Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults.
Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults.
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DOI：
10.1371/journal.pmed.1002279
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发表时间：
2017-04
期刊：
影响因子：
15.8
通讯作者：
China Kadoorie Biobank study
中科院分区：
文献类型：
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作者：
Du H;Li L;Bennett D;Guo Y;Turnbull I;Yang L;Bragg F;Bian Z;Chen Y;Chen J;Millwood IY;Sansome S;Ma L;Huang Y;Zhang N;Zheng X;Sun Q;Key TJ;Collins R;Peto R;Chen Z;China Kadoorie Biobank study
尽管食用新鲜水果对健康有益，但其对糖尿病的潜在影响以及糖尿病患者的死亡和主要血管并发症风险仍存在很大的不确定性。2004年6月至2008年7月，中国嘉道理生物样本库在全国范围内招募了来自中国10个不同地区的50万名年龄在30-79岁（平均51岁）的成年人。在约7年的随访期间，在482，591名基线时没有流行（先前诊断或筛查发现）糖尿病的参与者中记录了9，504例新发糖尿病病例，总发病率为2.8/1，000人-年。在基线时患有糖尿病的30，300名（5.9%）参与者中，发生了3，389例死亡（总死亡率为16.5/1，000），沿着9，746例大血管疾病和1，345例微血管疾病。考克斯回归得出了将每种疾病结局与自我报告的新鲜水果摄入量相关联的校正风险比（HR），并对潜在的混杂因素（如年龄、性别、地区、社会经济地位、其他生活方式因素、体重指数和糖尿病家族史）进行了校正。总体而言，18.8%的参与者报告每天食用新鲜水果，6.4%从不/很少（非消费者），先前诊断为糖尿病的人（18.9%）的非消费者比例约为筛查检测到糖尿病（6.7%）或无糖尿病（6.0%）的三倍。在基线时无糖尿病的人群中，水果摄入量增加与糖尿病发病风险显著降低相关（每日摄入水果与不摄入水果的人群相比，调整后的HR = 0.88 [95%CI 0.83-0.93]，p < 0.001，相当于5年绝对风险差异0.2%），具有明显的剂量-反应关系。在基线糖尿病患者中，水果摄入量增加与全因死亡风险降低相关（校正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），既往诊断和筛查发现糖尿病的个体HR相似;每日和非消费者之间5年绝对风险的估计差异分别为1.9%、1.1%和5.4%。本研究的主要局限性在于，由于其观察性质，我们无法完全排除残余混杂的影响。在这项针对中国成年人的大型流行病学研究中，更多的新鲜水果消费与糖尿病风险显著降低相关，并且在糖尿病患者中，死亡和发生主要血管并发症的风险较低。HuaidongDu和同事研究了中国人群中水果消费与糖尿病发病率之间的关系，沿着糖尿病并发症。尽管大多数饮食指南，包括糖尿病患者的饮食指南，建议更高水平的水果消费，但全球范围内关于水果消费与糖尿病发生和进展相关性的证据仍然有限。虽然水果和蔬菜通常被认为是一起的，但对于糖尿病患者来说，水果可能不像新鲜蔬菜那样健康，因为它的含糖量相对较高。这导致世界上许多地方的糖尿病患者经常避免食用水果（例如，中国）。迄今为止，尚无前瞻性证据表明新鲜水果消费对糖尿病发病率以及糖尿病患者中糖尿病相关血管并发症风险的潜在长期影响。在一个大型队列中对这两种关系的可靠发现对于健康促进非常重要。在2004-2008年期间，我们从中国十个不同的地区招募了超过50万名中国成年人。参与者完成了详细的问卷调查，并进行了身体测量和血液测试，随后对他们的健康状况进行了7年的跟踪。在研究开始时没有糖尿病的人（以前诊断或新发现）中，与从不或很少食用新鲜水果相比，每天食用新鲜水果与患糖尿病的相对风险降低12%相关。在研究开始前已经患有糖尿病的人中，每周食用新鲜水果超过三天与任何原因死亡的相对风险降低17%和发生影响大血管的糖尿病相关并发症的风险降低13%-28%相关（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）的人比每周吃水果少于一天的人多。据我们所知，这是第一个大型的前瞻性研究，证明了水果消费与糖尿病和糖尿病并发症的类似负相关。这些发现表明，更多的新鲜水果摄入量可能有利于糖尿病的初级和二级预防。对于已经患有糖尿病的人，限制新鲜水果的消费，这在世界许多地方都很常见，例如，中国和其他亚洲国家，不应受到鼓励。
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. 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. 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. Huaidong Du and colleagues study associations between fruit consumption and incidence of diabetes, along with complications of prevalent diabetes, in a Chinese population. 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. 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. 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.