Ultra Processed Food and Diabetes: What the Research Says
An evidence-based review of peer-reviewed research examining the relationship between ultra-processed food consumption and type 2 diabetes risk. Covering landmark cohort studies, proposed biological mechanisms, and practical considerations.
Medical Disclaimer
This guide is for educational purposes only and is not medical or endocrinology advice. Type 2 diabetes risk is influenced by genetics, body weight, physical activity, age, ethnicity, and many factors beyond diet composition. The studies cited are primarily observational. If you have diabetes or are at risk, work with your endocrinologist, primary care physician, or certified diabetes educator for personalized management. Do not modify diabetes medications or treatment plans based on this information.
The Diabetes Epidemic and Ultra-Processed Food
Type 2 diabetes is one of the most significant public health challenges of the 21st century. According to the Centers for Disease Control and Prevention (CDC), approximately 37 million Americans have diabetes -- roughly 1 in 10 -- with about 90-95% of cases being type 2. An additional 96 million American adults have prediabetes, a condition of elevated blood sugar that substantially increases the risk of progressing to type 2 diabetes. Globally, the International Diabetes Federation estimates that 537 million adults are living with diabetes, a figure projected to rise to 783 million by 2045.
At the same time, consumption of ultra-processed foods has risen steadily across most high-income and many middle-income countries. In the United States, UPFs account for approximately 57-60% of total calorie intake in adults. This parallel rise has prompted researchers to ask a critical question: is ultra-processed food consumption an independent risk factor for type 2 diabetes, beyond the well-established contributions of excess sugar, caloric surplus, and obesity?
This guide examines what peer-reviewed, published research currently tells us about the relationship between UPF consumption and type 2 diabetes risk. We distinguish between well-established findings and preliminary evidence, highlight what confounders have been accounted for, and note where important questions remain unanswered. For a broader overview of UPF and health outcomes, see our comprehensive health effects guide.
Americans with diabetes
Americans with prediabetes
US calories from UPFs
Important context: The established risk factors for type 2 diabetes include obesity, physical inactivity, family history, age over 45, and certain ethnicities. These factors have stronger and more direct evidence than UPF consumption. The research question is whether ultra-processing adds an independent layer of risk beyond these known contributors.
Key Research Findings
Multiple large-scale prospective cohort studies have examined the relationship between ultra-processed food intake and type 2 diabetes incidence. The consistency of findings across different populations, countries, and research teams has been notable. Here are the most significant studies published to date.
NutriNet-Santé Cohort (Srour et al., 2020)
Journal: JAMA Internal Medicine, 2020
Participants: ~104,000 French adults, followed over a median of 6 years
Key finding: A 10% increase in the proportion of ultra-processed food in the diet was associated with a 15% higher risk of type 2 diabetes, after adjusting for BMI, caloric intake, diet quality, physical activity, smoking, and family history.
Significance: This was one of the first large studies to directly test UPF-diabetes associations while controlling for known confounders including overall diet quality and BMI.
EPIC-InterAct Study (Levy et al., 2023)
Journal: The Lancet Regional Health -- Europe, 2023
Participants: ~340,000 adults across eight European countries
Key finding: Found a dose-response association between UPF consumption and type 2 diabetes incidence. Higher UPF intake was associated with increased T2D risk even after adjusting for BMI, energy intake, and dietary quality indicators.
Significance: As one of the largest European cohort studies, it demonstrated that the association held across multiple countries with different dietary cultures and UPF consumption patterns.
UK Biobank Analysis
Participants: ~200,000 adults in the United Kingdom, prospective design
Key finding: Higher UPF consumption was significantly associated with increased type 2 diabetes incidence. The association showed a clear dose-response pattern, with each incremental increase in UPF proportion corresponding to higher diabetes risk.
Significance: The large sample size and detailed phenotyping in the UK Biobank allowed for robust adjustment for genetic predisposition, physical activity, alcohol consumption, and socioeconomic status.
US Nurses' Health Study
Participants: ~120,000 US female health professionals, followed for decades
Key finding: Higher consumption of ultra-processed foods was associated with increased type 2 diabetes risk over long follow-up periods, with sugar-sweetened beverages and processed meats showing the strongest individual associations within the UPF category.
Significance: As one of the longest-running dietary cohort studies in the world, it provides data on long-term UPF exposure and diabetes outcomes that shorter studies cannot.
Brazilian Cohort Studies
Significance: Brazil is where the NOVA classification system originated, and Brazilian national dietary surveys have used NOVA categorization since the early 2010s. This provides uniquely detailed, NOVA-classified dietary data.
Key findings: Multiple Brazilian cohort analyses have found that higher UPF consumption is associated with metabolic syndrome components, including elevated fasting glucose and insulin resistance, which are precursors to type 2 diabetes. These studies are important because they come from a population with different baseline dietary patterns than European or North American cohorts, strengthening the cross-cultural consistency of findings.
The Critical Question
The central unresolved question is whether UPF consumption increases type 2 diabetes risk independently of obesity, sugar intake, and total caloric consumption. Many UPFs are high in added sugars and refined carbohydrates -- both well-established diabetes risk factors. If UPFs increase diabetes risk primarily because they deliver excess sugar and calories, then the “ultra-processing” classification adds limited value beyond existing nutritional guidance. However, several of the studies above found associations that persisted after adjusting for BMI and energy intake, suggesting that processing-related factors may contribute independent risk. This remains an active area of investigation.
Evidence level: The 2024 BMJ umbrella review (Lane et al.) rated the evidence linking UPF consumption to type 2 diabetes as “convincing” -- the highest evidence grade for observational research. This reflects the consistency and volume of findings, but it does not mean causation has been proven. No randomized controlled trial has directly tested whether reducing UPF consumption prevents type 2 diabetes.
Research Summary
The following table summarizes key studies examining UPF consumption and type 2 diabetes risk, including what confounders each study accounted for and their primary limitations.
| Study | Year | Participants | Key Finding | Adjusted For | Key Limitation |
|---|---|---|---|---|---|
| NutriNet-Santé (Srour et al.) | 2020 | ~104,000 | 10% UPF increase associated with 15% higher T2D risk | BMI, caloric intake, diet quality, activity, smoking, family history | Self-reported dietary data; predominantly female participants |
| EPIC-InterAct (Levy et al.) | 2023 | ~340,000 | Dose-response association between UPF intake and T2D | BMI, energy intake, diet quality, education, physical activity | Baseline dietary assessment only; food supply changed over follow-up |
| UK Biobank | 2023 | ~200,000 | Significant dose-response association with T2D incidence | Genetic risk, BMI, activity, alcohol, socioeconomic status | Single-ethnicity bias (predominantly White British) |
| US Nurses' Health Study | Ongoing | ~120,000 | SSBs and processed meats strongest UPF diabetes predictors | BMI, total energy, lifestyle, family history, HRT use | Female-only cohort; health professional population |
| Brazilian cohort studies | Various | Various | UPF linked to metabolic syndrome components and insulin resistance | BMI, physical activity, socioeconomic indicators | Smaller sample sizes than European/US studies |
| BMJ Umbrella Review (Lane et al.) | 2024 | ~10 million (pooled) | Rated UPF-T2D evidence as “convincing” | Varied by included study; meta-analytic approach | Pooled heterogeneous studies; no RCTs included |
Reading this table: “Adjusted for” indicates what confounding variables the researchers controlled for statistically. More adjustments generally increase confidence that the observed association is not entirely explained by other factors. However, residual confounding -- the influence of unmeasured or imperfectly measured variables -- is always possible in observational research. No study can fully eliminate confounding without randomization.
Potential Mechanisms: How UPFs May Affect Diabetes Risk
Researchers have proposed several biological pathways through which ultra-processed food consumption may influence type 2 diabetes risk. Some of these mechanisms are well-established in nutrition science, while others are newer and require further investigation. Most are not unique to the UPF framework -- they overlap with existing knowledge about sugar, obesity, and metabolic health.
1. Glycemic Impact of Refined Carbohydrates
Many ultra-processed foods contain refined carbohydrates -- white flour, modified starches, and added sugars -- that produce rapid spikes in blood glucose after consumption. Repeated high glycemic loads over time can contribute to insulin resistance, a core feature of type 2 diabetes pathophysiology. Industrial processing often removes fiber and alters the food matrix in ways that increase the speed of carbohydrate digestion and absorption compared to whole-food equivalents.
Evidence level: Strong. The relationship between glycemic load and diabetes risk is well-established independently of the UPF framework.
2. Added Sugars and Sugar-Sweetened Beverages
Sugar-sweetened beverages (SSBs) are the single most consistently implicated UPF subcategory in diabetes research. A meta-analysis published in the BMJ found that regular SSB consumption was associated with a 26% higher risk of type 2 diabetes per one to two daily servings. The mechanism is relatively straightforward: liquid sugar delivers a high glycemic load with minimal satiety, leading to blood glucose spikes and, over time, increased insulin resistance. This relationship is well-established and recognized by the American Diabetes Association, WHO, and other health organizations.
Evidence level: Strong. This is the best-established dietary risk factor for T2D within the UPF category, supported by both observational and some interventional evidence.
3. Artificial Sweeteners and Glucose Metabolism
A widely discussed 2014 study by Suez et al., published in Nature, found that non-nutritive sweeteners (saccharin, sucralose, and aspartame) altered gut microbiome composition in mice and impaired glucose tolerance in a subset of human volunteers. Subsequent studies have produced mixed results -- some confirming effects on insulin sensitivity and glucose metabolism, others finding no significant impact at normal consumption levels. A 2022 randomized trial by the same research group found that saccharin and sucralose affected glycemic responses in humans, but the effects were modest and varied between individuals.
Evidence level: Moderate but mixed. Individual responses appear to vary significantly. More research is needed, particularly longer-term human studies.
4. The Obesity Pathway
Obesity is the single strongest modifiable risk factor for type 2 diabetes. The 2019 NIH feeding trial by Kevin Hall demonstrated that ultra-processed diets lead to increased calorie consumption and weight gain compared to unprocessed diets, even when matched for available nutrients. If UPFs promote weight gain through hyper-palatability, faster eating speed, and weaker satiety signaling, and obesity drives insulin resistance and beta-cell dysfunction, then UPF consumption may increase diabetes risk primarily through this indirect pathway. Several of the cohort studies found that the UPF-diabetes association was attenuated -- but not eliminated -- after adjusting for BMI, suggesting that obesity explains part but not all of the observed relationship.
Evidence level: Strong. The UPF-obesity link is supported by the NIH RCT. The obesity-diabetes link is one of the most established relationships in medicine.
5. Gut Microbiome and Insulin Sensitivity
Emerging research suggests that certain food additives commonly found in ultra-processed foods -- including emulsifiers, artificial sweeteners, and preservatives -- may alter the composition and function of the gut microbiome in ways that affect insulin sensitivity and glucose metabolism. Animal studies have shown that emulsifiers like polysorbate 80 and carboxymethylcellulose can disrupt the gut mucus layer and promote metabolic inflammation. Human evidence is more limited but growing, with some studies linking UPF-associated microbiome changes to markers of insulin resistance. For more on this topic, see our gut health guide.
Evidence level: Preliminary. Strong in animal models; human evidence is emerging but not yet sufficient for definitive conclusions.
6. Chronic Low-Grade Inflammation
Chronic low-grade inflammation is increasingly recognized as a contributor to insulin resistance and type 2 diabetes pathogenesis. Several studies have found that higher UPF consumption is associated with elevated inflammatory markers, including C-reactive protein (CRP) and interleukin-6 (IL-6). Proposed inflammatory triggers in UPFs include advanced glycation end-products (AGEs) formed during high-heat industrial processing, certain emulsifiers and preservatives, and trans fats (where still present). Whether these inflammatory effects are sufficient to meaningfully increase diabetes risk independently of obesity-related inflammation remains an open question.
Evidence level: Moderate. Consistent associations in observational studies; mechanistic pathways are biologically plausible but not fully established in humans.
Key takeaway: The mechanisms linking UPFs to diabetes risk are not mutually exclusive. In practice, a diet high in ultra-processed foods may simultaneously deliver excess sugar and refined carbohydrates, promote weight gain, alter the gut microbiome, and increase systemic inflammation. The relative contribution of each pathway -- and whether any operate independently of sugar and obesity -- remains under active investigation. See our ingredients to avoid guide for more on specific additives of concern.
UPF Categories by Sugar and Glycemic Impact
Not all ultra-processed foods affect blood sugar in the same way. The following table provides a general overview of how different UPF food categories compare in terms of added sugar content, typical glycemic impact, and the proportion of products classified as ultra-processed within each category. These are population-level averages and individual products vary significantly.
| Food Category | Avg Added Sugar | Typical Glycemic Impact | UPF Percentage |
|---|---|---|---|
| Beverages (sodas, energy drinks) | Very High (25-40g per serving) | High | ~85% |
| Breakfast Cereals | High (8-18g per serving) | High | ~90% |
| Baked Goods (cookies, pastries) | High (10-25g per serving) | High | ~80% |
| Snacks (chips, crackers) | Moderate (2-8g per serving) | Moderate | ~75% |
| Dairy (flavored yogurts, ice cream) | Moderate (8-20g per serving) | Moderate | ~60% |
| Condiments (ketchup, dressings) | Low-Moderate (2-8g per serving) | Low | ~70% |
Important Nuance: Not All UPFs Affect Blood Sugar Equally
A sugar-sweetened soda and a high-protein bar may both be classified as ultra-processed under the NOVA system, but their effects on blood glucose are fundamentally different. The soda delivers a rapid glucose spike with no fiber, protein, or fat to slow absorption. The protein bar, despite containing additives and sweeteners, may produce a much more moderate glycemic response due to its protein and fat content. This is one reason why researchers increasingly argue that UPF subcategory analysis is more informative than treating all UPFs as equivalent.
Practical note: If you are managing blood sugar or diabetes risk, the glycemic impact column is arguably more relevant than whether a food is technically classified as ultra-processed. A whole-grain bread with an emulsifier (technically a UPF) may have a lower glycemic impact than white rice (technically not a UPF). Context matters. Use our product search to check individual product scores and ingredients.
What Major Diabetes Organizations Recommend
It is worth noting what the leading diabetes and health organizations currently recommend regarding diet and diabetes prevention, and how those recommendations relate to ultra-processed food consumption.
American Diabetes Association (ADA)
The ADA's dietary guidelines emphasize eating patterns based on whole foods: non-starchy vegetables, fruits, whole grains, lean proteins, and healthy fats. They recommend limiting added sugars, refined carbohydrates, and sugar-sweetened beverages. The ADA does not currently use the NOVA classification or specifically target “ultra-processed foods” as a category, but their recommendations naturally align with reducing the highest-concern UPF subcategories. They emphasize that there is no single ideal dietary pattern for diabetes and that nutrition therapy should be individualized.
World Health Organization (WHO)
The WHO recommends limiting free sugar intake to less than 10% of total energy intake, with a conditional recommendation of below 5% for additional health benefits. In 2023, the WHO also recommended against using non-sugar sweeteners for weight management or disease prevention. While the WHO has acknowledged the growing research on ultra-processed foods, its formal dietary guidelines remain primarily nutrient-focused rather than processing-focused.
Diabetes Prevention Program (DPP)
The landmark Diabetes Prevention Program trial demonstrated that a combination of modest weight loss (5-7% of body weight), 150 minutes per week of physical activity, and improved diet quality reduced diabetes risk by 58% in high-risk individuals -- more effective than metformin alone (31% risk reduction). The dietary component focused on reducing total fat and calories rather than specifically targeting ultra-processed foods, but the practical effect of following this guidance would substantially reduce UPF consumption.
A Note on Complexity
Diabetes management and prevention are complex. They involve not just dietary changes but also physical activity, weight management, blood glucose monitoring, and -- for many people -- medication. Focusing exclusively on ultra-processed food avoidance while neglecting other evidence-based interventions would be a mistake. Diet is one component of a comprehensive approach, and within dietary changes, reducing added sugars and refined carbohydrates has more direct evidence for diabetes prevention than reducing “ultra-processing” per se.
Key observation: The recommendations from major diabetes organizations align with reducing UPF consumption without explicitly using the NOVA framework. This suggests that whether you frame your dietary goals in terms of “reducing ultra-processed foods” or “eating more whole foods and limiting added sugars,” the practical dietary changes are largely the same.
Practical Perspective
Given the current state of the evidence -- substantial, consistent, but primarily observational -- what practical conclusions can be drawn about ultra-processed food and diabetes risk? The following points aim to place the research in a realistic context for individuals concerned about their metabolic health.
Established Risk Factors Come First
Obesity, physical inactivity, family history, and age have stronger and more direct evidence as type 2 diabetes risk factors than UPF consumption. Achieving and maintaining a healthy weight and engaging in regular physical activity remain the most evidence-based lifestyle interventions for diabetes prevention. The Diabetes Prevention Program demonstrated that modest weight loss (5-7%) combined with 150 minutes of weekly exercise reduced diabetes risk by 58%.
Sugary Beverages Have the Clearest Evidence
If you are looking for a single high-impact dietary change for diabetes risk reduction, the evidence most clearly supports reducing or eliminating sugar-sweetened beverages. This is one area where the UPF research, traditional nutrition science, and major health organization guidelines all converge. SSBs deliver a high glycemic load in liquid form, bypass satiety mechanisms, and are consistently associated with increased T2D risk across virtually every study population examined.
Whole-Food Diets Have the Strongest Prevention Evidence
The Mediterranean diet and DASH diet have both demonstrated significant reductions in type 2 diabetes risk in large clinical trials and meta-analyses. These dietary patterns emphasize vegetables, fruits, whole grains, legumes, nuts, olive oil, and fish while naturally minimizing ultra-processed foods. Following these patterns does not require understanding the NOVA classification -- the practical result is similar. See our guide to reducing UPFs for transition strategies.
Reducing UPFs May Help Through Multiple Pathways
Even if UPF consumption does not increase diabetes risk independently of sugar, calories, and obesity, reducing UPF intake may still support diabetes prevention by reducing added sugar consumption, lowering refined carbohydrate intake, reducing overall caloric consumption (given UPFs' tendency to promote overeating), and increasing intake of whole foods that provide fiber, which slows glucose absorption. The practical benefit may be the same regardless of whether the mechanism is direct or indirect.
Not All UPFs Affect Blood Sugar Equally
A high-protein bar and a can of soda are both classified as ultra-processed, but their glycemic effects are fundamentally different. If diabetes risk is your primary concern, the sugar content, glycemic index, and overall nutritional profile of a food are likely more relevant than its NOVA classification alone. Focus on reducing the UPF subcategories most strongly linked to metabolic harm: sugary beverages, refined grain products, and heavily sweetened snacks. For specific product comparisons, see our food swaps guide and meal planning guide.
Final reminder: This guide summarizes published research on UPF consumption and type 2 diabetes risk. It is not a substitute for professional medical advice. Diabetes prevention and management require individualized care that accounts for your medical history, genetic risk, current health status, and lifestyle factors. If you have diabetes, prediabetes, or concerns about your metabolic health, please consult your endocrinologist, primary care physician, or certified diabetes educator for guidance specific to your situation.
Frequently Asked Questions
Does ultra-processed food cause type 2 diabetes?
Multiple large observational studies have found consistent associations between higher ultra-processed food consumption and increased type 2 diabetes risk. The 2024 BMJ umbrella review rated this evidence as "convincing." However, observational studies cannot prove causation. The observed associations may be partly explained by the high sugar, refined carbohydrate, and caloric content of many UPFs, as well as confounding factors like obesity, physical inactivity, and socioeconomic status. No randomized controlled trial has directly tested whether reducing UPF intake prevents diabetes. Consult your endocrinologist or primary care physician for personalized diabetes risk assessment.
Are sugar-sweetened beverages the main UPF concern for diabetes?
Sugar-sweetened beverages have the strongest and most consistent evidence linking them to type 2 diabetes risk of any single UPF subcategory. A meta-analysis published in the BMJ found that consuming one to two sugary drinks per day was associated with a 26% higher risk of developing type 2 diabetes compared to consuming less than one per month. This association has been demonstrated across multiple populations and study designs. While other UPF subcategories also show associations with diabetes risk, the evidence for sugary beverages is the most robust and is recognized by major diabetes organizations including the American Diabetes Association.
Do artificial sweeteners affect blood sugar or diabetes risk?
The evidence on artificial sweeteners and diabetes risk is mixed and evolving. A 2014 study published in Nature (Suez et al.) found that certain non-nutritive sweeteners altered gut bacteria and impaired glucose tolerance in some individuals. However, other studies have found no significant effects on blood glucose or insulin sensitivity at typical consumption levels. In 2023, the WHO recommended against using non-sugar sweeteners for weight management or disease risk reduction. The American Diabetes Association states that non-nutritive sweeteners can be used as a short-term replacement for sugar-sweetened beverages but should not be considered health-promoting. Discuss artificial sweetener use with your healthcare provider, especially if you have diabetes or prediabetes.
What diet is best for preventing type 2 diabetes?
The strongest evidence for dietary diabetes prevention comes from whole-food-based dietary patterns rather than from avoiding specific food categories. The Mediterranean diet and the DASH diet have both demonstrated significant reductions in type 2 diabetes risk in large clinical trials. The Diabetes Prevention Program, a landmark NIH-funded trial, showed that a combination of modest weight loss (5-7% of body weight), increased physical activity, and improved diet quality reduced diabetes risk by 58% in high-risk individuals. Reducing ultra-processed food intake may help by lowering added sugar, refined carbohydrate, and overall calorie consumption, but it should be part of a comprehensive approach. Work with a certified diabetes educator or registered dietitian for a personalized prevention plan.
If I have prediabetes, should I eliminate all ultra-processed foods?
A blanket elimination of all ultra-processed foods is neither necessary nor practical for most people with prediabetes. The research suggests that not all UPFs affect blood sugar equally -- sugar-sweetened beverages, refined grain products, and heavily sweetened snacks have stronger associations with diabetes risk than fortified breads or plain yogurts with stabilizers. The most evidence-based approach for prediabetes management involves reducing added sugars and refined carbohydrates, increasing fiber intake, achieving modest weight loss if overweight, and increasing physical activity. These changes naturally reduce consumption of the highest-concern UPF subcategories. Always work with your endocrinologist, primary care physician, or certified diabetes educator to develop a management plan tailored to your individual situation.
Continue Learning
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Disclaimer: All tools and data visualizations are provided for educational and informational purposes only. They are not intended as health, medical, or dietary advice. Product formulations change frequently — always check the actual label for current ingredients and nutrition facts before making purchasing decisions. Consult healthcare professionals for personalized dietary guidance.