Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries.
Gundersen, Thomas E
van der Schouw, Yvonne T
Franks, Paul W
Gunter, Marc J
Nilsson, Peter M
Quirós, J Ramón
Spijkerman, Annemieke MW
BMJ (Clinical research ed.)
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Zheng, J., Sharp, S., Imamura, F., Chowdhury, R., Gundersen, T. E., Steur, M., Sluijs, I., et al. (2020). Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries.. BMJ (Clinical research ed.), 370 m2194. https://doi.org/10.1136/bmj.m2194
Objective The investigation of a link between fruit and vegetable intake and the risk of type 2 diabetes (T2D) has relied on self-report, with inconsistent findings. Circulating vitamin C and carotenoids are indicators of fruit and vegetable intake but research using objective measures is sparse. The aim was to investigate the association of these measures with incident T2D. Design Prospective case-cohort study. Setting Populations from eight European countries. Participants This analysis was conducted in the European Prospective Investigation into Cancer and Nutrition (EPIC) prospective EPIC-InterAct case-cohort study with 9,754 incident cases of T2D and a subcohort of 13,662 individuals. Main outcome measure Incident T2D. Results In a multivariable-adjusted model, higher plasma vitamin C was associated with lower hazard of T2D (hazard ratio per standard deviation (SD) 0.82 (95% confidence interval: 0.76 to 0.89)). A similar inverse association was demonstrated for total carotenoids (hazard ratio per SD 0.75 (0.68 to 0.82)). A composite biomarker score comprised of vitamin C and individual carotenoids was inversely associated with T2D with hazard ratios 0.77, 0.66, 0.59 and 0.50 for quintiles 2-5 compared with quintile 1. Median fruit and vegetable intake was 274g/d, 396g/d and 508g/d for participants in categories defined by quintiles 1, 3 and 5 of the composite biomarker score, respectively. One SD difference in the composite biomarker score, equivalent to a 66 (95% confidence interval: 61 to 71) g/d difference in total fruit and vegetable intake, was associated with a hazard ratio of 0.75 (0.67 to 0.83). Conclusions These findings provide evidence of an inverse association between plasma vitamin C, carotenoids and their composite biomarker score and incident T2D in different European countries. As these biomarkers are valid indicators of fruit and vegetable consumption, the public health implication is that even modestly higher fruit and vegetable consumption is relevant for T2D prevention.
Humans, Fruit, Vegetables, Diabetes Mellitus, Type 2, Ascorbic Acid, Carotenoids, Diet, Case-Control Studies, Prospective Studies, Europe, Female, Male, Biomarkers
The InterAct project was funded by the EU FP6 programme (grant number LSHM_CT_2006_037197). Biomarker measurements for vitamin C and carotenoids were funded jointly by the InterAct project, the EPIC-CVD project and the MRC Cambridge Initiative (RG71466, SJAH/004). EPIC-CVD has been supported by the UK Medical Research Council (MR/L003120/1), the British Heart Foundation (RG/13/13/30194; RG/18/13/33946), the European Commission Framework Programme 7 (HEALTH-F2-2012-279233), the European Research Council (268834) and the National Institute for Health Research (Cambridge Biomedical Research Centre at the Cambridge University Hospitals NHS Foundation Trust). Professor John Danesh is funded by the National Institute for Health Research (Senior Investigator Award). Professors Nicholas J Wareham and Nita G Forouhi acknowledge funding from the following agencies: Medical Research Council Epidemiology Unit MC_UU_12015/1 and MC_UU_12015/5, and NIHR Biomedical Research Centre Cambridge: Nutrition, Diet, and Lifestyle Research Theme (IS-BRC-1215-20014). Dr Ju-Sheng Zheng has received funding from Westlake University (No. YSYY0209) and the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 701708. Dr Tammy YN Tong has received funding from the Cancer Research UK (C570/A16491 and C8221/A19170), UK Medical Research Council (MR/M012190/1). Professor Paul W Franks has received funding from Swedish Research Council, Novo Nordisk, Swedish Diabetes Association, Swedish Heart-Lung Foundation, European Research Council. Professor Kay-Tee Khaw has received funding from Medical Research Council UK, Cancer Research UK. Dr Tilman Kühn has received funding from German Cancer Aid, German Cancer Research Center (DKFZ), German Federal Ministry of Education and Research (BMBF). Professor Peter M Nilsson has received funding from Swedish Research Council. Professor Kim Overvad has received funding from Danish Cancer Society. Professor Salvatore Panico has received funding from Compagnia di San Paolo. Dr J. Ramón Quirós has received funding from Regional Government of Asturias. Dr Olov Rolandsson has received funding from the Västerboten County Council. Professor Elio Riboli has received funding from Imperial College Biomedical Research Centre. EPIC Bilthoven and Utrecht acknowledge the Dutch Ministry of Public Health, Welfare and Sports, Netherlands Cancer Registry, LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF). The coordination of EPIC-Spain was financially supported by the Health Research Fund (FIS) - Instituto de Salud Carlos III (ISCIII), Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology (ICO) (Spain). The funders of the studies had no role in study design, data collection, data analysis, data interpretation, or report preparation.
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
European Commision (37197)
MEDICAL RESEARCH COUNCIL (MR/L00002/1)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10149)
British Heart Foundation (RG/13/13/30194)
British Heart Foundation (RG/18/13/33946)
External DOI: https://doi.org/10.1136/bmj.m2194
This record's URL: https://www.repository.cam.ac.uk/handle/1810/305629
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