Whole fresh fruit intake and risk of incident diabetes in different glycemic stages: a nationwide prospective cohort investigation

Abstract

Purpose Fruit intake is beneficial to several chronic diseases, but controversial in diabetes. We aimed to investigate prospectively the associations of whole fresh fruit intake with risk of incident type 2 diabetes (T2D) in subjects with different glucose regulation capacities. Methods The present study included 79,922 non-diabetic participants aged ≥ 40 years from an ongoing nationwide prospective cohort in China. Baseline fruit intake information was collected by a validated food frequency questionnaire. Plasma HbA1c, fasting and 2 h post-loading glucose levels were measured at both baseline and follow-up examinations. Cox proportional hazards models were used to calculate hazard ratio (HR) and 95% confidence intervals (CI) for incident diabetes among participants with normal glucose tolerance (NGT) and prediabetes, after adjusted for multiple confounders. Restricted cubic spline analysis was applied for dose–response relation. Results During a median 3.8-year follow-up, 5886 (7.36%) participants developed diabetes. Overall, we identified a linear and dose-dependent inverse association between dietary whole fresh fruit intake and risk of incident T2D. Each 100 g/d higher fruit intake was associated with 2.8% lower risk of diabetes (HR 0.972, 95%CI [0.949–0.996], P = 0.0217), majorly benefiting NGT subjects with 15.2% lower risk (HR 0.848, 95%CI [0.766–0.940], P = 0.0017), while not significant in prediabetes (HR 0.981, 95%CI 0.957–4.005, P = 0.1268). Similarly, the inverse association was present in normoglycemia individuals with a 48.6% lower risk of diabetes when consuming fruits > 7 times/week comparing to those < 1 time/week (HR 0.514, 95% CI [0.368–0.948]), but not in prediabetes (HR 0.883, 95% CI [0.762–1.023]). Conclusion These findings suggest that higher frequency and amount of fresh fruit intake may protect against incident T2D, especially in NGT, but not in prediabetes, highlighting the dietary recommendation of higher fresh fruit consumption to prevent T2D in normoglycemia population.

Dietary and other lifestyle factors and their influence on non-communicable diseases in the Western Pacific region

“…1 and Supplementary Table S2 summarize the key findings. Some main findings were: 1) decreased risk of DM was associated with increased dietary intakes of coarse grain, 7 , 8 fresh fruit, 9 , 10 , 11 wheat, 11 and vegetables, 8 , 11 while there was an increased risk with higher intakes of total fat and carbohydrates, 12 fish, 13 red meat, 11 , 13 , 14 and junk food 8 ; 2) CVD risks were lower with higher intakes of peanuts, 15 unprocessed meats, 16 and total fiber 17 ; 3) lower cancer risks were associated with several dietary patterns (i.e., the Alternative Healthy Eating Index updated in 2010, 18 an alternate Mediterranean diet score, 18 Dietary Approaches to Stop Hypertension [DASH], 18 a high-dairy and high-fruit-and-vegetable and low-alcohol pattern score, 19 and vegetable-fruit-soy pattern 20 ), food groups (i.e., higher intakes of milk, 21 , 22 red meat, 23 , 24 , 25 vegetables, 26 , 27 and fruits, 26 , 28 as well as lower consumption of grilled meat, 29 high-cholesterol foods, 29 and processed meat intake 30 ), some nutrients (i.e., lower sodium, 31 , 32 and saturated fat 33 ); and 4) a higher risk of COPD was associated with lower fish intake 34 and in those with a smoking history. 35 Please see more results in Supplementary Table S2 .…”

“…The DASH diet, Mediterranean dietary pattern, and vegetable and whole grain dietary pattern lower the risk of NCDs. 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 Moreover, increased whole grain intake was associated with decreased NCDs, but the intake of such nutritious foods in the Western Pacific region is decreasing. 75 While the availability and access to low-priced, ultra-processed, and energy-dense foods, including refined grains, are increasing as the result of rapid industrialization and globalization as well as national policies and standards that have prioritized safety over nutritional values and health promotion.…”

Association between dietary patterns and diabetic kidney disease in patients with type 2 diabetes mellitus and a mediational analysis: a cross-sectional study

“…However, these results have been inconsistent. Several meta-analyses and cohort studies have shown a negative correlation between fruits intake and the risk of diabetes mellitus [27][28][29] , whereas two studies conducted in European populations did not nd a correlation 30,31 . In our study, blood glucose levels were found to be one of the mediating effects between the 'nuts and fruits' dietary pattern and DKD.…”

The Practices and Glycated Hemoglobin Levels of Adults with Diabetic Neuropathy in Nakuru County, Kenya

“…For those with diabetes, foods with a low glycemic index, such as whole grains, non-starchy vegetables, legumes, and nuts, are best because they barely affect blood sugar levels (Forouhi et al, 2018). Studies have indicated that consumption of fresh or whole fruits was associated with a decreased risk of HbA1c among patients with diabetes (Du H et al, 2017;Li et al, 2023;Yu et al, 2022) substantial uncertainties remain about its potential effects on incident diabetes and, among those with diabetes, the risks of death and vascular complications. We aimed to assess the associations of fresh fruit consumption with the risk of incident diabetes and diabetic vascular complication.…”