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

Abstract

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.

Insulin resistance (HOMA-IR) and body fat (%) are associated to low intake of fruit and vegetables in Swedish, young adults: the cross-sectional lifestyle, biomarkers and atherosclerosis study

“…In China, and in many parts of the world, the relative high sugar content in fresh fruit have led to diminished fruit consumption in diabetic subjects. The findings of the Chinese study suggest that fresh fruit is beneficial for primary and secondary prevention of diabetes [25]. In a large study from Brazil, it was shown that among the dietary factors they studied a low intake of fruit, (< 300 g/day), was the largest contributor to cardiometabolic deaths.…”

“…In a large study, with results from different parts of the world, the importance of fruit and vegetable consumption, in relation to insulin resistance and diabetes have been pointed out [24]. Another example is a prospective Chinese study, 0.5 million Chinese adults were followed during 7 years to study the effect of fruit consumption on diabetes [25]. In China, and in many parts of the world, the relative high sugar content in fresh fruit have led to diminished fruit consumption in diabetic subjects.…”

Red meat, poultry and fish consumption and risk of diabetes: a 9 year prospective cohort study of the China Kadoorie Biobank

“…Baseline data collection in CKB Information on sociodemographic status, smoking [21], alcohol drinking, physical activity [22], medical history and diet [23,24] were collected by trained health professionals using a laptop-based questionnaire. Each participant provided a 10 ml venous blood sample (with time since last eating or drinking any energycontaining food or beverage recorded).…”

Associations between physical activity, sedentary behavior, and health risk behaviors among adolescents from a city in Southern Brazil

“…Poor diet, alcohol and tobacco use, low levels of PA and high levels of SB are related to obesity and cardiometabolic risk factors [2][3][4][5] , and their prevalence is high among adolescents 18 . This study found alarmingly low rates of fruit and vegetable consumption (over 70%), and high rates of alcohol (mild: 24.0%; excessive: 15.6%) and tobacco use (6.7%).…”

“…Adolescence is a period characterized by significant physical and psychological changes and during which several lifelong health related behaviors are adopted and established 1 . Youth establish values, beliefs and behaviors related to eating, smoking, alcohol drinking, and physical activity, and these interact to influence risk for obesity, diabetes and other chronic condition [2][3][4][5] . The high prevalence of unhealthy behaviors in adolescence is a major public health concern due to the tendency of behaviors to track into adulthood.…”