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

Autor: Du, Huaidong, Li, Liming, Bennett, Derrick, Guo, Yu, Turnbull, Iain, Yang, Ling, Bragg, Fiona, Bian, Zheng, Chen, Yiping, Chen, Junshi, Millwood, Iona Y., Sansome, Sam, Ma, Liangcai, Huang, Ying, Zhang, Ningmei, Zheng, Xiangyang, Sun, Qiang, Key, Timothy J., Collins, Rory, Peto, Richard, Chen, Zhengming
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Zdroj: PLoS Medicine
ISSN: 1549-1676
1549-1277
Popis: Background Despite 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 findings Between 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. Conclusion In 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.
Huaidong Du and colleagues study associations between fruit consumption and incidence of diabetes, along with complications of prevalent diabetes, in a Chinese population.
Author summary Why was this study done? Worldwide evidence on the relevance of fruit consumption for the occurrence and progression of diabetes is still limited, although most dietary guidelines, including those for diabetes patients, recommend a higher level of fruit consumption. Although fruit and vegetables are often considered together, fruit may not be viewed as being as healthy as fresh vegetables for individuals with diabetes, given its relatively high sugar content. This has led to frequent abstention from fruit consumption among individuals with diabetes in many parts of the world (e.g., China). No prospective evidence has been available thus far showing the potential long-term impacts of fresh fruit consumption on the incidence of diabetes and, among individuals with diabetes, on the risks of diabetes-related vascular complications. Reliable findings on these two relationships within a single large cohort would be important for health promotion. What did the researchers do and find? We recruited over 500,000 Chinese adults from ten diverse areas across China during 2004–2008. Participants completed a detailed questionnaire interview and underwent physical measurements and blood tests, with their health tracked subsequently for seven years. Among individuals who were free of diabetes (either previously diagnosed or newly detected) at the start of the study, daily consumption of fresh fruit was associated with a 12% lower relative risk of developing diabetes, compared to never or rarely consuming fresh fruit. In those individuals who already had diabetes prior to the start of the study, consuming fresh fruit more than three days a week was associated with a 17% lower relative risk of dying from any cause and a 13%–28% lower risk of developing diabetes-related complications affecting large blood vessels (e.g., ischaemic heart disease and stroke) and small blood vessels (i.e., kidney diseases, eye diseases, and neuropathy) than those who consumed fruit less than one day per week. What do these findings mean? To our knowledge, this is the first large prospective study demonstrating similar inverse associations of fruit consumption with both incident diabetes and diabetic complications. These findings suggest that a higher intake of fresh fruit is potentially beneficial for primary and secondary prevention of diabetes. For individuals who have already developed diabetes, restricted consumption of fresh fruit, which is common in many parts of the world, e.g., China and other Asian countries, should not be encouraged.
Databáze: OpenAIRE
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