Background: Ultra-processed foods (UPFs) contribute to almost 60% of energy intake in the American diet. The longitudinal association between UPF consumption and cardiometabolic risk is less known, especially in people with type 1 diabetes mellites (T1DM) who are at a higher risk of developing cardiometabolic diseases than people without diabetes (non-DM).

Methods: We performed a longitudinal analysis of data from the Coronary Artery Calcification in Type 1 Diabetes study (T1DM: n=652; non-DM: n=764) collected at baseline and years 3, 6, and 14. Baseline age was 37.8±9.3 years. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire, and cardiometabolic biomarkers (BMI, waist circumference, triglycerides, HDL-C, LDL-C, and systolic and diastolic blood pressure) were measured at all four time points. NOVA food classification was used to compute UPF consumption (servings/d). Linear mixed-effects models were used to estimate longitudinal associations of UPF consumption with cardiometabolic risk, adjusting for potential confounders (race, age, sex, education, physical activity, smoking, energy intake, antihypertensive and lipid-lowering drugs, and diabetes duration for T1DM).

Results: People with T1DM consumed more UPFs, including processed meat, soft drinks, salty snacks, and margarine, than non-DM at baseline (8.7±7.8 vs. 7.3±6.7 servings/d, P<0.01). Higher UPF consumption was associated with higher anthropometric measures (BMI: β=0.01±0.01, waist circumference: β=0.03±0.01), worse lipid levels (triglycerides: β=0.21±0.09, HDL-C: β=-0.04±0.02), and higher systolic blood pressure (β=0.05±0.02) when adjusted for diabetes status and other covariates (all P<0.05).

Conclusion: UPF consumption significantly worsened the cardiometabolic profile over time in people with and without T1DM. Decreasing UPF intake may reduce the risk of developing cardiometabolic diseases across the lifespan.


T.Pang: None. A.C.Alman: None. H.L.Gray: None. G.Dagne: None. A.Basu: None. A.W.Buro: None. J.K.Snell-bergeon: None.


American Diabetes Association (7-13-CD-10 to J.K.S-B.), (7-13-CE-02 to A.C.A.); National Heart, Lung, and Blood Institute (R01HL079611, R01HL113029); Diabetes Endocrinology Research Center (P30DK57516, P30DK1116073)

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