARTAN-HF demonstrates that targeted, risk-based screening can identify previously undiagnosed heart failure in approximately one in four high-risk patients with diabetes, enabling earlier intervention with guideline-directed therapy.”
Dr Christian Simon, head of global medical affairs at Roche Diagnostics, said: “We are proud to have supported the landmark TARTAN-HF trial. These findings demonstrate the transformative power of early, accessible diagnostics like the NT-proBNP blood test.
“By identifying unrecognised heart failure in people with diabetes, we enable clinicians to initiate appropriate treatments sooner, ultimately improving patient outcomes and lives.”
The UK has launched a £6.3m men’s health fund to back local projects aimed at helping men and boys live longer, healthier lives.
The Men’s Health Community Fund is a partnership between the Department of Health and Social Care, Movember and People’s Health Trust.
The government is contributing £3m, while the two charities are more than doubling that to take the total to £6.3m.
Grants will support community projects reaching underserved men and boys aged 16 and over, particularly in the most disadvantaged areas and at key points in their lives such as becoming a father, losing a job or retiring.
Projects could include support for new fathers, activities for men facing loneliness and social isolation, services to help young men engage with the health system, and support for men in work, out of work and moving into retirement.
The programme will bring together voluntary, community and social enterprise organisations to test new ways of reaching men who are least likely to use traditional health services.
An evaluation funded through the National Institute for Health and Care Research will assess what works and help inform future policy and delivery.
Health and social care secretary Wes Streeting said: “Too many men across the country are living shorter, less healthy lives, particularly those in our most disadvantaged communities.
“This new partnership will help men get the support they need in the places they feel most comfortable, their communities, among people they trust.
“By working with expert charities and local organisations, we can reach the men who are too often missed by traditional services and help them take better care of their mental and physical health.”
“It is a key step in delivering our first ever Men’s Health Strategy and driving forward our ambition to halve the gap in healthy life expectancy between the richest and poorest areas.”
The Men’s Health Strategy sets out plans to tackle the physical and mental health challenges men and boys face.
Men can be less likely to seek help and more likely to suffer in silence, while higher rates of smoking, drinking, gambling and drug use are damaging men’s health and affecting families, workplaces and communities.
The government is also investing £3.6m over the next three years in suicide prevention projects for middle-aged men in local communities across areas of England where men are most at risk, many of which are also among the most deprived. Suicide is one of the biggest killers of men under 50, and three-quarters of all suicides are men.
The projects will aim to break down barriers middle-aged men face in seeking support, including stigma around asking for help and a lack of awareness of what is available and how to access it.
They will be co-designed with experts and men with lived experience of mental health crises and suicidal thoughts.
Gut-friendly foods may damage heart, charity warns
Diabetes patients face increased risk of undiagnosed heart failure
UK government announces £6.3m fund to boost men’s health
Brain health collaboratory launches in Gulf South
