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Higher ultra-processed food intake is associated with less time in euglycaemic range, unfavourable cardiometabolic risk factors and a less diverse faecal microbiome in 427 adults with type 1 diabetes

Higher ultra-processed food intake is associated with less time in euglycaemic range, unfavourable cardiometabolic risk factors and a less diverse faecal microbiome in 427 adults with type 1 diabetes

Lente C.H.M. Blok1,2*, Oluwatomisono I. Akinrimisi1, Maaike A. van Bree3, Meggie M.A. Schyns1, Jordi Dengerink1,2, Pleun de Groen1, Coco M. Fuhri Snethlage1, Erik Serné1,2, Elena Rampanelli1,4, Max Nieuwdorp1,2, Maarten R. Soeters3*, Nordin M.J. Hanssen1,2*

  1. Department of (Experimental) Vascular and Internal Medicine, Amsterdam UMC, Amsterdam, The Netherlands
  2. Diabeter Centrum Amsterdam, Amsterdam, The Netherlands
  3. Department of Endocrinology and Metabolism, Amsterdam UMC, Amsterdam, The Netherlands
  4. Amsterdam institute for immunology and infectious diseases, Amsterdam, The Netherlands

 

Background

Despite advances in insulin therapy and continuous glucose monitoring (CGM), adults with type 1 diabetes (T1D) face a significantly reduced life expectancy. Ultra-processed food (UPF) consumption may adversely affect prognosis in T1D, and is addressed in current ADA-EASD dietary guidelines. However, evidence specifically in T1D is severely limited. This study examined associations between UPF intake and glycaemic and cardiometabolic outcomes in adults with T1D.

Methods

In this cross-sectional analysis, 427 adults with T1D completed validated dietary records to determine the proportion of energy derived from UPF using the NOVA classification. We assessed glycaemic control using CGM data, metabolic and inflammatory biomarkers, and faecal microbiome composition with shotgun metagenomic and used multivariable regression models adjusted for age, sex, diabetes duration, BMI, insulin use, lifestyle, and dietary composition.

Results

UPF accounted for 53±18% of total energy consumption. Each standard deviation increase in UPF intake was associated with lower odds of achieving target glycaemic outcomes, including time in euglycaemic range (TIR>70%; OR 0.59[0.47-0.72]), glucose variability (GCV≤36%: OR 0.72[0.58-0.89]) and HbA1c (HbA1c<53 mmol/mol; OR 0.79[0.64-0.95]. These associations were attenuated after adjustment for dietary components. Higher UPF consumption was further associated with higher systolic blood pressure (β=1.80[0.18-3.42] mmHg per SD increase) and reduced faecal microbiome alpha diversity (ρ=-0.18).

Discussion/Conclusion

Higher UPF consumption was associated with worse glycaemic control and cardiometabolic markers, and reduced faecal microbiome diversity in adults with T1D. These findings highlight the importance of dietary quality in T1D management and support the need for interventional studies to clarify whether reducing UPF lowers comorbidity and mortality in T1D.