Association between ultra-processed food consumption and depressive symptoms in individuals with type 2 diabetes

Ultra-processed food (UPF) consumption has been associated with adverse metabolic and mental health outcomes, yet evidence among individuals with type 2 diabetes mellitus (T2DM) remains limited. This study aimed to examine the association between UPF consumption and depressive symptoms among United States adults with T2DM. Data from 16,417,873 US. adults with T2DM were analyzed from the NHANES 2021–2023. UPF consumption was assessed using 24-h dietary recall and categorized according to the NOVA classification system. Depressive symptoms were measured using the 9-item Patient Health Questionnaire (PHQ-9), with scores ≥10 indicating moderate to severe symptoms. Multivariable logistic regression models were used to evaluate associations, adjusting for sociodemographic, lifestyle, and clinical factors. UPFs contributed 54.5% of total daily energy intake. Participants in the highest tertile of UPF consumption ( > 1441 kcal/day) had significantly greater odds of depressive symptoms compared to those in the lowest tertile ( < 847 kcal/day) (OR: 1.73; 95% CI: 1.72–1.73; p < 0.001). A graded positive association was observed across increasing tertiles of UPF intake. Participants with depressive symptoms also reported less physical activity, and either short or long sleep duration. Higher UPF consumption was associated with greater odds of depressive symptoms among US adults with T2DM. These findings highlight the potential relevance of integrated diabetes care approaches that address both dietary quality and mental health.