Fruit intake decreases risk of incident type 2 diabetes: an updated meta-analysis

Li, Shuangshuang; Song, Miao; Huang, Yubei; Liu, Zhaolu; Tian, Huan; Yin, Xiuxiu; Tang, Weihong; Steffen, Lyn M.; Xi, Bo

doi:10.1007/s12020-014-0351-6

Cited by 49 publications

(41 citation statements)

References 34 publications

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“…Several prospective studies have previously assessed the association of fruit consumption with risk of diabetes, showing inconsistent findings [6,7,9,26–29]. For example, higher fruit consumption was significantly associated with diabetes incidence in the Nurses’ Health Study (with 6,358 cases) and a small Finnish study with 383 cases [6,30], with HRs of 0.82 (95% CI 0.72–0.92) and 0.69 (0.50–0.93), respectively, when comparing the highest with the lowest fruit consumption category.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the sugar content in fruit is generally higher than in vegetables, leading to concerns about its potential harmful impacts on diabetes [5]. A few prospective studies have tried to assess the effects of fruit intake on risk of diabetes, but the results have been inconsistent, with some studies showing a moderately strong inverse association [6,7] and others, including those in China [8] and in European populations [9], finding no association. Furthermore, there is very limited evidence about the effects of fruit consumption on risks of death and major vascular complications among people with established diabetes [10–12].…”

Section: Introductionmentioning

confidence: 99%

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Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults

Bennett

et al. 2017

PLoS Med

122

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BackgroundDespite the well-recognised health benefits of fresh fruit consumption, substantial uncertainties remain about its potential effects on incident diabetes and, among those with diabetes, on risks of death and major vascular complications.Methods and findingsBetween June 2004 and July 2008, the nationwide China Kadoorie Biobank study recruited 0.5 million adults aged 30–79 (mean 51) y from ten diverse localities across China. During ~7 y of follow-up, 9,504 new diabetes cases were recorded among 482,591 participants without prevalent (previously diagnosed or screen-detected) diabetes at baseline, with an overall incidence rate of 2.8 per 1,000 person-years. Among 30,300 (5.9%) participants who had diabetes at baseline, 3,389 deaths occurred (overall mortality rate 16.5 per 1,000), along with 9,746 cases of macrovascular disease and 1,345 cases of microvascular disease. Cox regression yielded adjusted hazard ratios (HRs) associating each disease outcome with self-reported fresh fruit consumption, adjusting for potential confounders such as age, sex, region, socio-economic status, other lifestyle factors, body mass index, and family history of diabetes. Overall, 18.8% of participants reported consuming fresh fruit daily, and 6.4% never/rarely (non-consumers), with the proportion of non-consumers about three times higher in individuals with previously diagnosed diabetes (18.9%) than in those with screen-detected diabetes (6.7%) or no diabetes (6.0%). Among those without diabetes at baseline, higher fruit consumption was associated with significantly lower risk of developing diabetes (adjusted HR = 0.88 [95% CI 0.83–0.93] for daily versus non-consumers, p < 0.001, corresponding to a 0.2% difference in 5-y absolute risk), with a clear dose–response relationship. Among those with baseline diabetes, higher fruit consumption was associated with lower risks of all-cause mortality (adjusted HR = 0.83 [95% CI 0.74–0.93] per 100 g/d) and microvascular (0.72 [0.61–0.87]) and macrovascular (0.87 [0.82–0.93]) complications (p < 0.001), with similar HRs in individuals with previously diagnosed and screen-detected diabetes; estimated differences in 5-y absolute risk between daily and non-consumers were 1.9%, 1.1%, and 5.4%, respectively. The main limitation of this study was that, owing to its observational nature, we could not fully exclude the effects of residual confounding.ConclusionIn this large epidemiological study in Chinese adults, higher fresh fruit consumption was associated with significantly lower risk of diabetes and, among diabetic individuals, lower risks of death and development of major vascular complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults

Bennett

et al. 2017

PLoS Med

122

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“…However, no association was found between habitual pre-pregnancy fruit consumption and GDM risk in the other paper, a cohort study involving 13,475 female US nurses13. In addition, previous studies of fruit consumption and T2D risk have yielded mixed conclusions9101112. In some cases, greater fruit consumption was found to reduce T2D risk1619202122, in others, no significant association was discovered12232425.…”

Section: Discussionmentioning

confidence: 83%

“…However, some kinds of fruit also contain high levels of sugar (e.g., fructose), the excessive intake of which is likely to be harmful to human health78. Epidemiological studies have generated mixed results regarding the relationship between fruit consumption and type 2 diabetes (T2D) risk9101112. Although the Nurses’ Health Study (NHS) II investigated the association between pre-pregnancy habitual fruit consumption and GDM risk, the specific effects of fruit consumption during pregnancy have not yet been examined13.…”

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confidence: 99%

Excessive fruit consumption during the second trimester is associated with increased likelihood of gestational diabetes mellitus: a prospective study

Huang

et al. 2017

Sci Rep

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This study aimed to investigate the association between fruit consumption during the second trimester and the occurrence of gestational diabetes mellitus (GDM). A prospective study with 772 female participants was conducted in China from April 2013 to August 2014. Dietary intake was assessed in face-to-face and telephone interviews using a 3-day food record. GDM was ascertained using a standard 75 g 2 hour oral glucose tolerance test. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for various confounders. Of the 772 participants, 169 were diagnosed with GDM during the period under study. Greater total fruit consumption during the second trimester was associated with a higher likelihood of GDM (highest vs. lowest quartile: adjusted OR4.82, 95% CI 2.38 to 9.76). Fruits with a moderate or high glycaemic index (GI) were positively associated with the occurrence of GDM. Fruit subgroups were also categorised by polyphenol content, and tropical-fruit and citrus-fruit consumption was found to be positively related to the occurrence of GDM. These findings suggest that the excessive consumption of fruit, especially fruit with moderate or high GI values, tropical-fruit and citrus-fruit, increases the likelihood of GDM.

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“…Furthermore, only small differences were found in dietary behavior in comparison with cohort members without diabetes [21,22]. Another study found nonlinear association of fruit intake with type 2 diabetes [23]. Muraki et al concluded that there was heterogeneity in the associations between individual fruit consumption and risk of type 2 diabetes [24].…”

Section: Introductionmentioning

confidence: 99%

Principal Component Regression Analysis of Nutrition Factors and Physical Activities with Diabetes

Wang¹,

Liu²,

Xie³

et al. 2017

J Biom Biostat

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The associations of nutrition factors and physical activities with adult diabetes are inconsistent; while most of these factors are inter correlated. The aims of this study are to overcome the disturbance of the multicollinearity of the risk factors and examine the associations of these factors with diabetes using the principal component analysis (PCA) and regression analysis with principal component scores (PCS). Totally, 659 adults with diabetes and 2827 non-diabetic were selected from the 2012 Health Information National Trends Survey (HINTS 4, Cycle 2). PCA was utilized to deal with multicollinearity of the risk factors. Weighted univariate and multiple logistic regression analyses were used to estimate the associations of potential factors and PCS with diabetes. The odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. The first 3 PCs for nutrition factors and physical activities could explain 70% variances. The first principal component (PC 1 ) is a measure of nutrition factors (fruit and vegetables consumption), PC 2 is a measure for physical activities (moderate exercise and strength training), and PC3 is about calorie information use and soda use. Weighted multiple logistic regression showed that African Americans, middle aged adults (45-64 years), elderly (65+), never married, and with lower education were associated with increased odds of diabetes. After adjusting for others factors, the PC 1 showed marginal association with diabetes (OR=0.84, 95% CI=0.70-1.01); while PC 2 and PC 3 revealed significant associations with diabetes (OR=0.73, 95% CI=0.61-0.86 and OR=0.85, 95% CI=0.74-0.99, respectively). In conclusion, PCA can be used to reduce the indicators in complex survey data. The first 3 PCs of nutrition factors and physical activities were associated with diabetes. Promotion of health food and physical activities should be encouraged to help decrease the prevalence of diabetes.

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Fruit intake decreases risk of incident type 2 diabetes: an updated meta-analysis

Cited by 49 publications

References 34 publications

Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults

Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults

Excessive fruit consumption during the second trimester is associated with increased likelihood of gestational diabetes mellitus: a prospective study

Principal Component Regression Analysis of Nutrition Factors and Physical Activities with Diabetes

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