Impact of intra-category food substitutions on the risk of type 2 diabetes: a modelling study on the pizza category

Moufidath Adjibade, François Mariotti*, Pascal Leroy, Isabelle Souchon, Anne Saint-Eve, Guy Fagherazzi, Louis Georges Soler, Jean François Huneau

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

2 Citations (Scopus)
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Advice on replacing unhealthy foods with healthier alternatives within the same food category may be more acceptable and might ease the transition towards a healthy diet. Here, we studied the potential impact of substitutions within the pizza category on the risk of type 2 diabetes (T2D). The study sample consisted of 2510 adults from the INCA2 French national survey. Based on their nutritional characteristics, the 353 pizzas marketed in France were grouped into 100 clusters that were used to run various scenarios of pizza substitutions, which were either isoenergetic (IE) or non-isoenergetic (NIE). We then used a model structurally similar to the Preventable Risk Integrated ModEl to assess the expected rate of change in risk of T2D. Pizzas characterised by a low energy, high vegetable content and whole grain dough were associated with a greater reduction in the risk of T2D. The rates of change in risk of T2D were markedly stronger in men and for NIE substitutions. When the rates of change were estimated in the subsample of pizza consumers, replacing the observed pizzas with the best pizza resulted in a T2D risk reduction of-6·7 % (-8·4 %;-4·9 %, IE) and-8·9 % (-11·2 %;-6·3 %, NIE), assuming that this is their usual diets. The greatest risk reduction induced by an IE substitution of the observed pizza with a mixed dish was similar to that observed with the best pizzas. Overall, this modelling study suggests that healthy swaps within a category can effectively supplement broader dietary changes towards a healthier diet.

Original languageEnglish
Pages (from-to)1240-1249
Number of pages10
JournalBritish Journal of Nutrition
Issue number8
Early online date14 Jun 2021
Publication statusPublished - 28 Apr 2022


  • Food substitutions
  • Pizza categories
  • Public health
  • Type 2 diabetes


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