Very interesting study! Which diet score did you use to adjust for?
Hello! Thanks for your words! In this study, we used the Lifelines Diet Score (LLDS), which is a fully-evidenced based diet score developed according to the Dutch Dietary Guideline 2015.
Here is the paper by my colleague who developed the LLDS, if you are interested : D
Thanks for your reply! Can it also be used in other cohorts or is it especially developed for Lifelines?
Hello! I think it is possible to be used in other cohorts as well, as long as the intake data is available~ Or with identical/similar food groupings.
The LLDS score is based on the intake of 9 food groups with positive health effects (vegetables, fruit, whole grain products, legumes/nuts, fish, oils/soft margarines, unsweetened dairy products, coffee, and tea) and 3 food groups with negative health effects (red/processed meat, butter/hard margarines, and sugary beverages).
And did I understand correctly that you classified soft drinks as a warm savory snack?
Hello! Thanks for your question.
The “Warm Savory Snack” is actually the name that we gave to the identified ultra-processed food consumption pattern, based on the characteristics of this pattern. It’s a “name”, purely, for helping us easily recognize this pattern with its specific feature. xD
For this warm savory snack pattern, it was characterized by high intake of mayonnaise (both low fat and full fat), frietjes, meals from fast-food restaurants, warm savory snacks (such as croquettes, minced meat hotdogs, sausage rolls), and also soft drinks (sugar sweetened beverages). Hope this info helps!~
Nice presentation, thank you.
Do you consider bread an ultraprocessed food?
Hello! Thanks for your interesting question!
Actually, the “bread” is really an interesting one that worths a discussion.
According to the NOVA classification, if the bread is produced freshly from the bakery and unpacked, then it is processed food (NOVA level 3). However, if it is mass-produced packaged breads and buns, then it is ultra-processed food (NOVA level 4).
One “straightforward” example, if you go to Albert Heijn, then you will find both of them. The bread sold (in front of the small in-store bakery) is processed food (NOVA 3) with only flour, yeast, salt, water, and some other nuts/seeds. However, if you find bread (with a bit cheaper the price) on another shelf, then you will find the sliced bread is made with many E-products (additives) in it, then it is considered as ultra-processed food (NOVA level 4).
However, of course, according to our commonly-used FFQ for research, it is not really possible for us to distinguish clearly between those two different kinds of breads. But what we have illustrated in our study, is that, indeed even if it is categorized as ultra-processed food, then it seems that the bread is not associated with increased risk of type 2 diabetes – more or less a neutral effect. And we also consulted the consumption database in the Netherlands, it seems that the consumption of bread is more likely to be ultra-processed bread (NOVA level 4) compared to processed bread (NOVA level 3).
Hope this info help!~