A prospective study of the association between quantity and variety of fruit and vegetable intake and incident type 2 diabetes

Abstract

Objective: The association between quantity of fruit and vegetable (F&V) intake and risk of type 2 diabetes (T2D) is not clear, and the relationship with variety of intake is unknown. The current study examined the association of both quantity and variety of F&V intake and risk of T2D.

Research design and methods: We examined the 11-year incidence of T2D in relation to quantity and variety of fruit, vegetables, and combined F&V intake in a case-cohort study of 3,704 participants (n = 653 diabetes cases) nested within the European Prospective Investigation into Cancer and Nutrition-Norfolk study, who completed 7-day prospective food diaries. Variety of intake was derived from the total number of different items consumed in a 1-week period. Multivariable, Prentice-weighted Cox regression was used to estimate hazard ratios (HRs) and 95% CIs.

Results: A greater quantity of combined F&V intake was associated with 21% lower hazard of T2D (HR 0.79 [95% CI 0.62-1.00]) comparing extreme tertiles, in adjusted analyses including variety. Separately, quantity of vegetable intake (0.76 [0.60-0.97]), but not fruit, was inversely associated with T2D in adjusted analysis. Greater variety in fruit (0.70 [0.53-0.91]), vegetable (0.77 [0.61-0.98]), and combined F&V (0.61 [0.48-0.78]) intake was associated with a lower hazard of T2D, independent of known confounders and quantity of intake comparing extreme tertiles.

Conclusions: These findings suggest that a diet characterized by a greater quantity of vegetables and a greater variety of both F&V intake is associated with a reduced risk of T2D.

Figure 1

The upper percentile of the first tertile for quantity and variety of F&V intake was used as the reference category. A: The association between quantity of F&V intake and HR (95% CI) of diabetes adjusted for sex, BMI, waist circumference, education level, Townsend Deprivation Index, occupational social class, physical activity level, smoking status, family history of diabetes, total energy intake, and season. B: Same as A but additionally adjusted for variety of F&V intake. C: The association between variety of F&V intake and HR (95% CI) of diabetes adjusted for sex, BMI, waist circumference, education level, Townsend Deprivation Index, occupational social class, physical activity level, smoking status, family history of diabetes, total energy intake, and season. D: Same as C but additionally adjusted for quantity of F&V intake.