Cohort studyindependent cross-checkabstract checked I-UPF-108 standard review
Food processing and type 2 diabetes in Europe
Food consumption by degree of food processing and risk of type 2 diabetes mellitus: a prospective cohort analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC).
Overview
Dicken SJ et al.. Lancet Reg Health Eur 2024 · PMID 39529810 · DOI 10.1016/j.lanepe.2024.101043
Each 10% more of the diet from UPF was linked to 17% more type 2 diabetes, but some UPF groups such as breads and cereals were linked to less.
Does the study support the specific claim? Partly · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
To link processing level with diabetes.
- How was the study done?
Large European cohort.
- How many people, animals or samples were studied?
311,892 adults.
- What was actually found?
More UPF, more diabetes; heterogeneity by food group.
- How large was the observed effect?
HR 1.17 (1.14-1.19) per 10%.
- What do the results mean in everyday life?
Specific UPF matter more than the label.
- What are the study's limitations?
Observational.
- What does it say about Elawady's specific claim?
Supports T2D part of C-UPF-03.
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
Cannot prove causation.
Scientific in-depth review
1. Full reference
- Authors
- Dicken SJ et al.
- Journal
- Lancet Reg Health Eur
- Year
- 2024
- Identifier
- PMID 39529810 DOI 10.1016/j.lanepe.2024.101043 · PMC11551512
- Verification
- verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
COI statement in record (truncated here): first author receives royalties for a self-published book that mentions UPF and payments from Red Pen Reviews; other disclosures listed. Funding: International Agency for Research on Cancer.
2. Research question
Is degree of food processing associated with incident type 2 diabetes?
3. Study design and population
- Study design
- Cohort study – Prospective cohort analysis (EPIC)
- Population
European adults
- Country
European countries (EPIC; number not stated in abstract)
- Period
Average follow-up 10.9 years
- Sample size
311,892; 14,236 T2D cases
- Inclusion and exclusion criteria
EPIC participants
4. Methods and endpoints
- Exposure / intervention
Nova groups (% g/day)
- Comparator
Per 10% increment; substitution
- Endpoints
Incident T2D
- Statistical methods
Cox regression; substitution analysis; UPF subgroups
5. Actual results
- Results
Each 10% increment of UPF: T2D HR 1.17 (1.14-1.19). MPF+PCI HR 0.94 (0.92-0.96); processed food HR 0.92 (0.89-0.95). Heterogeneity: breads, biscuits and breakfast cereals, sweets and desserts, and plant-based alternatives associated with lower T2D.
- Absolute risks
not reported in abstract
- Authors' conclusion
Findings support recommendations to focus on reducing specific UPF to lower T2D risk.
6. Strengths
- Large, verified cases
7. Weaknesses
- Observational
- Single dietary assessment
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Observational.
9. Assessment of the statistical interpretation
Robust association; subgroup heterogeneity.
10. Relevance to the specific claim
Supports the T2D association; shows some UPF subgroups (including sweets and desserts) inversely associated.
11. Independent contrary findings
Subgroup heterogeneity.
12. Transferability to Germany and Europe
High.
13. Overall methodological judgement
Supports C-UPF-03 for T2D; argues for food-specific advice.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Explanation of inverse subgroups.