Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis
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Abstract The ongoing outbreak of COVID-19 challenges health systems and epidemiological responses of all countries worldwide. Although mitigation measures have been globally considered, the spatial heterogeneity of its effectiveness is evident, underscoring global health inequalities. Using Bayesian-based Markov chain Monte Carlo simulations, we evidenced that factors contributing to poverty are also risk factors for COVID-19 case-fatality, and unexpectedly, their impact on the case-fatality risk is comparable to that produced by health factors. Additionally, we confirm that both case-fatality risk and multidimensional poverty index have a heterogeneous spatial distribution, where the lastest consists of health, educational, dwelling, and employment dimensions. Spatio-temporal analysis reveals that the spatial heterogeneity in case-fatalities is associated with the percentage contribution of the health (RR 1.89 95%CI=1.43-2.48) and dwelling (RR 2.01 95%CI=1.37-2.63) dimensions to the multidimensional poverty, but also with the educational (RR 1.21 95%CI=1.03-1.49), and employment (RR 1.23 95%CI=1.02-1.47) dimensions. This spatial correlation indicates that the case-fatality risk increase by 189% and 201% in regions with a higher contribution of the health dimension (i.e., lack of health insurance and self-reporting) and dwelling dimension (i.e., lack of access to safe water, inadequate disposal of human feces, poor housing construction, and critical overcrowding), respectively. Furthermore, although a temporal decrease is evident, the relative risk of dying by COVID-19 in Colombia is still 200% higher than the established case-fatality risk based on the COVID-19 dynamics in Italy and China. These findings assist policy-makers in the spatial and temporal planning of strategies focused on mitigating the case-fatality risk in most vulnerable communities and preparing for future pandemics by progressively reducing the factors that generate health inequality.
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Major epidemiological studies have consistently identified that vegetable- and fruit-rich diets improve every major risk factor for PH and CVD, including blood pressure, ischemic stroke, ischemic heart disease, obesity, insulin resistance and diabetes, and metabolic syndrome.
“Major epidemiological studies have consistently identified that vegetable- and fruit-rich diets improve every major risk factor for PH and CVD, including blood pressure[361,363,364], ischemic stroke[365], ischemic heart disease[366], obesity, insulin resistance and diabetes[367], and metabolic syndrome[365,366,368,369].”
From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [367]
Meta-analyses report no benefits of overall vegetable consumption for type II diabetes, although dose-response meta-analyses suggest benefit up to 2-3 servings/day and a threshold beyond this where type II diabetes risk does not reduce further.
“Meta-analyses also report no benefits of overall vegetable consumption for type II diabetes [ 57 – 59 ], although dose–response meta-analyses also suggest benefit up to 2–3 servings/day and a threshold beyond this where type II diabetes risk does not reduce further [ 60 ].”
From Increasing vegetable intakes: rationale and systematic review of published interventions (2016) · cites this paper as [57]
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References 69 · Cited by 728
- Authors
- Carter, P., Gray, L. J., Troughton, J., Khunti, K., & Davies, M. J.
- Affiliations
- University of Leicester (GB)
- Leicester Royal Infirmary (GB)
- Corresponding author
- Carter, P.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2010-08-19
- Volume
- 341
- Issue
- aug18 4
- Pages
- c4229-c4229
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2924474
- OpenAlex
- W2097067599
- Cited by
- 728
- References
- 69
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 21 · 2023: 23 · 2022: 38 · 2021: 40 · 2020: 38 · 2019: 49 · 2018: 61 · 2017: 61 · 2016: 68 · 2015: 60 · 2014: 69 · 2013: 68 · 2012: 67
- FWCI
- 8.00
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
- Leicester Research Archive (University of Leicester) (submittedVersion)
- Funders
- University Hospitals of Leicester NHS Trust
- National Institute for Health and Care Research
- University of Leicester
- Medical Research Council
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- fruit and vegetable intake, type 2 diabetes, diabetes incidence, dietary intake, Multidimensional Poverty Index, spatial heterogeneity, health disparities, Colombia
- MeSH terms
- Adult, Aged, Diabetes Mellitus, Type 2, Diet, Epidemiologic Methods, Female, Fruit, Humans, Male, Middle Aged, Prospective Studies, Vegetables, Publication Bias
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