The association between a biomarker score for fruit and vegetable intake and incident type 2 diabetes: the EPIC-Norfolk study
European Journal of Clinical Nutrition
Nature Publishing Group
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Cooper, A., Sharp, S., Luben, R., Khaw, K., Wareham, N., & Forouhi, N. (2014). The association between a biomarker score for fruit and vegetable intake and incident type 2 diabetes: the EPIC-Norfolk study. European Journal of Clinical Nutrition, 69 449-454. https://doi.org/10.1038/ejcn.2014.246
Background/Objectives: Biomarkers for a mixed fruit and vegetable (FV) diet are needed to provide a better understanding of the association between FV intake and type 2 diabetes. We aimed to examine the prospective association between a composite score comprised of three biomarkers of FV intake in free-living populations and incident diabetes. Subjects/Methods: A total of 318 incident diabetes cases and 926 controls from the EPIC-Norfolk study aged 40-79 years at baseline (1993-1997) completed 7-day food diaries (7DD) and had plasma vitamin C and carotenoid measures. A composite biomarker score (CB-score) comprising the sum of plasma vitamin C, beta-carotene and lutein was derived. Odds ratios (OR) and 95% confidence intervals for incident diabetes were estimated using multivariable logistic regression. Results: A strong inverse association was found between the CB-score and incident diabetes. The OR (95% CI) of diabetes comparing quartiles Q2, Q3 and Q4 of the CB-score with Q1 (reference category) were 0.70 (0.49, 1.00), 0.34 (0.23, 0.52) and 0.19 (0.12, 0.32), respectively, and 0.49 (0.40, 0.58) per SD change in CB-score in a model adjusted for demographic and lifestyle factors. The association was marginally attenuated after additionally adjusting for BMI and waist circumference (0.60 (0.49, 0.74) per SD change in CB-score). Conclusions: A combination of biomarkers representing the intake of a mixed FV diet was strongly inversely associated with incident diabetes. These findings provide further support for measuring dietary biomarkers in studies of diet-disease associations and highlight the importance of consuming FV for the prevention of diabetes.
The EPIC Norfolk study is supported by programme grants from the Medical Research Council UK and Cancer Research UK. The sponsors did not participate in the design or conduct of this study; in the collection, management, analysis, or interpretation of data; in the writing of the manuscript; or in the preparation, review, approval, or decision to submit this manuscript for publication. We acknowledge support from the MRC Epidemiology Unit (MC_UU_12015/5).
Medical Research Council (MC_U106179471)
Medical Research Council (MC_U106179474)
External DOI: https://doi.org/10.1038/ejcn.2014.246
This record's URL: https://www.repository.cam.ac.uk/handle/1810/246148