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Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies
Open accessAbstract
OBJECTIVE: To determine whether individual fruits are differentially associated with risk of type 2 diabetes. DESIGN: Prospective longitudinal cohort study. SETTING: Health professionals in the United States. PARTICIPANTS: 66,105 women from the Nurses' Health Study (1984-2008), 85,104 women from the Nurses' Health Study II (1991-2009), and 36,173 men from the Health Professionals Follow-up Study (1986-2008) who were free of major chronic diseases at baseline in these studies. MAIN OUTCOME MEASURE: Incident cases of type 2 diabetes, identified through self report and confirmed by supplementary questionnaires. RESULTS: During 3,464,641 person years of follow-up, 12,198 participants developed type 2 diabetes. After adjustment for personal, lifestyle, and dietary risk factors of diabetes, the pooled hazard ratio of type 2 diabetes for every three servings/week of total whole fruit consumption was 0.98 (95% confidence interval 0.97 [corrected] to 0.99). With mutual adjustment of individual fruits, the pooled hazard ratios of type 2 diabetes for every three servings/week were 0.74 (0.66 to 0.83) for blueberries, 0.88 (0.83 to 0.93) for grapes and raisins, 0.89 (0.79 to 1.01) for prunes, 0.93 (0.90 to 0.96) for apples and pears, 0.95 (0.91 to 0.98) for bananas, 0.95 (0.91 to 0.99) for grapefruit, 0.97 (0.92 to 1.02) for peaches, plums, and apricots, 0.99 (0.95 to 1.03) for oranges, 1.03 (0.96 to 1.10) for strawberries, and 1.10 (1.02 to 1.18) for cantaloupe. The pooled hazard ratio for the same increment in fruit juice consumption was 1.08 (1.05 to 1.11). The associations with risk of type 2 diabetes differed significantly among individual fruits (P<0.001 in all cohorts). CONCLUSION: Our findings suggest the presence of heterogeneity in the associations between individual fruit consumption and risk of type 2 diabetes. Greater consumption of specific whole fruits, particularly blueberries, grapes, and apples, is significantly associated with a lower risk of type 2 diabetes, whereas greater consumption of fruit juice is associated with a higher risk.
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“Ezetimibe or a PCSK9 inhibitor as add‐on to statin therapy is shown to reduce the incidence of CVD in patients with diabetes and hyper‐LDL‐cholesterolemia 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 (grade B: 88% agreement).”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [29]
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Self-citationDietary Fiber, Glycemic Load, and Risk of Non—insulin-dependent Diabetes Mellitus in Women
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Self-citationPrevention and management of type 2 diabetes: dietary components and nutritional strategies
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Self-citationSatija, A., Bhupathiraju, S. N., Rimm, E. B., Spiegelman, D., Chiuve, S. E., Borgi, L., Willett, W. C., Manson, J. E., Sun, Q., & Hu, F. B. (2016) · PLOS Medicine · doi:10.1371/journal.pmed.1002039 · Cited by 1,069
Self-citationImamura, F., O’Connor, L., Ye, Z., Mursu, J., Hayashino, Y., Bhupathiraju, S. N., & Forouhi, N. G. (2015) · BMJ · doi:10.1136/bmj.h3576 · Cited by 977
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Metadata
- Authors
- Muraki, I., Imamura, F., Manson, J. E., Hu, F. B., Willett, W. C., van Dam, R. M., & Sun, Q.
- Affiliations
- Harvard University (US)
- University of Cambridge (GB)
- Brigham and Women's Hospital (US)
- Corresponding author
- Sun, Q.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2013-08-28
- Volume
- 347
- Issue
- aug28 1
- Pages
- f5001-f5001
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC3978819
- OpenAlex
- W2010234625
- Cited by
- 544
- References
- 60
- Citations by year
- 2026: 20 · 2025: 33 · 2024: 40 · 2023: 32 · 2022: 54 · 2021: 50 · 2020: 57 · 2019: 40 · 2018: 37 · 2017: 35 · 2016: 51 · 2015: 46 · 2014: 42 · 2013: 7
- FWCI
- 6.94
- Type
- journal article
- Language
- en
- Update notices
- correction (2013-12-04)
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- National University of Singapore (submittedVersion)
- Funders
- Medical Research Council (MC_UU_12015/5)
- National Heart, Lung, and Blood Institute (R00HL098459)
- National Cancer Institute (CA-167552, CA-87969, CA-55075, P01CA087969, CA50385, UM1CA176726, CA176726, P01CA055075, R01CA050385, UM1CA167552)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK058845, DK-082486, R01DK082486, DK58845, T32DK007703)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Biochemistry (medical) › Phytochemicals and Antioxidant Activities
- Keywords
- type 2 diabetes, fruit consumption, whole fruit, fruit juice, blueberry, prunes, banana, grapefruit, strawberry, cantaloupe, dietary risk factors, Nurses' Health Study, Health Professionals Follow-up Study, prospective cohort, pooled hazard ratio, diabetes prevention
- MeSH terms
- Beverages, Diabetes Mellitus, Type 2, Diet, Epidemiologic Methods, Female, Fruit, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Body Mass Index
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