Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studiesBMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5001 (Published 29 August 2013) Cite this as: BMJ 2013;347:f5001
- Isao Muraki, research fellow1,
- Fumiaki Imamura, investigator scientist2,
- JoAnn E Manson, professor of medicine345,
- Frank B Hu, professor of nutrition and epidemiology135,
- Walter C Willett, professor of epidemiology and nutrition135,
- Rob M van Dam, associate professor16,
- Qi Sun, assistant professor15
- 1Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
- 2MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
- 3Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- 4Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- 5Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- 6Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Correspondence to: Q Sun
- Accepted 10 July 2013
Objective To determine whether individual fruits are differentially associated with risk of type 2 diabetes.
Design Prospective longitudinal cohort study.
Setting Health professionals in the United States.
Participants 66 105 women from the Nurses’ Health Study (1984-2008), 85 104 women from the Nurses’ Health Study II (1991-2009), and 36 173 men from the Health Professionals Follow-up Study (1986-2008) who were free of major chronic diseases at baseline in these studies.
Main outcome measure Incident cases of type 2 diabetes, identified through self report and confirmed by supplementary questionnaires.
Results During 3 464 641 person years of follow-up, 12 198 participants developed type 2 diabetes. After adjustment for personal, lifestyle, and dietary risk factors of diabetes, the pooled hazard ratio of type 2 diabetes for every three servings/week of total whole fruit consumption was 0.98 (95% confidence interval 0.96 to 0.99). With mutual adjustment of individual fruits, the pooled hazard ratios of type 2 diabetes for every three servings/week were 0.74 (0.66 to 0.83) for blueberries, 0.88 (0.83 to 0.93) for grapes and raisins, 0.89 (0.79 to 1.01) for prunes, 0.93 (0.90 to 0.96) for apples and pears, 0.95 (0.91 to 0.98) for bananas, 0.95 (0.91 to 0.99) for grapefruit, 0.97 (0.92 to 1.02) for peaches, plums, and apricots, 0.99 (0.95 to 1.03) for oranges, 1.03 (0.96 to 1.10) for strawberries, and 1.10 (1.02 to 1.18) for cantaloupe. The pooled hazard ratio for the same increment in fruit juice consumption was 1.08 (1.05 to 1.11). The associations with risk of type 2 diabetes differed significantly among individual fruits (P<0.001 in all cohorts).
Conclusion Our findings suggest the presence of heterogeneity in the associations between individual fruit consumption and risk of type 2 diabetes. Greater consumption of specific whole fruits, particularly blueberries, grapes, and apples, is significantly associated with a lower risk of type 2 diabetes, whereas greater consumption of fruit juice is associated with a higher risk.
Contributors: RMvD, FBH, and WC obtained funding from the National Institutes of Health. IM, RMvD, and QS designed this study. RMvD, QS, JEM, FBH, and WCW were involved in data collection. IM, FI, QS, and RMvD provided statistical expertise. IM analysed the data and wrote the first draft of the manuscript. All authors contributed to the interpretation of the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. IM and QS are the guarantors of this investigation.
Funding: This study was funded by research grants CA87969, CA176726, CA55075, CA50385, CA167552, DK58845, and DK082486 from the National Institutes of Health. Dr. Sun was supported by a career development award R00HL098459 from the National Heart, Lung, and Blood Institute. The funding sources had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The authors are not affiliated with the funding institutions.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The study protocol was approved by the institutional review boards of the Brigham and Women’s Hospital, and the Harvard School of Public Health. The completion of the self administered questionnaire was considered to imply informed consent.
Data sharing: No additional data available.
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