Fruit and Vegetable Intake and Risk of Type 2 Diabetes Mellitus: Meta-analysis of Prospective Cohort Studies

Overview

Journal BMJ Open

Specialty General Medicine

Date 2014 Nov 8

PMID 25377009

Citations 172

Authors

Min Li

Yingli Fan

Xiaowei Zhang

Wenshang Hou

Zhenyu Tang

Affiliations

Soon will be listed here.

Abstract

Objective: To clarify and quantify the potential dose-response association between the intake of fruit and vegetables and risk of type 2 diabetes.

Design: Meta-analysis and systematic review of prospective cohort studies.

Data Source: Studies published before February 2014 identified through electronic searches using PubMed and Embase.

Eligibility Criteria For Selecting Studies: Prospective cohort studies with relative risks and 95% CIs for type 2 diabetes according to the intake of fruit, vegetables, or fruit and vegetables.

Results: A total of 10 articles including 13 comparisons with 24,013 cases of type 2 diabetes and 434,342 participants were included in the meta-analysis. Evidence of curve linear associations was seen between fruit and green leafy vegetables consumption and risk of type 2 diabetes (p=0.059 and p=0.036 for non-linearity, respectively). The summary relative risk of type 2 diabetes for an increase of 1 serving fruit consumed/day was 0.93 (95% CI 0.88 to 0.99) without heterogeneity among studies (p=0.477, I(2)=0%). For vegetables, the combined relative risk of type 2 diabetes for an increase of 1 serving consumed/day was 0.90 (95% CI 0.80 to 1.01) with moderate heterogeneity among studies (p=0.002, I(2)=66.5%). For green leafy vegetables, the summary relative risk of type 2 diabetes for an increase of 0.2 serving consumed/day was 0.87 (95% CI 0.81 to 0.93) without heterogeneity among studies (p=0.496, I(2)=0%). The combined estimates showed no significant benefits of increasing the consumption of fruit and vegetables combined.

Conclusions: Higher fruit or green leafy vegetables intake is associated with a significantly reduced risk of type 2 diabetes.

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References

Hodge A, English D, ODea K, Giles G . Dietary patterns and diabetes incidence in the Melbourne Collaborative Cohort Study. Am J Epidemiol. 2007; 165(6):603-10. DOI: 10.1093/aje/kwk061. View

Morimoto A, Ohno Y, Tatsumi Y, Mizuno S, Watanabe S . Effects of healthy dietary pattern and other lifestyle factors on incidence of diabetes in a rural Japanese population. Asia Pac J Clin Nutr. 2012; 21(4):601-8. View

Eshak E, Iso H, Mizoue T, Inoue M, Noda M, Tsugane S . Soft drink, 100% fruit juice, and vegetable juice intakes and risk of diabetes mellitus. Clin Nutr. 2012; 32(2):300-8. DOI: 10.1016/j.clnu.2012.08.003. View

Zhang P, Zhang X, Brown J, Vistisen D, Sicree R, Shaw J . Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010; 87(3):293-301. DOI: 10.1016/j.diabres.2010.01.026. View

Carter P, Gray L, Troughton J, Khunti K, Davies M . Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ. 2010; 341:c4229. PMC: 2924474. DOI: 10.1136/bmj.c4229. View

Hamer M, Chida Y . Intake of fruit, vegetables, and antioxidants and risk of type 2 diabetes: systematic review and meta-analysis. J Hypertens. 2007; 25(12):2361-9. DOI: 10.1097/HJH.0b013e3282efc214. View

Esposito K, Kastorini C, Panagiotakos D, Giugliano D . Prevention of type 2 diabetes by dietary patterns: a systematic review of prospective studies and meta-analysis. Metab Syndr Relat Disord. 2010; 8(6):471-6. DOI: 10.1089/met.2010.0009. View

Li M, Hou W, Zhang X, Hu L, Tang Z . Hyperuricemia and risk of stroke: a systematic review and meta-analysis of prospective studies. Atherosclerosis. 2014; 232(2):265-70. DOI: 10.1016/j.atherosclerosis.2013.11.051. View

McKee L, Latner T . Underutilized sources of dietary fiber: a review. Plant Foods Hum Nutr. 2000; 55(4):285-304. DOI: 10.1023/a:1008144310986. View

10.

Cooper A, Sharp S, Lentjes M, Luben R, Khaw K, Wareham N . A prospective study of the association between quantity and variety of fruit and vegetable intake and incident type 2 diabetes. Diabetes Care. 2012; 35(6):1293-300. PMC: 3357245. DOI: 10.2337/dc11-2388. View

11.

Martinez-Gonzalez M, de la Fuente-Arrillaga C, Lopez-Del-Burgo C, Vazquez-Ruiz Z, Benito S, Ruiz-Canela M . Low consumption of fruit and vegetables and risk of chronic disease: a review of the epidemiological evidence and temporal trends among Spanish graduates. Public Health Nutr. 2011; 14(12A):2309-15. DOI: 10.1017/S1368980011002564. View

12.

Liu S, Serdula M, Janket S, Cook N, Sesso H, Willett W . A prospective study of fruit and vegetable intake and the risk of type 2 diabetes in women. Diabetes Care. 2004; 27(12):2993-6. DOI: 10.2337/diacare.27.12.2993. View

13.

Montonen J, Jarvinen R, Heliovaara M, Reunanen A, Aromaa A, Knekt P . Food consumption and the incidence of type II diabetes mellitus. Eur J Clin Nutr. 2005; 59(3):441-8. DOI: 10.1038/sj.ejcn.1602094. View

14.

von Ruesten A, Feller S, Bergmann M, Boeing H . Diet and risk of chronic diseases: results from the first 8 years of follow-up in the EPIC-Potsdam study. Eur J Clin Nutr. 2013; 67(4):412-9. DOI: 10.1038/ejcn.2013.7. View

15.

Yu R, Woo J, Chan R, Sham A, Ho S, Tso A . Relationship between dietary intake and the development of type 2 diabetes in a Chinese population: the Hong Kong Dietary Survey. Public Health Nutr. 2011; 14(7):1133-41. DOI: 10.1017/S136898001100053X. View

16.

Begg C, Mazumdar M . Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994; 50(4):1088-101. View

17.

Zhu Y, Zhang Y, Ling W, Feng D, Wei X, Yang C . Fruit consumption is associated with lower carotid intima-media thickness and C-reactive protein levels in patients with type 2 diabetes mellitus. J Am Diet Assoc. 2011; 111(10):1536-42. DOI: 10.1016/j.jada.2011.07.010. View

18.

Sluijs I, Beulens J, van der A D, Spijkerman A, Grobbee D, van der Schouw Y . Dietary intake of total, animal, and vegetable protein and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-NL study. Diabetes Care. 2009; 33(1):43-8. PMC: 2797984. DOI: 10.2337/dc09-1321. View

19.

Hozawa A, Jacobs Jr D, Steffes M, Gross M, Steffen L, Lee D . Associations of serum carotenoid concentrations with the development of diabetes and with insulin concentration: interaction with smoking: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Epidemiol. 2006; 163(10):929-37. DOI: 10.1093/aje/kwj136. View

20.

Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D . Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol. 2011; 175(1):66-73. PMC: 3244608. DOI: 10.1093/aje/kwr265. View