Ultra-processed food, even if it’s seemingly healthy, is associated with higher cardiovascular disease (CVD) mortality in people with type 2 diabetes, a new study finds.
Even if something appears to be healthy, like fruit yogurt, people with diabetes may need to take a closer look at how processed the item is.
The new research, published last month in The American Journal of Clinical Nutrition, found that higher consumption of ultra-processed foods (UPFs) was associated with higher cardiovascular disease (CVD) mortality for people with type 2 diabetes, even when people’s diet quality was otherwise considered healthy.
Previous dietary recommendations for preventing and managing type 2 diabetes have focused almost exclusively on less processed, nutritionally balanced foods that fit into a dietary pattern like the Mediterranean or DASH diet, explained lead study author Marialaura Bonaccio, PhD, from the Department of Epidemiology and Prevention at the IRCCS Neuromed Mediterranean Neurological Institute.
But, even healthy foods may become problematic when exposed to high degrees of processing.
“Rating foods on the basis of their nutritional content alone is thought to have some important limitations since other non-nutritional aspects are relevant to health,” Bonaccio said.
Non-nutritional aspects include how many steps of processing are involved in taking a food from its original form to its finished state, or how many additives are used.
Think: vegetables that get turned into veggie chips or whole grains that are processed into granola bars.
“Our findings suggest that people with type 2 diabetes should not only pay attention to the nutritional composition of foods but also contextually limit consumption of UPFs,” Bonaccio said.
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In order to best understand the connection between ultra-processed foods and heart disease in people with type 2 diabetes, it’s helpful to realize that these individuals are more vulnerable to cardiovascular disease in general.
A 2018 study in Cardiovascular Diabetology found that overall CVD affects approximately 32.2% of all people with type 2 diabetes. This is compared to 5.5% prevalence in the general population, this number is quite high.
“People diagnosed with type 2 diabetes have twice the risk of developing CVD than those who do not have diabetes,” dietitian and certified diabetes educator Erin Palinski-Wade, RD, CDCES, LDN, CPT, author of 2 Day Diabetes Diet, told Health.
“Insulin resistance can increase the risk of CVD, and co-morbidities associated with diabetes including hypertension and obesity can further increase disease risk.”
When it comes to heart health in people with diabetes, diet matters—and, according to Bonaccio and her colleagues’ research, adding ultra-processed foods to the mix doesn’t help.
The researchers collected data on 1,065 participants with type 2 diabetes with an average follow-up of 11.6 years. Over that time, participants logged their food choices, which were analyzed for levels of processing using a classification system called NOVA.
“NOVA classification categorizes foods on the basis of the extent and purpose of processing, regardless of nutritional quality of foods,” Bonaccio said.
The study was able to identify 22 foods and beverages, including fruit yogurts, savory snacks, salty biscuits, aperitif biscuits, crackers, and carbonated drinks.
Participants were split up based on the amount of processed foods they regularly ate. Those with the highest consumption of ultra-processed foods had a 60% increased risk of dying from any cause; their risk of dying from cardiovascular disease was also more than double the risk of people who consumed less UPFs.
The study found that even when people reported adhering to a healthy, Mediterranean-style diet, this did not substantially change the effects of ultra-processed foods on their heart health.
Bonaccio explained that the nutritional content of the food isn’t the key focus here—it’s the non-nutritional factors like additives, contaminants from plastics, alterations to the food, etc. that seem to be associated with poor cardiovascular health outcomes.
Ultimately, the study suggests that the further from nature foods get, the more they may trigger heart disease in people with type 2 diabetes.
Since the average eater isn’t likely to have NOVA definitions on hand when grocery shopping, you may wonder how to identify foods that are ultra-processed.
Palinski-Wade defines ultra-processed foods as a form of processed food that has been altered to include added sugars, salt, fats (including oils), and starches.
“This can include commercially made breads and cereals, soft drinks, hot dogs, crackers, cookies, and some frozen foods (i.e. chicken nuggets),” she said.
A lengthy ingredient list is often a sign of ultra-processing, even if the item seems healthy. It’s helpful to take a look not only at the length of an ingredient list, but what it contains. If a food features numerous additives and unfamiliar ingredients, that’s a likely sign of ultra-processing.
Bonaccio and her team recommend people with type 2 diabetes limit ultra-processed foods for the sake of heart health. But in a world that runs on convenience, that can seem like an intimidating ask.
Fortunately, according to Palinski-Wade, ruthlessly eliminating all ultra-processed foods probably isn’t necessary.
“People with diabetes can absolutely include ultra-processed foods in their diet,” she said. “The real focus needs to be on how much of the diet is made up of ultra-processed foods as well as the level of processing these foods have undergone.”
For example, roasted salted nuts and pork rinds could both be considered ultra-processed, but they have vastly different effects on health.
Palinski-Wade also pointed out that the study looked at association, not causation. A variety of factors that influence heart disease risk in people with diabetes may not have been considered.
“A person who eats a large amount of ultra-processed foods may also include additional lifestyle factors that may contribute to an increase mortality risk,” she said. “For instance, they may consume a low overall intake of fruits and vegetables, or may be under high-stress levels, which leads to a lack of time to prepare foods at home or don’t exercise often.”
Ultimately, it’s best to limit ultra-processed foods, regardless of health status. But eating them occasionally probably won’t be a dealbreaker for your cardiovascular health.
“There is no need to panic or restrict these foods entirely,” Palinski-Wade said. “Having some of these foods as part of a balanced meal plan that is rich in whole foods, fiber, and slow-digested carbs can still promote blood sugar balance and fight against future disease.
