MON-600 - Association of Ultra-Processed Food Intake and HbA1c Among Normoglycemic and Prediabetic U.S. Adults: An Analysis of NHANES 2017-March 2020 Prepandemic

Background
Ultra-processed foods (UPFs), as defined by the NOVA classification system, have been increasingly implicated in adverse metabolic outcomes. Prediabetes represents a critical transitional state in glucose metabolism. Dietary behaviors may change following identification of dysglycemia, potentially influencing observed associations in cross-sectional studies. However, whether the association between UPF intake and glycemic markers varies by glycemic status remains unclear.

Methods
We conducted a cross-sectional analysis of adults aged 20–64 years participating in the National Health and Nutrition Examination Survey (NHANES) 2017–2018 and 2019–March 2020 prepandemic cycles. Participants with diagnosed diabetes, HbA1c ≥6.5%, pregnancy, or use of glucose-lowering medications were excluded. Ultra-processed food intake was quantified as the percentage of total daily energy intake derived from UPFs based on Day 1 dietary recall. Weighted linear regression models assessed the association between UPF intake (per 10% increase) and HbA1c, adjusting for age, sex, race/ethnicity, body mass index, total energy intake, poverty income ratio, and smoking status. Effect modification by glycemic status (normoglycemia vs. prediabetes) was evaluated using an interaction term.

Results
The analytic sample represented approximately 4660 U.S. adults, with a weighted mean age of 40.8 years; 20.4% had prediabetes. In adjusted models, UPF intake was not significantly associated with HbA1c among normoglycemic adults (β = 0.004 per 10% increase in UPF intake; p = 0.25). Prediabetes was independently associated with higher HbA1c levels (β = 0.60; p < 0.001). The association between UPF intake and HbA1c differed by glycemic status (p-interaction = 0.07), with evidence of effect modification by glycemic status, characterized by a differential association among adults with prediabetes.

Conclusions
The relationship between ultra-processed food intake and HbA1c varies by glycemic status. While UPF intake was not associated with HbA1c among normoglycemic adults, evidence of effect modification suggests a differential association among individuals with prediabetes. These findings highlight the importance of considering metabolic status when evaluating dietary exposures and glycemic outcomes. The observed associations may be influenced by dietary behavior changes following identification of prediabetes, a known limitation of cross-sectional studies.

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