TY - JOUR
T1 - Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes
T2 - EPIC-InterAct case-cohort study in eight European countries
AU - Zheng, Ju-Sheng
AU - Sharp, Stephen J
AU - Imamura, Fumiaki
AU - Chowdhury, Rajiv
AU - Gundersen, Thomas E
AU - Steur, Marinka
AU - Sluijs, Ivonne
AU - van der Schouw, Yvonne T
AU - Agudo, Antonio
AU - Aune, Dagfinn
AU - Barricarte, Aurelio
AU - Boeing, Heiner
AU - Chirlaque, María-Dolores
AU - Dorronsoro, Miren
AU - Freisling, Heinz
AU - El-Fatouhi, Douae
AU - Franks, Paul W
AU - Fagherazzi, Guy
AU - Grioni, Sara
AU - Gunter, Marc J
AU - Kyrø, Cecilie
AU - Katzke, Verena
AU - Kühn, Tilman
AU - Khaw, Kay-Tee
AU - Laouali, Nasser
AU - Masala, Giovanna
AU - Nilsson, Peter M
AU - Overvad, Kim
AU - Panico, Salvatore
AU - Papier, Keren
AU - Quirós, J Ramón
AU - Rolandsson, Olov
AU - Redondo-Sánchez, Daniel
AU - Ricceri, Fulvio
AU - Schulze, Matthias B
AU - Spijkerman, Annemieke M W
AU - Tjønneland, Anne
AU - Tong, Tammy Y N
AU - Tumino, Rosario
AU - Weiderpass, Elisabete
AU - Danesh, John
AU - Butterworth, Adam S
AU - Riboli, Elio
AU - Forouhi, Nita G
AU - Wareham, Nicholas J
PY - 2020/7/8
Y1 - 2020/7/8
N2 - OBJECTIVE: To investigate the association of plasma vitamin C and carotenoids, as indicators of fruit and vegetable intake, with the risk of type 2 diabetes.DESIGN: Prospective case-cohort study.SETTING: Populations from eight European countries.PARTICIPANTS: 9754 participants with incident type 2 diabetes, and a subcohort of 13 662 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort of 340 234 participants: EPIC-InterAct case-cohort study.MAIN OUTCOME MEASURE: Incident type 2 diabetes.RESULTS: In a multivariable adjusted model, higher plasma vitamin C was associated with a lower risk of developing type 2 diabetes (hazard ratio per standard deviation 0.82, 95% confidence interval 0.76 to 0.89). A similar inverse association was shown for total carotenoids (hazard ratio per standard deviation 0.75, 0.68 to 0.82). A composite biomarker score (split into five equal groups), comprising vitamin C and individual carotenoids, was inversely associated with type 2 diabetes with hazard ratios 0.77, 0.66, 0.59, and 0.50 for groups 2-5 compared with group 1 (the lowest group). Self-reported median fruit and vegetable intake was 274 g/day, 396 g/day, and 508 g/day for participants in categories defined by groups 1, 3, and 5 of the composite biomarker score, respectively. One standard deviation difference in the composite biomarker score, equivalent to a 66 (95% confidence interval 61 to 71) g/day difference in total fruit and vegetable intake, was associated with a hazard ratio of 0.75 (0.67 to 0.83). This would be equivalent to an absolute risk reduction of 0.95 per 1000 person years of follow up if achieved across an entire population with the characteristics of the eight European countries included in this analysis.CONCLUSIONS: These findings indicate an inverse association between plasma vitamin C, carotenoids, and their composite biomarker score, and incident type 2 diabetes in different European countries. These biomarkers are objective indicators of fruit and vegetable consumption, and suggest that diets rich in even modestly higher fruit and vegetable consumption could help to prevent development of type 2 diabetes.
AB - OBJECTIVE: To investigate the association of plasma vitamin C and carotenoids, as indicators of fruit and vegetable intake, with the risk of type 2 diabetes.DESIGN: Prospective case-cohort study.SETTING: Populations from eight European countries.PARTICIPANTS: 9754 participants with incident type 2 diabetes, and a subcohort of 13 662 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort of 340 234 participants: EPIC-InterAct case-cohort study.MAIN OUTCOME MEASURE: Incident type 2 diabetes.RESULTS: In a multivariable adjusted model, higher plasma vitamin C was associated with a lower risk of developing type 2 diabetes (hazard ratio per standard deviation 0.82, 95% confidence interval 0.76 to 0.89). A similar inverse association was shown for total carotenoids (hazard ratio per standard deviation 0.75, 0.68 to 0.82). A composite biomarker score (split into five equal groups), comprising vitamin C and individual carotenoids, was inversely associated with type 2 diabetes with hazard ratios 0.77, 0.66, 0.59, and 0.50 for groups 2-5 compared with group 1 (the lowest group). Self-reported median fruit and vegetable intake was 274 g/day, 396 g/day, and 508 g/day for participants in categories defined by groups 1, 3, and 5 of the composite biomarker score, respectively. One standard deviation difference in the composite biomarker score, equivalent to a 66 (95% confidence interval 61 to 71) g/day difference in total fruit and vegetable intake, was associated with a hazard ratio of 0.75 (0.67 to 0.83). This would be equivalent to an absolute risk reduction of 0.95 per 1000 person years of follow up if achieved across an entire population with the characteristics of the eight European countries included in this analysis.CONCLUSIONS: These findings indicate an inverse association between plasma vitamin C, carotenoids, and their composite biomarker score, and incident type 2 diabetes in different European countries. These biomarkers are objective indicators of fruit and vegetable consumption, and suggest that diets rich in even modestly higher fruit and vegetable consumption could help to prevent development of type 2 diabetes.
UR - http://www.scopus.com/inward/record.url?scp=85087737394&partnerID=8YFLogxK
U2 - 10.1136/bmj.m2194
DO - 10.1136/bmj.m2194
M3 - Journal article
C2 - 32641421
SN - 0959-8146
VL - 370
JO - The BMJ
JF - The BMJ
M1 - m2194
ER -