Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries

Ju-Sheng Zheng; Stephen J Sharp; Fumiaki Imamura; Rajiv Chowdhury; Thomas E Gundersen; Marinka Steur; Ivonne Sluijs; Yvonne T van der Schouw; Antonio Agudo; Dagfinn Aune; Aurelio Barricarte; Heiner Boeing; María-Dolores Chirlaque; Miren Dorronsoro; Heinz Freisling; Douae El-Fatouhi; Paul W Franks; Guy Fagherazzi; Sara Grioni; Marc J Gunter; Cecilie Kyrø; Verena Katzke; Tilman Kühn; Kay-Tee Khaw; Nasser Laouali; Giovanna Masala; Peter M Nilsson; Kim Overvad; Salvatore Panico; Keren Papier; J Ramón Quirós; Olov Rolandsson; Daniel Redondo-Sánchez; Fulvio Ricceri; Matthias B Schulze; Annemieke M W Spijkerman; Anne Tjønneland; Tammy Y N Tong; Rosario Tumino; Elisabete Weiderpass; John Danesh; Adam S Butterworth; Elio Riboli; Nita G Forouhi; Nicholas J Wareham

doi:10.1136/bmj.m2194

Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries

Ju-Sheng Zheng, Stephen J Sharp, Fumiaki Imamura, Rajiv Chowdhury, Thomas E Gundersen, Marinka Steur, Ivonne Sluijs, Yvonne T van der Schouw, Antonio Agudo, Dagfinn Aune, Aurelio Barricarte, Heiner Boeing, María-Dolores Chirlaque, Miren Dorronsoro, Heinz Freisling, Douae El-Fatouhi, Paul W Franks, Guy Fagherazzi, Sara Grioni, Marc J GunterCecilie Kyrø, Verena Katzke, Tilman Kühn, Kay-Tee Khaw, Nasser Laouali, Giovanna Masala, Peter M Nilsson, Kim Overvad, Salvatore Panico, Keren Papier, J Ramón Quirós, Olov Rolandsson, Daniel Redondo-Sánchez, Fulvio Ricceri, Matthias B Schulze, Annemieke M W Spijkerman, Anne Tjønneland, Tammy Y N Tong, Rosario Tumino, Elisabete Weiderpass, John Danesh, Adam S Butterworth, Elio Riboli, Nita G Forouhi, Nicholas J Wareham

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Abstract

OBJECTIVE: To investigate the association of plasma vitamin C and carotenoids, as indicators of fruit and vegetable intake, with the risk of type 2 diabetes.

DESIGN: Prospective case-cohort study.

SETTING: Populations from eight European countries.

PARTICIPANTS: 9754 participants with incident type 2 diabetes, and a subcohort of 13 662 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort of 340 234 participants: EPIC-InterAct case-cohort study.

MAIN OUTCOME MEASURE: Incident type 2 diabetes.

RESULTS: In a multivariable adjusted model, higher plasma vitamin C was associated with a lower risk of developing type 2 diabetes (hazard ratio per standard deviation 0.82, 95% confidence interval 0.76 to 0.89). A similar inverse association was shown for total carotenoids (hazard ratio per standard deviation 0.75, 0.68 to 0.82). A composite biomarker score (split into five equal groups), comprising vitamin C and individual carotenoids, was inversely associated with type 2 diabetes with hazard ratios 0.77, 0.66, 0.59, and 0.50 for groups 2-5 compared with group 1 (the lowest group). Self-reported median fruit and vegetable intake was 274 g/day, 396 g/day, and 508 g/day for participants in categories defined by groups 1, 3, and 5 of the composite biomarker score, respectively. One standard deviation difference in the composite biomarker score, equivalent to a 66 (95% confidence interval 61 to 71) g/day difference in total fruit and vegetable intake, was associated with a hazard ratio of 0.75 (0.67 to 0.83). This would be equivalent to an absolute risk reduction of 0.95 per 1000 person years of follow up if achieved across an entire population with the characteristics of the eight European countries included in this analysis.

CONCLUSIONS: These findings indicate an inverse association between plasma vitamin C, carotenoids, and their composite biomarker score, and incident type 2 diabetes in different European countries. These biomarkers are objective indicators of fruit and vegetable consumption, and suggest that diets rich in even modestly higher fruit and vegetable consumption could help to prevent development of type 2 diabetes.

Original language	English
Article number	m2194
Number of pages	14
Journal	BMJ (Clinical research ed.)
Volume	370
DOIs	https://doi.org/10.1136/bmj.m2194
Publication status	Published - 08 Jul 2020
Externally published	Yes

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Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries
© 2020 The Authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.
Final published version, 562 KBLicence: CC BY

Cite this

Zheng, J.-S., Sharp, S. J., Imamura, F., Chowdhury, R., Gundersen, T. E., Steur, M., Sluijs, I., van der Schouw, Y. T., Agudo, A., Aune, D., Barricarte, A., Boeing, H., Chirlaque, M.-D., Dorronsoro, M., Freisling, H., El-Fatouhi, D., Franks, P. W., Fagherazzi, G., Grioni, S., ... Wareham, N. J. (2020). Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries. BMJ (Clinical research ed.), 370, Article m2194. https://doi.org/10.1136/bmj.m2194

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title = "Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries",

abstract = "OBJECTIVE: To investigate the association of plasma vitamin C and carotenoids, as indicators of fruit and vegetable intake, with the risk of type 2 diabetes.DESIGN: Prospective case-cohort study.SETTING: Populations from eight European countries.PARTICIPANTS: 9754 participants with incident type 2 diabetes, and a subcohort of 13 662 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort of 340 234 participants: EPIC-InterAct case-cohort study.MAIN OUTCOME MEASURE: Incident type 2 diabetes.RESULTS: In a multivariable adjusted model, higher plasma vitamin C was associated with a lower risk of developing type 2 diabetes (hazard ratio per standard deviation 0.82, 95% confidence interval 0.76 to 0.89). A similar inverse association was shown for total carotenoids (hazard ratio per standard deviation 0.75, 0.68 to 0.82). A composite biomarker score (split into five equal groups), comprising vitamin C and individual carotenoids, was inversely associated with type 2 diabetes with hazard ratios 0.77, 0.66, 0.59, and 0.50 for groups 2-5 compared with group 1 (the lowest group). Self-reported median fruit and vegetable intake was 274 g/day, 396 g/day, and 508 g/day for participants in categories defined by groups 1, 3, and 5 of the composite biomarker score, respectively. One standard deviation difference in the composite biomarker score, equivalent to a 66 (95% confidence interval 61 to 71) g/day difference in total fruit and vegetable intake, was associated with a hazard ratio of 0.75 (0.67 to 0.83). This would be equivalent to an absolute risk reduction of 0.95 per 1000 person years of follow up if achieved across an entire population with the characteristics of the eight European countries included in this analysis.CONCLUSIONS: These findings indicate an inverse association between plasma vitamin C, carotenoids, and their composite biomarker score, and incident type 2 diabetes in different European countries. These biomarkers are objective indicators of fruit and vegetable consumption, and suggest that diets rich in even modestly higher fruit and vegetable consumption could help to prevent development of type 2 diabetes.",

author = "Ju-Sheng Zheng and Sharp, {Stephen J} and Fumiaki Imamura and Rajiv Chowdhury and Gundersen, {Thomas E} and Marinka Steur and Ivonne Sluijs and {van der Schouw}, {Yvonne T} and Antonio Agudo and Dagfinn Aune and Aurelio Barricarte and Heiner Boeing and Mar{\'i}a-Dolores Chirlaque and Miren Dorronsoro and Heinz Freisling and Douae El-Fatouhi and Franks, {Paul W} and Guy Fagherazzi and Sara Grioni and Gunter, {Marc J} and Cecilie Kyr{\o} and Verena Katzke and Tilman K{\"u}hn and Kay-Tee Khaw and Nasser Laouali and Giovanna Masala and Nilsson, {Peter M} and Kim Overvad and Salvatore Panico and Keren Papier and Quir{\'o}s, {J Ram{\'o}n} and Olov Rolandsson and Daniel Redondo-S{\'a}nchez and Fulvio Ricceri and Schulze, {Matthias B} and Spijkerman, {Annemieke M W} and Anne Tj{\o}nneland and Tong, {Tammy Y N} and Rosario Tumino and Elisabete Weiderpass and John Danesh and Butterworth, {Adam S} and Elio Riboli and Forouhi, {Nita G} and Wareham, {Nicholas J}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2020",

month = jul,

day = "8",

doi = "10.1136/bmj.m2194",

language = "English",

volume = "370",

journal = "BMJ (Clinical research ed.)",

issn = "0959-8138",

publisher = "British Medical Association",

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Zheng, J-S, Sharp, SJ, Imamura, F, Chowdhury, R, Gundersen, TE, Steur, M, Sluijs, I, van der Schouw, YT, Agudo, A, Aune, D, Barricarte, A, Boeing, H, Chirlaque, M-D, Dorronsoro, M, Freisling, H, El-Fatouhi, D, Franks, PW, Fagherazzi, G, Grioni, S, Gunter, MJ, Kyrø, C, Katzke, V, Kühn, T, Khaw, K-T, Laouali, N, Masala, G, Nilsson, PM, Overvad, K, Panico, S, Papier, K, Quirós, JR, Rolandsson, O, Redondo-Sánchez, D, Ricceri, F, Schulze, MB, Spijkerman, AMW, Tjønneland, A, Tong, TYN, Tumino, R, Weiderpass, E, Danesh, J, Butterworth, AS, Riboli, E, Forouhi, NG & Wareham, NJ 2020, 'Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries', BMJ (Clinical research ed.), vol. 370, m2194. https://doi.org/10.1136/bmj.m2194

TY - JOUR

T1 - Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries

AU - Zheng, Ju-Sheng

AU - Sharp, Stephen J

AU - Imamura, Fumiaki

AU - Chowdhury, Rajiv

AU - Gundersen, Thomas E

AU - Steur, Marinka

AU - Sluijs, Ivonne

AU - van der Schouw, Yvonne T

AU - Agudo, Antonio

AU - Aune, Dagfinn

AU - Barricarte, Aurelio

AU - Boeing, Heiner

AU - Chirlaque, María-Dolores

AU - Dorronsoro, Miren

AU - Freisling, Heinz

AU - El-Fatouhi, Douae

AU - Franks, Paul W

AU - Fagherazzi, Guy

AU - Grioni, Sara

AU - Gunter, Marc J

AU - Kyrø, Cecilie

AU - Katzke, Verena

AU - Kühn, Tilman

AU - Khaw, Kay-Tee

AU - Laouali, Nasser

AU - Masala, Giovanna

AU - Nilsson, Peter M

AU - Overvad, Kim

AU - Panico, Salvatore

AU - Papier, Keren

AU - Quirós, J Ramón

AU - Rolandsson, Olov

AU - Redondo-Sánchez, Daniel

AU - Ricceri, Fulvio

AU - Schulze, Matthias B

AU - Spijkerman, Annemieke M W

AU - Tjønneland, Anne

AU - Tong, Tammy Y N

AU - Tumino, Rosario

AU - Weiderpass, Elisabete

AU - Danesh, John

AU - Butterworth, Adam S

AU - Riboli, Elio

AU - Forouhi, Nita G

AU - Wareham, Nicholas J

PY - 2020/7/8

Y1 - 2020/7/8

N2 - OBJECTIVE: To investigate the association of plasma vitamin C and carotenoids, as indicators of fruit and vegetable intake, with the risk of type 2 diabetes.DESIGN: Prospective case-cohort study.SETTING: Populations from eight European countries.PARTICIPANTS: 9754 participants with incident type 2 diabetes, and a subcohort of 13 662 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort of 340 234 participants: EPIC-InterAct case-cohort study.MAIN OUTCOME MEASURE: Incident type 2 diabetes.RESULTS: In a multivariable adjusted model, higher plasma vitamin C was associated with a lower risk of developing type 2 diabetes (hazard ratio per standard deviation 0.82, 95% confidence interval 0.76 to 0.89). A similar inverse association was shown for total carotenoids (hazard ratio per standard deviation 0.75, 0.68 to 0.82). A composite biomarker score (split into five equal groups), comprising vitamin C and individual carotenoids, was inversely associated with type 2 diabetes with hazard ratios 0.77, 0.66, 0.59, and 0.50 for groups 2-5 compared with group 1 (the lowest group). Self-reported median fruit and vegetable intake was 274 g/day, 396 g/day, and 508 g/day for participants in categories defined by groups 1, 3, and 5 of the composite biomarker score, respectively. One standard deviation difference in the composite biomarker score, equivalent to a 66 (95% confidence interval 61 to 71) g/day difference in total fruit and vegetable intake, was associated with a hazard ratio of 0.75 (0.67 to 0.83). This would be equivalent to an absolute risk reduction of 0.95 per 1000 person years of follow up if achieved across an entire population with the characteristics of the eight European countries included in this analysis.CONCLUSIONS: These findings indicate an inverse association between plasma vitamin C, carotenoids, and their composite biomarker score, and incident type 2 diabetes in different European countries. These biomarkers are objective indicators of fruit and vegetable consumption, and suggest that diets rich in even modestly higher fruit and vegetable consumption could help to prevent development of type 2 diabetes.

AB - OBJECTIVE: To investigate the association of plasma vitamin C and carotenoids, as indicators of fruit and vegetable intake, with the risk of type 2 diabetes.DESIGN: Prospective case-cohort study.SETTING: Populations from eight European countries.PARTICIPANTS: 9754 participants with incident type 2 diabetes, and a subcohort of 13 662 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort of 340 234 participants: EPIC-InterAct case-cohort study.MAIN OUTCOME MEASURE: Incident type 2 diabetes.RESULTS: In a multivariable adjusted model, higher plasma vitamin C was associated with a lower risk of developing type 2 diabetes (hazard ratio per standard deviation 0.82, 95% confidence interval 0.76 to 0.89). A similar inverse association was shown for total carotenoids (hazard ratio per standard deviation 0.75, 0.68 to 0.82). A composite biomarker score (split into five equal groups), comprising vitamin C and individual carotenoids, was inversely associated with type 2 diabetes with hazard ratios 0.77, 0.66, 0.59, and 0.50 for groups 2-5 compared with group 1 (the lowest group). Self-reported median fruit and vegetable intake was 274 g/day, 396 g/day, and 508 g/day for participants in categories defined by groups 1, 3, and 5 of the composite biomarker score, respectively. One standard deviation difference in the composite biomarker score, equivalent to a 66 (95% confidence interval 61 to 71) g/day difference in total fruit and vegetable intake, was associated with a hazard ratio of 0.75 (0.67 to 0.83). This would be equivalent to an absolute risk reduction of 0.95 per 1000 person years of follow up if achieved across an entire population with the characteristics of the eight European countries included in this analysis.CONCLUSIONS: These findings indicate an inverse association between plasma vitamin C, carotenoids, and their composite biomarker score, and incident type 2 diabetes in different European countries. These biomarkers are objective indicators of fruit and vegetable consumption, and suggest that diets rich in even modestly higher fruit and vegetable consumption could help to prevent development of type 2 diabetes.

U2 - 10.1136/bmj.m2194

DO - 10.1136/bmj.m2194

M3 - Article

C2 - 32641421

SN - 0959-8138

VL - 370

JO - BMJ (Clinical research ed.)

JF - BMJ (Clinical research ed.)

M1 - m2194

ER -

Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries

Abstract

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