Abstract Body: Background: The consumption of ultra-processed food may increase the risk of complications by adversely affecting cardiometabolic health. However, in persons with cardiometabolic disease such as type 2 diabetes, it is unclear whether ultra-processed food is associated with adverse outcomes.

Methods: We conducted a prospective cohort analysis in middle-aged adults with type 2 diabetes in the Atherosclerosis Risk in Communities study, with follow-up from 1987-1989 until December 31, 2021. Diabetes was defined as fasting blood glucose ≥126 mg/dL, non-fasting blood glucose ≥200 mg/dL, self-reported physician diagnosed diabetes, or use of diabetes medication. Ultra-processed food was defined according to the NOVA classification from a 66-item food frequency questionnaire. We used Cox models to examine the association between residual-adjusted quartiles of ultra-processed food consumption and incident cardiovascular outcomes (coronary heart disease, stroke, or heart failure), incident chronic kidney disease, and all-cause mortality.

Results: Among 1,624 participants (mean age of 56 years, 42% Black, 55% female), there were 1,398 deaths, 750 incident cardiovascular events, and 793 cases of incident chronic kidney disease over a median follow-up of 20 years. There were no significant differences in the risk of all-cause mortality, cardiovascular disease (overall and across subtypes), or chronic kidney disease across residual-adjusted quartiles of ultra-processed food consumption after adjusting for demographic, socioeconomic, and lifestyle characteristics (Table).

Conclusion: Among middle-aged adults with type 2 diabetes, higher levels of ultra-processed food consumption was not associated with higher risk of incident cardiovascular disease, chronic kidney disease, or mortality. In persons with cardiometabolic disease, consumption of ultra-processed food may not confer additional risk for major complications.