Li Li1, Hai-Yan Yang1, Yan Ma2, Xing-Huan Liang1, Ying-Fen Qin3, Zuo-Jie Luo4, Min Xu5,6, Jie Zhang1, Zhen-Xing Huang1, Li-Heng Meng1, Jia Zhou1, Jing Xian1, Ying-Jun Suo1, Song Huang1, Jin-Wei Cai1, Bi-Hui Meng1, Zhi-Yun Zhao5,6, Jie-Li Lu5,6, Yu Xu5,6, Tian-Ge Wang5,6, Mian Li5,6, Yu-Hong Chen5,6, Wei-Qing Wang5,6, Yu-Fang Bi5,6, Guang Ning5,6, Fei-Xia Shen7, Ru-Ying Hu8, Gang Chen9, Li Chen10, Lu-Lu Chen11, Hua-Cong Deng12, Zheng-Nan Gao13, Ya-Nan Huo14, Qiang Li15, Chao Liu16, Yi-Ming Mu17, Gui-Jun Qin18, Li-Xin Shi19, Qing Su20, Qin Wan21, Gui-Xia Wang22, Shuang-Yuan Wang5,6, You-Min Wang23, Sheng-Li Wu24, Yi-Ping Xu25, Li Yan26, Tao Yang27, Zhen Ye8, Xue-Feng Yu28, Yin-Fei Zhang29, Jia-Jun Zhao30, Tian-Shu Zeng11, Xu-Lei Tang31. 1. Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021, Guangxi, China. 2. Department of Ultrasonography, The First Affiliated Hospital of Guangxi Medical University, Nanning, China. 3. Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021, Guangxi, China. yingfenq@126.com. 4. Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021, Guangxi, China. zluo888@163.com. 5. Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 6. Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai, China. 7. The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. 8. Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China. 9. Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China. 10. Qilu Hospital of Shandong University, Jinan, China. 11. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 12. The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. 13. Dalian Municipal Central Hospital, Dalian, China. 14. Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China. 15. The Second Affiliated Hospital of Harbin Medical University, Harbin, China. 16. Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China. 17. Chinese People's Liberation Army General Hospital, Beijing, China. 18. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. 19. Affiliated Hospital of Guiyang Medical College, Guiyang, China. 20. Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. 21. The Affiliated Hospital of Southwest Medical University, Luzhou, China. 22. The First Hospital of Jilin University, Changchun, China. 23. The First Affiliated Hospital of Anhui Medical University, Hefei, China. 24. Karamay Municipal People's Hospital, Xinjiang, China. 25. Clinical Trials Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 26. Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China. 27. The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 28. Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 29. Central Hospital of Shanghai Jiading District, Shanghai, China. 30. Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China. 31. The First Hospital of Lanzhou University, Lanzhou, China.
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.
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.
Authors: Donna K Arnett; Roger S Blumenthal; Michelle A Albert; Andrew B Buroker; Zachary D Goldberger; Ellen J Hahn; Cheryl Dennison Himmelfarb; Amit Khera; Donald Lloyd-Jones; J William McEvoy; Erin D Michos; Michael D Miedema; Daniel Muñoz; Sidney C Smith; Salim S Virani; Kim A Williams; Joseph Yeboah; Boback Ziaeian Journal: Circulation Date: 2019-03-17 Impact factor: 29.690
Authors: Ju-Sheng Zheng; Stephen J Sharp; Fumiaki Imamura; Rajiv Chowdhury; Thomas E Gundersen; Marinka Steur; Ivonne Sluijs; Yvonne T van der Schouw; Antonio Agudo; Dagfinn Aune; Aurelio Barricarte; Heiner Boeing; María-Dolores Chirlaque; Miren Dorronsoro; Heinz Freisling; Douae El-Fatouhi; Paul W Franks; Guy Fagherazzi; Sara Grioni; Marc J Gunter; Cecilie Kyrø; Verena Katzke; Tilman Kühn; Kay-Tee Khaw; Nasser Laouali; Giovanna Masala; Peter M Nilsson; Kim Overvad; Salvatore Panico; Keren Papier; J Ramón Quirós; Olov Rolandsson; Daniel Redondo-Sánchez; Fulvio Ricceri; Matthias B Schulze; Annemieke M W Spijkerman; Anne Tjønneland; Tammy Y N Tong; Rosario Tumino; Elisabete Weiderpass; John Danesh; Adam S Butterworth; Elio Riboli; Nita G Forouhi; Nicholas J Wareham Journal: BMJ Date: 2020-07-08