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August 18, 2025Open Access

Ultra-processed foods and diet quality in association with long-term weight change and progression to type 2 diabetes among individuals with a history of gestational diabetes mellitus – a prospective study

Key Points

Increased consumption of ultra-processed foods is associated with greater weight gain among women post-gestational diabetes.
1,040 cases of type 2 diabetes were identified, showing a positive correlation between ultra-processed food intake and diabetes risk.
Joint modeling of diet quality (AHEI) with ultra-processed foods indicated only stable lower intake and diet quality maintained weight over four years.
Findings highlight the need for dietary strategies to mitigate weight gain and diabetes risk in women with a history of gestational diabetes.

Abstract

Objective We examined the associations of overall and group-specific ultra-processed food (UPF) consumption with long-term weight change and T2D progression following gestational diabetes mellitus (GDM)-complicated pregnancies. Research Design and Methods We included 4,207 women with a history of GDM from the Nurses' Health Study II (1991–2021). UPF intake (servings/day) was assessed via food frequency questionnaires every 4 years and quantified per the NOVA classification. Diet quality was evaluated using the Alternate Healthy Eating Index-2010 (AHEI). Associations between UPF intake changes and weight changes (kg) were assessed using generalized estimating equations (GEE) (n=3,781). Cox regression models estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of habitual UPF intake modeled by time-updated cumulative averages with T2D risk. Joint associations of UPF and AHEI with weight change and T2D risk were examined, using the same GEE and Cox regression models, respectively. Results 1,040 T2D cases developed. Increased UPF consumption was associated with greater weight gain (p-trend

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