Changes in fruit, vegetable and juice consumption after the diagnosis of type 2 diabetes: a prospective study in men

Abstract

Given the importance of prevention of complications in type 2 diabetes (T2D), we aimed to examine changes over time in consumption of fruits, vegetables and juice among men who were diagnosed with T2D in comparison with men without diabetes. The prospective Cohort of Swedish Men, aged 45-79 years in 1997, was used to examine changes in diet after diagnosis of T2D. Dietary intake was assessed using FFQ in 1997 and 2009. In all, 23 953 men who were diabetes free at baseline (1997) and completed both FFQ were eligible to participate in the study. Diagnosis of T2D was reported by subjects and ascertained through registers. Multivariable linear mixed models were used to examine changes in mean servings/week over time. In total, 1741 men developed T2D during the study period. Increased consumption of vegetables and fruits was observed among those who developed T2D (equivalent to 1·6 servings/week, 95 % CI 1·08, 2·03) and men who remained diabetes free (0·7 servings/week, 95 % CI 0·54, 0·84). Consumption of juice decreased by 0·6 servings/week (95 % CI −0·71, −0·39) among those who developed T2D and increased by 0·1 servings/week (95 % CI 0·05, 0·15) in those who were diabetes free. Changes over time and between groups were statistically significant. Although improvements in diet were observed, only 36 % of those with T2D and 35 % of those without diabetes consumed ≥5 servings of fruits and vegetables/d in 2009.Key words: Diets: Change in diet: Type 2 diabetes: Prospective studies: Cohort studies Diet is an important and effective component in the treatment of type 2 diabetes (T2D) as it contributes to improved metabolic control and reduced risk of complications related to T2D (1)(2)(3) . Energy balance, metabolic goal and individual dietary preferences are recommended to be taken into account when supporting a healthy eating pattern (1)(2)(3) .Existing data indicate that the vast majority of those diagnosed with T2D do not make major lifestyle changes (4)(5)(6) and do not meet dietary recommendations (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) . However, cross-sectional studies also indicate that individuals with T2D differ from the general population with regard to diet (11)(12)(13)(14)(15)(16)18) . Individuals with diabetes tend to have a higher intake of protein and a lower intake of carbohydrates (11)(12)(13)(14)(15) , and they acquire more energy from fat (13,15,16) compared with individuals without diabetes. Moreover, those with diabetes have a higher intake of fruits (12,15,16) and vegetables (16,18) and a lower intake of juice (18) . To the best of our knowledge, the only studies exploring possible changes in diet due to the diagnosis of T2D in longitudinal settings observed that women in the Nurses' Health Study began consuming high-fat and low-sucrose diets after T2D diagnosis (15) , whereas no change in diet quality (using Alternative Healthy Eating Index) was observed among men and women in the Whitehall II study (19) . Even though reported differences in dietary patterns may point towards an atte...

Fruit and vegetable consumption and risk of COPD: a prospective cohort study of men

“…However, the FFQ used in this study had a relatively high validity. Moreover, consumption of fruits and vegetables in the studied cohort was relatively stable between 1997 and 2009 (increased only by 0.7 serving/week) 36. Nevertheless, any misclassification of fruit and vegetable consumption, because of the prospective design, would be non-differential and most likely have attenuated rather than exaggerated the true associations.…”

Consumption of fruit and vegetables and the risk of type 2 diabetes: a 4-year longitudinal study among Swedish adults

“…The interpretation regarding causality between vegetable intake and T2D should nevertheless be done with great caution, as one can only infer causality with certainty from randomised controlled trials (42) . Moreover, a misclassification between T2D and latent autoimmune diabetes of adults (43) , and of type 1 diabetes as T2D and vice-versa might have occurred. One major problem is the high rate of undiagnosed disease as about one-third of all diabetics have not yet received a diagnosis (19) .…”

Inadequate Vitamin C Status in Prediabetes and Type 2 Diabetes Mellitus: Associations with Glycaemic Control, Obesity, and Smoking

“…As dietary vitamin C contributes to plasma vitamin C concentrations, potential differences in the intake between those with normal glucose control and T2DM must also be considered. A prospective study of 48,850 men revealed that while the baseline consumption of fruit and vegetables was similar, men who developed T2DM increased their consumption of fruit and vegetables by 1.6 serves/week compared to an increase of 0.7 serves/week in those who remained diabetes free [ 12 ]. Therefore, it seems that people with T2DM are altering their diet in an attempt to manage their blood sugar.…”

“…Indeed, clinical advice to those newly-diagnosed with T2DM focuses on improving the diet. However, the dietary changes appear to be small and, furthermore, those with T2DM appear to have a similar intake of fruit and vegetables to those without T2DM [ 12 ].…”