新鲜水果消费与事件糖尿病和糖尿病血管并发症有关：中国50

StephenW

Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults

    Huaidong Du ,
    Liming Li ,
    Derrick Bennett,
    Yu Guo,
    Iain Turnbull,
    Ling Yang,
    Fiona Bragg,
    Zheng Bian,
    Yiping Chen,
    Junshi Chen,
    Iona Y. Millwood,
    Sam Sansome,
    Liangcai Ma,
     [ ... ],
    China Kadoorie Biobank study
    [ view all ]


PLOS x

    Published: April 11, 2017
    https://doi.org/10.1371/journal.pmed.1002279


Abstract
Background

Despite the well-recognised health benefits of fresh fruit consumption, substantial uncertainties remain about its potential effects on incident diabetes and, among those with diabetes, on risks of death and major vascular complications.
Methods and findings

Between June 2004 and July 2008, the nationwide China Kadoorie Biobank study recruited 0.5 million adults aged 30–79 (mean 51) y from ten diverse localities across China. During ~7 y of follow-up, 9,504 new diabetes cases were recorded among 482,591 participants without prevalent (previously diagnosed or screen-detected) diabetes at baseline, with an overall incidence rate of 2.8 per 1,000 person-years. Among 30,300 (5.9%) participants who had diabetes at baseline, 3,389 deaths occurred (overall mortality rate 16.5 per 1,000), along with 9,746 cases of macrovascular disease and 1,345 cases of microvascular disease. Cox regression yielded adjusted hazard ratios (HRs) associating each disease outcome with self-reported fresh fruit consumption, adjusting for potential confounders such as age, sex, region, socio-economic status, other lifestyle factors, body mass index, and family history of diabetes. Overall, 18.8% of participants reported consuming fresh fruit daily, and 6.4% never/rarely (non-consumers), with the proportion of non-consumers about three times higher in individuals with previously diagnosed diabetes (18.9%) than in those with screen-detected diabetes (6.7%) or no diabetes (6.0%). Among those without diabetes at baseline, higher fruit consumption was associated with significantly lower risk of developing diabetes (adjusted HR = 0.88 [95% CI 0.83–0.93] for daily versus non-consumers, p < 0.001, corresponding to a 0.2% difference in 5-y absolute risk), with a clear dose–response relationship. Among those with baseline diabetes, higher fruit consumption was associated with lower risks of all-cause mortality (adjusted HR = 0.83 [95% CI 0.74–0.93] per 100 g/d) and microvascular (0.72 [0.61–0.87]) and macrovascular (0.87 [0.82–0.93]) complications (p < 0.001), with similar HRs in individuals with previously diagnosed and screen-detected diabetes; estimated differences in 5-y absolute risk between daily and non-consumers were 1.9%, 1.1%, and 5.4%, respectively. The main limitation of this study was that, owing to its observational nature, we could not fully exclude the effects of residual confounding.
Conclusion

In this large epidemiological study in Chinese adults, higher fresh fruit consumption was associated with significantly lower risk of diabetes and, among diabetic individuals, lower risks of death and development of major vascular complications.

Author summary
Why was this study done?

    Worldwide evidence on the relevance of fruit consumption for the occurrence and progression of diabetes is still limited, although most dietary guidelines, including those for diabetes patients, recommend a higher level of fruit consumption.
    Although fruit and vegetables are often considered together, fruit may not be viewed as being as healthy as fresh vegetables for individuals with diabetes, given its relatively high sugar content. This has led to frequent abstention from fruit consumption among individuals with diabetes in many parts of the world (e.g., China).
    No prospective evidence has been available thus far showing the potential long-term impacts of fresh fruit consumption on the incidence of diabetes and, among individuals with diabetes, on the risks of diabetes-related vascular complications. Reliable findings on these two relationships within a single large cohort would be important for health promotion.

What did the researchers do and find?

    We recruited over 500,000 Chinese adults from ten diverse areas across China during 2004–2008. Participants completed a detailed questionnaire interview and underwent physical measurements and blood tests, with their health tracked subsequently for seven years.
    Among individuals who were free of diabetes (either previously diagnosed or newly detected) at the start of the study, daily consumption of fresh fruit was associated with a 12% lower relative risk of developing diabetes, compared to never or rarely consuming fresh fruit.
    In those individuals who already had diabetes prior to the start of the study, consuming fresh fruit more than three days a week was associated with a 17% lower relative risk of dying from any cause and a 13%–28% lower risk of developing diabetes-related complications affecting large blood vessels (e.g., ischaemic heart disease and stroke) and small blood vessels (i.e., kidney diseases, eye diseases, and neuropathy) than those who consumed fruit less than one day per week.

What do these findings mean?

    To our knowledge, this is the first large prospective study demonstrating similar inverse associations of fruit consumption with both incident diabetes and diabetic complications.
    These findings suggest that a higher intake of fresh fruit is potentially beneficial for primary and secondary prevention of diabetes.
    For individuals who have already developed diabetes, restricted consumption of fresh fruit, which is common in many parts of the world, e.g., China and other Asian countries, should not be encouraged.

StephenW

新鲜水果消费与事件糖尿病和糖尿病血管并发症有关：中国50万人的7年前瞻性研究

    惠东杜，
    李立明，
    德里克·本内特
    余国，
    伊恩特恩布尔
    凌阳，
    菲奥娜·布拉格，
    郑璧，
    陈平平，
    陈俊史，
    Iona Y. Millwood，
    Sam Sansome，
    马彩马，
     [...]
    中国嘉道理生物银行研究
    [ 查看全部 ]


PLOS x

    发布时间：2017年4月11日
    https://doi.org/10.1371/journal.pmed.1002279


抽象
背景

尽管新鲜水果消费获得了公认的健康益处，但其对糖尿病事件和糖尿病患者对死亡风险和主要血管并发症的潜在影响仍有很大的不确定性。
方法和发现

2004年6月至2008年7月，全国中国嘉道理生物银行研究招募了来自全国十个不同地区的50万至30岁的50万成年人（平均51岁）。在约7年的随访期间，在482,591名参与者中记录了9,504例新的糖尿病病例，没有流行（以前诊断或筛检）糖尿病基线，总发病率为每千人年2.8。在基线患有糖尿病的30,300名（5.9％）参与者中，发生了3389例死亡（总死亡率为16.5 / 1000），以及9,746例大血管病和1,345例微血管病。 Cox回归产生调整后的风险比（HR），将每种疾病结果与自报新鲜水果消费相关联，调整潜在的混杂因素，如年龄，性别，区域，社会经济状况，其他生活方式因素，体重指数和家族史糖尿病。总体而言，有18.8％的参与者报告每天摄取新鲜水果，6.4％的人从未/很少（非消费者），非消费者比例比以前诊断的糖尿病患者高出三倍（18.9％）。检出的糖尿病（6.7％）或无糖尿病（6.0％）。在没有糖尿病基线的患者中，较高的水果消费与显着降低发生糖尿病的风险相关（每日和非消费者的调整后HR = 0.88 [95％CI 0.83-0.93]，p <0.001，相当于0.2％差异5-y绝对风险），具有明确的剂量反应关系。在基线型糖尿病患者中，较高的水果消费量与全因死亡风险降低有关（HR = 0.83 [95％CI 0.74-0.93] / 100 g / d）和微血管（0.72 [0.61-0.87]）和大血管（0.87 [0.82-0.93]）并发症（p <0.001），具有先前诊断和筛选糖尿病的个体的HR相似;估计每日和非消费者5年绝对风险的差异分别为1.9％，1.1％和5.4％。这项研究的主要限制是，由于其观察性质，我们不能完全排除残留混杂的影响。
结论

在中国大型流行病学研究中，较高的新鲜水果消费与糖尿病风险显着降低相关，糖尿病患者死亡风险和主要血管并发症发生率较低。
作者总结
为什么这项研究完成了？

    关于水果消费对糖尿病发生和进展的相关性的全球证据仍然有限，尽管大多数饮食指南，包括糖尿病患者的饮食指南都建议更高水平的水果消费。
    虽然水果和蔬菜通常被认为是一起的，但鉴于糖含量相对较高，水果可能不会被视为像新鲜蔬菜一样健康的糖尿病患者。这导致了世界许多地方（如中国）糖尿病患者的水果消费量的频繁弃权。
    目前尚无可见的证据表明，新鲜水果消费对糖尿病发病率和糖尿病患者潜在的长期影响可能与糖尿病相关的血管并发症的风险有关。在单个大型队列中对这两个关系的可靠发现对促进健康来说将是重要的。

研究人员做了什么和发现？

    2004-2008年期间，我们从全国十个不同地区招募了超过50万名中国大人。参与者完成了详细的问卷调查面试，接受了身体测量和血液检查，随后健康跟踪了七年。
    在研究开始时，没有糖尿病的人（以前被诊断或新检测到）中，新鲜水果的每日消费量相对于没有或很少消费的新鲜水果相比，发生糖尿病的相对风险降低了12％。
    在研究开始之前已经患有糖尿病的个人中，每周消耗新鲜水果的人数与任何原因死亡的相对风险降低了17％，发生糖尿病的风险降低了13％-28％ （例如，缺血性心脏病和中风）和小血管（即肾脏疾病，眼睛疾病和神经病变）相关的并发症比每周饮用水果少于一天的那些。

这些发现是什么意思？

    据我们所知，这是第一个展示水果消费与糖尿病和糖尿病并发症反相关联的大型前瞻性研究。
    这些研究结果表明，摄入更多的新鲜水果可能有益于一级和二级预防糖尿病。
    对于已经发展为糖尿病的个体，不应该鼓励限制世界许多地方常见的新鲜水果的消费，例如中国和其他亚洲国家。

StephenW

http://journals.plos.org/plosmed ... ournal.pmed.1002279