PLoS Medicine (Apr 2017)

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

  • Huaidong Du,
  • Liming Li,
  • Derrick Bennett,
  • Yu Guo,
  • Iain Turnbull,
  • Ling Yang,
  • Fiona Bragg,
  • Zheng Bian,
  • Yiping Chen,
  • Junshi Chen,
  • Iona Y Millwood,
  • Sam Sansome,
  • Liangcai Ma,
  • Ying Huang,
  • Ningmei Zhang,
  • Xiangyang Zheng,
  • Qiang Sun,
  • Timothy J Key,
  • Rory Collins,
  • Richard Peto,
  • Zhengming Chen,
  • China Kadoorie Biobank study

DOI
https://doi.org/10.1371/journal.pmed.1002279
Journal volume & issue
Vol. 14, no. 4
p. e1002279

Abstract

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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 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.