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Tag: Diabetes Mellitus

  • Bariatric surgery outperforms traditional treatments for long-term diabetes control

    Bariatric surgery outperforms traditional treatments for long-term diabetes control

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    In a recent study published in the Journal of American Medical Association (JAMA), researchers from the United States of America (US) compared the safety, efficacy, and long-term outcomes of bariatric surgery and medical and lifestyle management in patients with type 2 diabetes mellitus (T2DM). They found that patients undergoing bariatric surgery had better glycemic control and higher remission rates at 7–12 years compared to medical management.

    Study: Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes. Image Credit: Terelyuk / ShutterstockStudy: Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes. Image Credit: Terelyuk / Shutterstock

    Background

    T2DM affects over 500 million adults globally, presenting significant economic burdens. Although bariatric surgery has shown superiority over medical and lifestyle therapies in treating the condition, limited randomized controlled trials (RCTs) with constraints in sample size and follow-up duration have hindered widespread recommendations. This has led to less than 1% of individuals with a body mass index (BMI) of 35 kg/m2 or higher considering surgical treatment. Despite advances in weight loss medications, their cost, uncertain long-term efficacy, and the need for prolonged use pose challenges.

    The Alliance of Randomized Trials of Medicine vs. Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) consortium conducted the most extensive pooled analysis to date, combining long-term observational data from four US single-center randomized trials. It aimed to assess bariatric surgery’s safety, durability, and efficacy compared to medical/lifestyle treatment for T2DM. At three years, the study revealed the superior and sustained effectiveness of bariatric surgery over medical/lifestyle intervention, even in individuals with a BMI of 25–35 kg/m2. In the present study, researchers report the extended follow-up results at 7–12 years after randomization.

    About the study

    The study included 262 T2DM patients with a BMI of 27–45 kg/m2. The mean age was 49.9 years, and 68.3% of them were female. Patients were randomized to undergo intensive medical and lifestyle management (n = 96), or bariatric surgery (Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding), and postoperative care (n =166). Based on self-reported racial information, about 31% of patients were Black, and 67.2% were White. While the study was conducted between 2007 and 2013, the observational follow-up was conducted until 2022.

    The study’s primary outcome was a between-group difference in the change (%) in glycated hemoglobin (HbA1c) from baseline to seven years, with extended data up to 12 years. The secondary outcomes were changes in HbA1c, changes in various metabolic and cardiovascular parameters, and diabetes remission, with a hypothesis favoring bariatric surgery over medical/lifestyle treatment. Adverse events were systematically collected, covering serious events and complications up to 12 years. The statistical methods involved the use of a linear mixed-effect model, inverse probability weighting, sensitivity analysis, and exploratory analyses.

    Results and discussion

    In spite of higher baseline values, the bariatric surgery group consistently maintained significantly lower HbA1c levels than the medical group, with a difference of -1.4% and -1.1% at seven years and 12 years, respectively. At seven years, HbA1c improvements were similar between Roux-en-Y gastric bypass and sleeve gastrectomy, while adjustable gastric banding showed less improvement than sleeve gastrectomy (P = .007) and Roux-en-Y gastric bypass (P = .03). As 25% of patients switched from medical management to surgery during the study, a per-protocol sensitivity analysis was conducted, which confirmed the main results.

    At one year, diabetes remission was achieved by 0.5% of patients in the medical group as compared to 50.8% in the surgery group. At seven years, remission rates were 6.2% vs. 18.2% in the medical group and surgery group, respectively, and the difference persisted at 12 years. HbA1c was found to be < 7% in 26.7% of patients in the medical group vs. 54.1% of those in the surgery group. Additionally, bariatric surgery resulted in significantly higher weight loss and rates of non-obesity at 7 and 12 years. The surgery group also experienced significantly reduced medication and insulin use as compared to the medical group. Further, the bariatric group showed significantly higher high-density lipoprotein (HDL) and lower triglycerides. No significant differences were observed for systolic blood pressure, low-density lipoprotein (LDL), serum creatinine, or urine albumin-to-creatinine ratio in the two groups at seven years. Adverse events were found to be similar between the groups, with increased gastrointestinal events in the surgery group.

    The study is strengthened by its larger sample size, diversity in sampling, inclusion of data on the most common surgical procedures, and longer follow-up compared to previous studies. However, the study is limited by its open-label design, heterogeneous treatments, missing data, lack of power for procedure-specific outcomes, and changes in surgical procedures and medication use during follow-up.

    Conclusion

    In conclusion, after 7 to 12 years, patients assigned to bariatric surgery demonstrated better glycemic control, reduced diabetes medication usage, and higher rates of diabetes remission compared to those on medical/lifestyle intervention. The findings endorse the employment of bariatric surgery as a viable treatment option for T2DM in individuals with obesity.

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  • AI-based model enhances efficiency of Type II diabetes prevention efforts

    AI-based model enhances efficiency of Type II diabetes prevention efforts

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    Better prevention of Type II diabetes could save both lives and money. The U.S. spends over $730 billion a year -; nearly a third of all health care spending -; on treating preventable diseases like diabetes.

    For the 98 million adults who are prediabetic and at risk of developing Type II diabetes, preventive treatments such as the drug metformin can help stave off the disease. But the medicines are expensive. With limited budgets, insurers and health care facilities need to allocate them to the patients they can help the most.

    Currently, a health provider calculates a patient’s risk of developing diabetes, using a simple charting tool. Patients whose risk scores exceed a predetermined threshold get enrolled in preventive care.

    Now, a new study from Texas McCombs has developed a novel tool for identifying those patients, based on artificial intelligence.

    Maytal Saar-Tsechansky, a professor of information, risk, and operations management, developed an AI- and machine learning-driven model to predict which patients are most likely to benefit from preventive treatment.

    Escalating health care costs necessitate more efficient and cost-effective approaches to disease prevention, particularly preventable diseases such as Type II diabetes.”


    Maytal Saar-Tsechansky, professor of information, risk, and operations management, Texas McCombs

    One hurdle for allocation models is that they’re often based on crude estimates of how a patient will benefit, she says. With Mathias Kraus of Friedrich-Alexander-Universität and Stefan Feuerriegel of the Munich School of Management, she leveraged a rich source of data to produce better assessments: electronic health records on 89,191 prediabetic patients from 2003 to 2012.

    The records came from a health insurer that wanted to improve care for patients at risk of developing Type II diabetes.

    When the researchers applied their decision model to the insurer’s data -; including body measurements, lab tests, disease codes, drug prescriptions, and sociodemographic information -; it improved both health and economic efficiency.

    • It prevented 25% more cases of Type II diabetes from developing than the use of traditional diabetes risk scores did.

    • It saved $2.9 million more per 10,000 patients than savings garnered through the traditional clinical baseline method.

    • If applied to the entire U.S. population, the model could save $1.1 billion annually in health care costs.

    “By enabling data-driven and cost-effective allocation of resources, this approach is instrumental in making preventive care more impactful,” Saar-Tsechansky says.

    The data-drive decision model could help prevent other conditions, she adds, such as respiratory diseases and cardiovascular disease, the leading cause of death in the U.S. It could improve patient outcomes for both, reducing long-term costs for the U.S. health care system.

    Using quality data, such as accurate electronic medical health records, could lead to another benefit: more customized approaches to health care.

    “For patients, especially those at risk for diseases such as Type 2 diabetes, our model means a more personalized and effective approach to preventive care,” Saar-Tsechansky says.

    “It suggests future preventive care could be more tailored to individual risk factors, increasing the effectiveness of interventions and potentially reducing the likelihood of disease onset.”

    Source:

    University of Texas at Austin

    Journal reference:

    Kraus, M., et al. (2023) Data-Driven Allocation of Preventive Care with Application to Diabetes Mellitus Type II. Manufacturing and Service Operations Management. doi.org/10.1287/msom.2021.0251.

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  • Spirulina shows promise in battling heart disease and diabetes

    Spirulina shows promise in battling heart disease and diabetes

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    In a recent study published in the journal Nutrients, a team of Italian researchers reviewed clinical and experimental findings from recent studies to understand the therapeutic contributions of Spirulina, also called blue-green cyanobacteria, in managing cardiovascular disease and its risk factors.

    Study: Beneficial Effects of Spirulina Supplementation in the Management of Cardiovascular Diseases. Image Credit: baibaz / ShutterstockStudy: Beneficial Effects of Spirulina Supplementation in the Management of Cardiovascular Diseases. Image Credit: baibaz / Shutterstock

    Background

    Although Spirulina has recently gained popularity as a ‘superfood’ because of its high nutritional content, the use of microalga in diet dates back to the ancient times of the Aztecs in Mexico. Spirulina is also known as blue-green cyanobacteria and are microscopic, photosynthesizing, filamentous microalgae of the genus Arthrospira, with A. plantensis and A. maxima being the two species most commonly used for their therapeutic and nutritional value.

    They grow in the tropics, in alkaline lakes with high bicarbonate and carbonate salt concentrations, although they have been known to survive in extremely cold temperatures. Spirulina is considered a ‘superfood’ because 60% to 70% of its dry weight is composed of protein, while it is also abundant in minerals, vitamins, carbohydrates, phycocyanin, carotenes, and fatty acids. As a nutraceutical, it has been added to various types of foods, including sports supplements and baby foods, while the pharmaceutical industry has popularized it in the form of capsules, dehydrated powders, and tablets.

    Therapeutic effects of Spirulina

    Research indicates that Spirulina exhibits a wide range of therapeutic effects such as anti-inflammatory, antidiabetic, antioxidant, hypolipidemic, and neuroprotective properties. The antioxidant properties are attributed mainly to the pigments phycocyanin, β-carotene, diatoxanthin, and diadinoxanthin found in Spirulina.

    Given its hypolipidemic and antioxidant properties, supplementation with Spirulina could be beneficial in lowering the risk of cardiovascular disease. Furthermore, diabetes, along with dyslipidemia and hypertension, is one of the risk factors for cardiovascular disease. Therefore, the present review examined how the cumulative health benefits of Spirulina could lower the overall risk of cardiovascular disease, which continues to be one of the major causes of mortality across the globe.

    Beneficial effects of Spirulina in CVDs.Beneficial effects of Spirulina in CVDs.

    Spirulina and hypertension

    The impact of Spirulina in lowering the risk of hypertension and stroke has been studied extensively in clinical trials, and the findings from these studies have shown that daily consumption of Spirulina, even added to foods such as salad dressing, significantly reduced the diastolic and systolic blood pressure.

    Consumption of Spirulina in the form of nutraceutical tablets also showed similar hypotensive results. Furthermore, animal studies using hypertensive rat models have shown that the high silicon content of Spirulina could be responsible for improving the elasticity of the arterial walls, along with angiotensin-converting enzyme-inhibiting properties that result in hypotensive effects.

    Antidiabetic effects of Spirulina

    Diabetes mellitus increases the risk of cardiovascular events such as heart failure, myocardial infarction, stroke, and peripheral vascular disease due to the micro- and macrovascular consequences of hyperglycemia. Cellular membrane integrity is also impacted by hyperglycemia, causing the peripheral tissues and liver to become insulin-resistant, increasing the generation of reactive oxygen species.

    In comparison to metformin, which is the standard treatment for hyperglycemia during diabetes, supplementation with Spirulina is believed to not only lower the levels of circulating glucose but also have a positive impact on lipid metabolism, which is linked to diabetes. The hypoglycemic and hypolipidemic properties of Spirulina are believed to have a cumulative effect in decreasing the risk of cardiovascular disease.

    The review discussed various clinical trials and studies using animal models of diabetes mellitus that have investigated the hypoglycemic properties of Spirulina and compared its efficacy in lowering blood sugar levels with that of metformin.

    While the mechanism through which Spirulina impacts blood glucose levels is not yet fully understood, the researchers believe that it could be influencing the secretion of insulin from the β-cells in the islets of Langerhans in the pancreas or further downstream, facilitating the transport of glucose from blood to all the peripheral tissue.

    Hyperlipidemia and Spirulina

    Spirulina has also demonstrated hypolipidemic properties by lowering the concentrations of low-density-lipoprotein cholesterol and triglycerides in the plasma while increasing the levels of high-density lipoprotein cholesterol, with the beneficial effects not being dose-dependent or toxic at high concentrations.

    Studies in animal models and overweight or obese human participants have reported significant benefits of Spirulina supplementation in lowering triglyceride levels, either as food additives or as nutraceutical pills or tablets. Spirulina was also found to be beneficial as an adjunct therapy to metformin in overweight diabetes patients.

    Conclusions

    Overall, this comprehensive review reported that consumption of Spirulina, either as an additive to regular foods or as a nutraceutical supplement, had numerous potential benefits, such as hypoglycemic, antioxidant, and hypolipidemic effects. However, the dosage and timing of Spirulina supplementation need to be standardized for optimal benefits in lowering the risk of cardiovascular disease.

    In conclusion, based on these data, more rigorous studies should be planned in the future aiming to address these critical questions, putting the foundations for developing a common guideline on “how and when” to use Spirulina.

    Journal reference:

    • Prete, V., Abate, A. C., Pietro, D., Lucia, D., Vecchione, C., & Carrizzo, A. (2024). Beneficial Effects of Spirulina Supplementation in the Management of Cardiovascular Diseases. Nutrients, 16(5). DOI: 10.3390/nu16050642, https://www.mdpi.com/2072-6643/16/5/642

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  • Risk of non-alcoholic fatty liver disease for cardiovascular disease and all cause death in patients with type 2 diabetes mellitus

    Risk of non-alcoholic fatty liver disease for cardiovascular disease and all cause death in patients with type 2 diabetes mellitus

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    In a recent study published in the British Medical Journal, researchers investigated the link between non-alcoholic fatty liver disease (NAFLD) in individuals with type 2 diabetes mellitus (T2DM) and all-cause death and cardiovascular disease. They found that individuals with NAFLD and T2DM show an increased risk of cardiovascular disease (CVD) and all-cause death.

    Study: Association of non-alcoholic fatty liver disease with cardiovascular disease and all cause death in patients with type 2 diabetes mellitus: nationwide population based study. Image Credit: Explode/Shutterstock.com
    Study: Association of non-alcoholic fatty liver disease with cardiovascular disease and all cause death in patients with type 2 diabetes mellitus: nationwide population based study. Image Credit: Explode/Shutterstock.com

    Background

    The prevalence of NAFLD is on the rise globally and is often associated with metabolic disorders involving insulin resistance. It poses a significant health concern due to its potential to lead to liver complications and CVD, which is a leading cause of mortality, especially among NAFLD patients.

    T2DM is a major risk factor for CVD and is closely linked to higher NAFLD prevalence and severity. The complex relationship between NAFLD and T2DM suggests a synergistic effect on cardiovascular risk, with a substantial proportion of T2DM patients also having NAFLD. However, studies examining their association with CVD have yielded mixed results. While some found no correlation, others demonstrated a doubled risk of CVD in T2DM patients with NAFLD compared to those without. Additionally, previous studies were limited by their cross-sectional designs and small sample sizes.

    To address this gap, researchers in the present study aimed to assess the risk of CVD and all-cause mortality associated with NAFLD in T2DM patients using a large-scale, population-based longitudinal approach.

    About the study

    This nationwide cohort study utilized data from the National Health Information Database linked t the National Health Screening Program. The exclusion criteria were age ≤ 20 years, consumption of ≥30 g/day alcohol, missing data, or a history of type 1 diabetes mellitus, chronic hepatitis B, and C, liver cirrhosis, hepatocellular carcinoma, or CVD. Additionally, patients who developed CVD within one year were also excluded.

    A total of 7,796,763 participants were selected, and the endpoint was the occurrence of all-cause death, CVD, or until 31 December 2018. CVD included myocardial infarction or ischemic stroke, confirmed through hospital admissions with corresponding claims for brain magnetic resonance imaging or computed tomography. The patients were followed-up for a median of 8.13 years.

    Data on anthropometric measurements and laboratory parameters were collected. Blood pressure was measured in a seated position, and fasting venous blood samples were taken to assess various parameters, including glucose, liver enzymes, lipid profile, and creatinine levels. Additionally, the estimated glomerular filtration rate was determined.

    Information on lifestyle factors such as smoking, alcohol consumption, regular exercise, and socioeconomic status was obtained through a standardized self-assessment questionnaire. Statistical methods included Cox proportional hazards models adjusted for various factors, Kaplan-Meier survival curves, and subgroup analyses.

    Results and discussion

    Among the participants, 6.49% of the participants had T2DM. Grade 1 and 2 NAFLD were found in 22.04% and 11.11% of participants, respectively. A higher proportion of T2DM patients had grade 2 NAFLD (26.73%) and grade 1 NAFLD (34.06%) compared to those without T2DM. Among participants with T2DM, 6.77% had CVD, and about 8.38% of participants died. In contrast, among those without T2DM, 2.24% had CVD, and about 2.71% of participants died.

    Incidence rates for CVD, myocardial infarction, ischemic stroke, and all-cause mortality increased with the severity of NAFLD and were higher in patients with T2DM than in those without. Hazard ratios for these outcomes were also higher with grade 1 and grade 2 NAFLD compared to no NAFLD, regardless of T2DM status. Moreover, the five-year absolute risk for these outcomes increased with NAFLD severity, particularly in patients with T2DM. Risk differences for CVD, myocardial infarction, ischemic stroke, and all-cause death were higher between no NAFLD and grade 2 NAFLD than between no NAFLD and grade 1 NAFLD. Additionally, these risk differences were higher in patients with T2DM compared to those without T2DM.

    NAFLD was linked to an increased risk of cardiovascular disease, myocardial infarction, ischemic stroke, and all-cause death in both T2DM and non-T2DM patients (p<0.001). Among NAFLD patients, those with grade 2 NAFLD exhibited the highest risk, followed by grade 1 NAFLD.

    Further, the incidence rates of CVD, myocardial infarction, ischemic stroke, and all-cause death increased sequentially from no NAFLD to grade 1 NAFLD and to grade 2 NAFLD across all age groups, with higher rates observed in T2DM patients.

    The study’s limitations include the use of the fatty liver index for NAFLD definition, lack of assessment of glycated hemoglobin variability and changes in diabetes drugs, limited generalizability to other ethnicities, and the inability to evaluate hepatic fibrosis.

    Conclusion

    In conclusion, patients with T2DM and even mild NAFLD have a higher risk of cardiovascular disease and all-cause death. The risk gap between no NAFLD and grade 1 or grade 2 NAFLD is more significant in T2DM patients than in those without. The findings emphasize the need for NAFLD screening and prevention in T2DM patients to reduce subsequent cardiovascular risk and mortality.

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  • Study may open up new ways of approaching metabolic diseases

    Study may open up new ways of approaching metabolic diseases

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    A study led by the University of Barcelona and the Biomedical Research Networking Center in Diabetes and Associated Metabolic Disorders (CIBERDEM) reveals how a new mechanism could improve the efficiency of currently available treatments for diabetes. The study, carried out on mice and cell cultures, may open up new ways of approaching metabolic diseases that are a global health problem.

    The study, published in the journal Metabolism, focuses on the GDF15 protein, a factor that is expressed at high levels in many diseases, such as heart failure, cancer and fatty liver disease. Obese patients also have elevated levels of this protein, but its function is altered and those affected may develop resistance to GDF15 — that is, a reduction in the effectiveness of its activity.

    The study is led by Professor Manuel Vázquez-Carrera, from the Faculty of Pharmacy and Food Sciences of the UB, the Institute of Biomedicine of the UB (IBUB), the Sant Joan de Déu Research Institute (IRSJD) and CIBERDEM. The study also highlights the participation of researchers Patricia Rada and ángela María Valverde, also collaborators at CIBERDEM, the Spanish National Research Council (CSIC) and the Autonomous University of Madrid (UAM). The work has the collaboration of Professor Walter Wahli of the University of Lausanne (Switzerland), among other experts.

    New alternatives to reduce glucose synthesis in the liver

    Our study reveals that GDF15 inhibits glucose synthesis in the liver. This pathway plays a decisive role in the generation of hyperglycemia (increased blood glucose levels) in patients with type 2 diabetes mellitus.”

    Professor Manuel Vázquez-Carrera

    “The action of the protein would also help reduce the presence of liver fibrosis, a condition associated with increased mortality in patients with fatty liver disease”, the researcher notes.

    The study reveals that mice deficient in GDF15 have glucose intolerance and low levels of AMPK protein in the liver, which is a sensor of energy metabolism in the cell against type 2 diabetes.

    Moreover, increased glucose synthesis in the liver (hepatic gluconeogenesis) was also detected in these study models, as well as increased liver fibrosis.

    All indications are that all the described alterations were triggered by increased hepatic levels of transforming growth factor-beta 1 (TGF-β1) and an SMAD3mediator protein, which are the main inducers of liver fibrosis. Thus, treatment with recombinant CDF15 can activate AMPK and decrease levels of active SMAD3 in mouse liver and in primary hepatocyte cultures.

    “In conclusion, the results indicate that GDF15 activates AMPK protein and inhibits hepatic gluconeogenesis and fibrosis through the reduction of the TGF-β1/SMAD3 pathway”, says Vázquez-Carrera.

    “These results suggest that modulation of GDF15 levels could be useful to improve the effectiveness of current anti-diabetic treatments, as hepatic gluconeogenesis is key in hyperglycaemia in patients with type 2 diabetes mellitus, and serum TGF-β1 levels are also increased in these patients”, concludes the researcher.

    Source:

    Journal reference:

    Jurado-Aguilar, J., et al. (2024). GDF15 activates AMPK and inhibits gluconeogenesis and fibrosis in the liver by attenuating the TGF-β1/SMAD3 pathway. Metabolism. doi.org/10.1016/j.metabol.2023.155772.

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  • Study links ultra-processed foods to higher metabolic disease risk

    Study links ultra-processed foods to higher metabolic disease risk

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    A recent Frontiers in Nutrition study assesses the association between metabolic diseases and the consumption of ultra-processed foods (UPFs). 

    Study: Ultra-processed food consumption and metabolic disease risk: An umbrella review of systematic reviews with meta-analyses of observational studies. Image Credit: JeniFoto / Shutterstock.com Study: Ultra-processed food consumption and metabolic disease risk: An umbrella review of systematic reviews with meta-analyses of observational studies. Image Credit: JeniFoto / Shutterstock.com

    Background

    Reducing the consumption of UPFs is typically recommended to prevent the development of metabolic diseases like type 2 diabetes mellitus (T2DM) and obesity. Metabolic diseases adversely affect organs, tissues, or cells and are caused by the decomposition and abnormal synthesis of certain substances during metabolism.

    The precise etiology of metabolic diseases remains unclear. Nevertheless, both environmental and genetic factors influence their occurrence, among which diet is an easily modifiable environmental factor.

    The NOVA food classification system defines UPFs as a class of foods arising from industrial formulations created from extracted substances, additives, and little intact food. Examples of UPFs include cakes, snacks, sausages, and sweetened beverages.

    Research has identified an association between various metabolic diseases and UPF consumption. However, some question this association, claiming that these relationships established in the literature are prone to biases.

    About the study

    The present study involved an umbrella review (UR), in which published systematic reviews were analyzed with meta-analyses to assess their credibility and validate the robustness of the relationship between metabolic disease and UPF consumption.

    The Web of Science, PubMed, Embase, and Cochrane Library databases were systematically searched until July 15, 2023. Language restrictions were not imposed, and citations of included studies were monitored to detect additional eligible studies.

    Articles involving laboratory and animal studies, as well as genetic polymorphisms, were excluded. Additionally, studies unable to obtain study-specific data, those without quantitative evaluations, and those that included fewer than three original studies were excluded from the meta-analyses. 

    Key findings

    An extensive overview of 13 meta-analyses was performed to evaluate the credibility of relationships between the consumption of UPFs and metabolic disease. To this end, all studies suggested that the consumption of UPFs was associated with the development of obesity and T2DM. 

    The highest level of UPF consumption and a 1.55-fold higher obesity risk were established in seven cross-sectional studies and several prospective cohort studies; therefore, UPF consumption could be considered a risk factor for obesity. These findings indicate that there may be health benefits associated with reducing the consumption of UPFs. This should be considered in the future by healthcare professionals and policymakers while formulating dietary guidelines.

    Two meta-analyses revealed a significant association between UPF consumption and T2DM, thus suggesting that consuming UPFs could be a risk factor for developing T2DM. Within UPFs, processed meat and sugar-sweetened beverages were strongly related to the risk of T2DM, with the dose of these UPFs potentially dictating this association.

    In the moderate and lowest meta-analysis, the association between T2DM and UPFs was supported by weak evidence. This association was insignificant in the Asian population. 

    The consumption of UPFs was also associated with an increased risk of non-alcoholic fatty liver disease (NAFLD), hypertension, and metabolic syndrome (MetS). However, these associations were not robust across subgroups, which necessitates the need for additional studies to explore these associations.

    Conclusions

    The current study provides evidence that the consumption of UPFs is associated with a greater risk of metabolic diseases, particularly obesity and T2DM. For other metabolic diseases, the associations should be explored further in future studies.

    The main strength of this study is the comprehensive assessment of the quality and credibility of each meta-analysis. In fact, this is the first UR to offer an extensive summary of the association between metabolic diseases and UPF consumption.

    One limitation of this study could be due to underlying studies lacking specific data or the exclusion of studies by previous meta-analyses. Future studies should address this concern by including other outcome variables, such as hyperuricemia and dyslipidemia. Residual confounding and measurement errors were also not considered due to the lack of randomized controlled trials. 

    Few underlying studies used the NOVA classification system to define UPFs, and some meta-analyses simultaneously included studies that used the NOVA system and those that did not. This made it difficult to maintain consistency while reporting findings and could have led to the misclassification of UPFs.

    The generalizability of the results could be questioned, as most studies were conducted in the United States, across several European countries, and Brazil. 

    Journal reference:

    • Lv, J., Wei, Y., Sun, J., et al. (2024) Ultra-processed food consumption and metabolic disease risk: An umbrella review of systematic reviews with meta-analyses of observational studies. Frontiers in Nutrition 11. doi:10.3389/fnut.2024.1306310

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