Skip to main content
SpringerLink
Log in

Fruit intake decreases risk of incident type 2 diabetes: an updated meta-analysis

  • Meta-Analysis
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Association between fruit intake and risk of type 2 diabetes is inconsistent. In this study, we performed a meta-analysis of all prospective cohort studies to clarify the association between fruit intake and risk of type 2 diabetes. Relevant studies were identified by searches of the PubMed and Embase databases up to November 2013. The summary relative risks of association were obtained using a fixed- or random-effects model. A total of nine prospective studies (403,259 participants, including 27,940 with incident type 2 diabetes) from seven publications were included in the meta-analysis of fruit intake and risk of type 2 diabetes. We found that individuals in the highest category of fruit intake had a reduced risk of type 2 diabetes (relative risk 0.92, 95 % confidence interval 0.86–0.97, p = 0.003) compared to those in the lowest category, with moderate evidence of between-study heterogeneity (I 2 = 37.6 %, p = 0.12). There was an evident non-linear association of fruit intake with type 2 diabetes (P for nonlinearity <0.001). A non-linear threshold of 200 g/day of fruit intake was identified and the risk of type 2 diabetes reduced by about 13 % at this cut-off. Our findings are consistent with diet recommendations to consume about 200 g/day of fruits to prevent type 2 diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

CI:

Confidence interval

HR:

Hazard ratio

RR:

Relative risk

References

  1. J.E. Shaw, R.A. Sicree, P.Z. Zimmet, Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res. Clin. Pract. 87, 4–14 (2010)

    Article  CAS  PubMed  Google Scholar 

  2. C.L. Gillies, K.R. Abrams, P.C. Lambert, N.J. Cooper, A.J. Sutton, R.T. Hsu, K. Khunti, Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ. 334, 299 (2007)

    Article  PubMed Central  PubMed  Google Scholar 

  3. L. Dauchet, P. Amouyel, S. Hercberg, J. Dallongeville, Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J. Nutr. 136, 2588–2593 (2006)

    CAS  PubMed  Google Scholar 

  4. F.J. He, C.A. Nowson, G.A. MacGregor, Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet. 367, 320–326 (2006)

    Article  PubMed  Google Scholar 

  5. D. Aune, D.S. Chan, A.R. Vieira, D.A. Rosenblatt, R. Vieira, D.C. Greenwood, T. Norat, Fruits, vegetables and breast cancer risk: a systematic review and meta-analysis of prospective studies. Breast Cancer Res. Treat. 134, 479–493 (2012)

    Article  CAS  PubMed  Google Scholar 

  6. J. Liu, J. Wang, Y. Leng, C. Lv, Intake of fruit and vegetables and risk of esophageal squamous cell carcinoma: a meta-analysis of observational studies. Int. J. Cancer 133, 473–485 (2013)

    Article  CAS  PubMed  Google Scholar 

  7. K.A. Meyer, L.H. Kushi, D.R. Jacobs Jr, J. Slavin, T.A. Sellers, A.R. Folsom, Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am. J. Clin. Nutr. 71, 921–930 (2000)

    CAS  PubMed  Google Scholar 

  8. S. Liu, M. Serdula, S.J. Janket, N.R. Cook, H.D. Sesso, W.C. Willett, J.E. Manson, J.E. Buring, A prospective study of fruit and vegetable intake and the risk of type 2 diabetes in women. Diabetes Care 27, 2993–2996 (2004)

    Article  PubMed  Google Scholar 

  9. J. Montonen, R. Järvinen, M. Heliövaara, A. Reunanen, A. Aromaa, P. Knekt, Food consumption and the incidence of type II diabetes mellitus. Eur. J. Clin. Nutr. 59, 441–448 (2005)

    Article  CAS  PubMed  Google Scholar 

  10. R. Villegas, X.O. Shu, Y.T. Gao, G. Yang, T. Elasy, H. Li, W. Zheng, Vegetable but not fruit consumption reduces the risk of type 2 diabetes in Chinese women. J. Nutr. 138, 574–580 (2008)

    PubMed Central  CAS  PubMed  Google Scholar 

  11. A.J. Cooper, N.G. Forouhi, Z. Ye, B. Buijsse, L. Arriola, B. Balkau, A. Barricarte, J.W. Beulens, H. Boeing, F.L. Büchner, C.C. Dahm, B. de Lauzon-Guillain, G. Fagherazzi, P.W. Franks, C. Gonzalez, S. Grioni, R. Kaaks, T.J. Key, G. Masala, C. Navarro, P. Nilsson, K. Overvad, S. Panico, J. Ramón Quirós, O. Rolandsson, N. Roswall, C. Sacerdote, M.J. Sánchez, N. Slimani, I. Sluijs, A.M. Spijkerman, B. Teucher, A. Tjonneland, R. Tumino, S.J. Sharp, C. Langenberg, E.J. Feskens, E. Riboli, N.J. Wareham, InterAct consortium. Fruit and vegetable intake and type 2 diabetes: EPIC-InterAct prospective study and meta-analysis. Eur. J. Clin. Nutr. 66, 1082–1092 (2012)

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. K. Kurotani, A. Nanri, A. Goto, T. Mizoue, M. Noda, M. Kato, M. Inoue, S. Tsugane, Japan Public Health Center-based Prospective Study Group. Vegetable and fruit intake and risk of type 2 diabetes: Japan Public Health Center-based Prospective Study. Br. J. Nutr. 109, 709–717 (2013)

    Article  CAS  PubMed  Google Scholar 

  13. I. Muraki, F. Imamura, J.E. Manson, F.B. Hu, W.C. Willett, R.M. van Dam, Q. Sun, Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ. 347, f5001 (2013)

    Article  PubMed Central  PubMed  Google Scholar 

  14. M. Hamer, Y. Chida, Intake of fruit, vegetables, and antioxidants and risk of type 2 diabetes: systematic review and meta-analysis. J. Hypertens. 25, 2361–2369 (2007)

    Article  CAS  PubMed  Google Scholar 

  15. P. Carter, L.J. Gray, J. Troughton, K. Khunti, M.J. Davies, Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ. 341, c4229 (2010)

    Article  PubMed Central  PubMed  Google Scholar 

  16. D.F. Stroup, J.A. Berlin, S.C. Morton, I. Olkin, G.D. Williamson, D. Rennie, D. Moher, B.J. Becker, T.A. Sipe, S.B. Thacker, Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 283, 2008–2012 (2000)

    Article  CAS  PubMed  Google Scholar 

  17. Wells GA, Shea B, O’connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed October 2013

  18. R. DerSimonian, N. Laird, Meta-analysis in clinical trials. Control. Clin. Trials 7, 177–188 (1986)

    Article  CAS  PubMed  Google Scholar 

  19. N. Mantel, W. Haenszel, Statistical aspects of the analysis of data from retrospective studies of disease. J. Natl. Cancer Inst. 22, 719–748 (1959)

    CAS  PubMed  Google Scholar 

  20. J.P. Higgins, S.G. Thompson, J.J. Deeks, D.G. Altman, Measuring inconsistency in meta-analyses. BMJ. 327, 557–560 (2003)

    Article  PubMed Central  PubMed  Google Scholar 

  21. S. Greenland, M.P. Longnecker, Methods for trend estimation from summarized dose–response data, with applications to meta-analysis. Am. J. Epidemiol. 135, 1301–1309 (1992)

    CAS  PubMed  Google Scholar 

  22. N. Orsini, R. Bellocco, S. Greenland, Generalized least squares for trend estimation of summarized dose–response data. Stata J. 6, 40–57 (2006)

    Google Scholar 

  23. Y. Rong, L. Chen, T. Zhu, Y. Song, M. Yu, Z. Shan, A. Sands, F.B. Hu, L. Liu, Egg consumption and risk of coronary heart disease and stroke: dose–response meta-analysis of prospective cohort studies. BMJ. 346, e8539 (2013)

    Article  PubMed Central  PubMed  Google Scholar 

  24. D.E. Threapleton, D.C. Greenwood, C.E. Evans, C.L. Cleghorn, C. Nykjaer, C. Woodhead, J.E. Cade, C.P. Gale, V.J. Burley, Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. BMJ. 347, f6879 (2013)

    Article  PubMed Central  PubMed  Google Scholar 

  25. E. Riboli, T. Norat, Epidemiologic evidence of the protective effect of fruit and vegetables on cancer risk. Am. J. Clin. Nutr. 78, 559S–569S (2003)

    CAS  PubMed  Google Scholar 

  26. P. Royston, A strategy for modelling the effect of a continuous covariate in medicine and epidemiology. Stat. Med. 19, 1831–1847 (2000)

    Article  CAS  PubMed  Google Scholar 

  27. M. Egger, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 315, 629–634 (1997)

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. G.A. Colditz, J.E. Manson, M.J. Stampfer, B. Rosner, W.C. Willett, F.E. Speizer, Diet and risk of clinical diabetes in women. Am. J. Clin. Nutr. 55, 1018–1023 (1992)

    CAS  PubMed  Google Scholar 

  29. L.A. Bazzano, T.Y. Li, K.J. Joshipura, F.B. Hu, Intake of fruit, vegetables, and fruit juices and risk of diabetes in women. Diabetes Care 31, 1311–1317 (2008)

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. K. Esposito, C.M. Kastorini, D.B. Panagiotakos, D. Giugliano, Prevention of type 2 diabetes by dietary patterns: a systematic review of prospective studies and meta-analysis. Metab. Syndr. Relat. Disord. 8, 471–476 (2010)

    Article  PubMed  Google Scholar 

  31. Esposito K, Chiodini P, Maiorino MI, Bellastella G, Panagiotakos D, Giugliano D. Which diet for prevention of type 2 diabetes? A meta-analysis of prospective studies. Endocrine:1-10 (2014)

  32. K. Hodgson, B. Govan, N. Ketheesan, J. Morris, Dietary composition of carbohydrates contributes to the development of experimental type 2 diabetes. Endocrine 43, 447–451 (2013)

    Article  CAS  PubMed  Google Scholar 

  33. A.H. Harding, N.J. Wareham, S.A. Bingham, K. Khaw, R. Luben, A. Welch, N.G. Forouhi, Plasma vitamin C level, fruit and vegetable consumption, and the risk of new-onset type 2 diabetes mellitus: the European prospective investigation of cancer—Norfolk prospective study. Arch. Intern. Med. 168, 1493–1499 (2008)

    Article  PubMed  Google Scholar 

  34. M. Gordon, Dietary antioxidants in disease prevention. Nat. Prod. Rep. 13, 265–273 (1996)

    Article  CAS  PubMed  Google Scholar 

  35. D. Montero, G. Walther, C.D. Stehouwer, A.J. Houben, J.A. Beckman, A. Vinet, Effect of antioxidant vitamin supplementation on endothelial function in type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Obes. Rev. (2013). doi:10.1111/obr.12114

    PubMed  Google Scholar 

  36. A.D. Liese, A.K. Roach, K.C. Sparks, L. Marquart, R.B. D’Agostino Jr, E.J. Mayer-Davis, Whole-grain intake and insulin sensitivity: the insulin resistance atherosclerosis study. Am. J. Clin. Nutr. 78, 965–971 (2003)

    CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None

Author information

Authors and Affiliations

  1. Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China

    Shuangshuang Li & Bo Xi

  2. Shandong Medical College, Jinan, China

    Song Miao

  3. Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

    Yubei Huang

  4. Department of Maternal and Child Health, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China

    Zhaolu Liu, Huan Tian, Xiuxiu Yin & Bo Xi

  5. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, WBOB 300, Minneapolis, MN, 55454, USA

    Weihong Tang & Lyn M. Steffen

Authors
  1. Shuangshuang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Song Miao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yubei Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhaolu Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Huan Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiuxiu Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Weihong Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lyn M. Steffen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bo Xi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Lyn M. Steffen or Bo Xi.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 198 kb)

Supplementary material 2 (DOC 70 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, S., Miao, S., Huang, Y. et al. Fruit intake decreases risk of incident type 2 diabetes: an updated meta-analysis. Endocrine 48, 454–460 (2015). https://doi.org/10.1007/s12020-014-0351-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-014-0351-6

Keywords

Search

Navigation