Are all ultra-processed foods created equal? Relevance of food processing and nutritional quality

In over 70,000 adults from three Korean cohorts, Kim et al. observed that the highest (vs. lowest) quartile of ultra-processed food (UPF) intake was associated with an 11% (2–21%) increased risk of type 2 diabetes (T2D) [1]. This association persisted after adjustment for potential mediating effects of body mass index and diet quality. Kim et al. also conducted a meta-analysis of findings from this study and cohorts from Europe, the United Kingdom, the Americas, and the Middle East, observing a stronger association [excess relative risk (RR) for the highest vs. lowest categories of UPF intake: 26%; 16–36%] [1]. A cross-regional comparison showed a weaker magnitude in the UPF-T2D associations for non-Western compared to Western countries [1]. In addition, this meta-analysis observed divergent associations between specific UPF groups and T2D: only certain types of UPF defined by the Nova framework [2] were detrimental, whereas others, although highly processed, may exert neutral or protective effects. These findings have important implications for dietary recommendations and policies related to UPF, as well as methodological approaches in nutritional epidemiologic studies of UPF. …