Green Leafy Vegetables, Fruit Consumption Reduces Risk for Diabetes

Consumption of green leafy vegetables and fruit was associated with a lower hazard of type 2 diabetes mellitus (DM), whereas consumption of fruit juices may be associated with an increased hazard of diabetes among women, according to the results of a study.

"Fruit and vegetable consumption has been associated with decreased incidence of and mortality from a variety of health outcomes including obesity, hypertension, and cardiovascular diseases in epidemiologic studies," write Lydia A. Bazzano, MD, PhD, from Tulane University School of Public Health and Tropical Medicine in New Orleans, Louisiana, and colleagues. "However, few prospective studies have examined the relationship between fruit and vegetable intake and risk of DM, and their results are not entirely consistent."

The goal of this study was to determine the association between intake of fruits, vegetables, and fruit juices and the development of type 2 DM in a cohort of 71,346 female nurses, aged 38 to 63 years, who were free of cardiovascular disease, cancer, and DM in 1984.

During follow-up for 18 years in the Nurses’ Health Study, a semiquantitative food frequency questionnaire (FFQ) was administered every 4 years, and diagnosis of DM was self-reported.

There were 4529 cases of DM documented during follow-up, with a cumulative incidence of DM at 7.4%. For total fruit and vegetable consumption, an increase of 3 servings per day was not associated with the development of DM (multivariate-adjusted hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.94 – 1.05). However, the same increase in whole-fruit consumption was associated with a lower hazard of DM (HR, 0.82; 95% CI, 0.72 – 0.94).

For intake of green leafy vegetables, an increase of 1 serving per day was associated with a slightly reduced hazard of DM (HR, 0.91; 95% CI, 0.84 – 0.98). However, the same change in fruit juice intake was associated with an increased hazard of DM (HR, 1.18; 95% CI, 1.10 – 1.26).

"Consumption of green leafy vegetables and fruit was associated with a lower hazard of DM, whereas consumption of fruit juices may be associated with an increased hazard among women," the study authors write. "These associations were independent of known risk factors for type 2 DM, including age, BMI [body mass index], family history, smoking, postmenopausal hormone use, alcohol intake, physical activity, smoking, total energy intake and consumption of whole grains, nuts, processed meats, coffee and potatoes."

"Our findings of a positive association of fruit juice intake with hazard of DM suggest that caution should be observed in replacing some beverages with fruit juices in an effort to provide healthier options," the study authors conclude. "Moreover, the same caution applies to the recommendation that 100% fruit juice be considered a serving of fruit as it is in the present national dietary guidelines. . . . If fruits and vegetables are used to replace refined grains and white potatoes, both of which have been shown to be associated with increased risk of DM, the benefits of regular consumption of fruits and vegetables should be substantial."

Practice Pearls:

• In the Nurses’ Health Study, consumption of green leafy vegetables and fruit was associated with a lower risk for the development of DM. For total fruit and vegetable consumption, an increase of 3 servings per day was not associated with the development of DM. An increase of 3 servings per day in whole-fruit consumption was associated with a lower risk for DM, and an increase of 1 serving per day of green leafy vegetables was associated with a slightly decreased risk for DM.
• In this study, consumption of fruit juices was associated with a higher risk for the development of DM. An increase of 1 serving per day in fruit juice intake was associated with an increased hazard of DM. The investigators advise caution in replacing some beverages with fruit juices in an attempt to provide healthier options and in classifying 100% fruit juice as a serving of fruit.

Diabetes Care. online April 4, 2008.
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