Background: Over the past 50 years, the consumption of ultra-processed food (UPF) has increased significantly, paralleling the rising trend in obesity. UPF has been shown to have numerous adverse health outcomes and is associated with various lifestyle-related diseases. Although the relationship between UPF and visceral adipose tissue has been explored, comprehensive analyses of UPF in relation to abdominal ultrasound parameters and glycemic parameters in patients with abdominal obesity and type 2 diabetes mellitus (T2DM) remain limited. Therefore, this study was conducted to investigate the aforementioned relationship in this specific patient population.

Methods: A retrospective study was conducted on 286 T2DM patients admitted to our hospital from January 2021 to December 2024, consisting of 172 patients with abdominal obesity. The T2DM patients with abdominal obesity were divided into two groups: low UPF intake group (n = 74) and high UPF intake group (n = 98). Spearman's rank correlation was used to assess associations between variables. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of relevant indicators in T2DM patients with or without abdominal obesity.

Results: There were no statistically significant differences in age, gender, hypertension, smoking status, alcohol consumption, Triglycerides (TG). Glycosylated hemoglobin (HbA1c), and interleukin-6 (IL-6) between the low UPF intake group and the high UPF intake group (p > 0.05). However, differences in Body Mass Index (BMI); Glucose (GLU); Total Cholesterol (TC), Hypersensitive C-reactive Protein (hsCRP), Subcutaneous Adipose Tissue (SAT), and visceral adipose tissue (VAT) were statistically significant (p < 0.05). Correlation analysis indicated that UPF intake was positively correlated with Glucose (GLU), TC, hsCRP, SAT, and VAT (r = 0.437, 0.287, 0.192, 0.372, 0.447; p < 0.05). Furthermore, BMI, SAT, VAT, and UPF intake significantly differed between patients with and without abdominal obesity (p < 0.05). Binary Logistics regression analysis revealed that SAT, VAT, and UPF intake were independent influencing factors for abdominal obesity in T2DM patients (p < 0.05). ROC analysis demonstrated that the area under the curve of the composite index was 0.799, with a standard error of 0.027 (95% CI: 0.747–0.852), a Youden index of 0.53, sensitivity of 70.35%, and specificity of 82.46%.

Conclusion: UPF intake is positively correlated with GLU, TC, hsCRP, SAT, and VAT, and the combination of UPF intake with SAT and VAT has a high predictive value for abdominal obesity in T2DM patients.