Fruit and vegetable intake and type 2 diabetes: EPIC-InterAct prospective study and meta-analysis

A. J. Cooper, N. G. Forouhi, Z. Ye, B. Buijsse, L. Arriola, B. Balkau, A. Barricarte, J. W J Beulens, H. Boeing, F. L. Büchner, C. C. Dahm, B. De Lauzon-Guillain, G. Fagherazzi, P. W. Franks, C. Gonzalez, S. Grioni, R. Kaaks, T. J. Key, G. Masala, C. NavarroP. Nilsson, K. Overvad, S. Panico, J. Ramón Quirós, O. Rolandsson, N. Roswall, C. Sacerdote, M. J. Sánchez, N. Slimani, I. Sluijs, A. M W Spijkerman, B. Teucher, A. Tjonneland, R. Tumino, S. J. Sharp, C. Langenberg, E. J M Feskens, E. Riboli, N. J. Wareham

Research output: Contribution to journalArticlepeer-review


Fruit and vegetable intake (FVI) may reduce the risk of type 2 diabetes (T2D), but the epidemiological evidence is inconclusive. The aim of this study is to examine the prospective association of FVI with T2D and conduct an updated meta-analysis. In the European Prospective Investigation into Cancer-InterAct (EPIC-InterAct) prospective case-cohort study nested within eight European countries, a representative sample of 16 154 participants and 12 403 incident cases of T2D were identified from 340 234 individuals with 3.99 million person-years of follow-up. For the meta-analysis we identified prospective studies on FVI and T2D risk by systematic searches of MEDLINE and EMBASE until April 2011. In EPIC-InterAct, estimated FVI by dietary questionnaires varied more than twofold between countries. In adjusted analyses the hazard ratio (95% confidence interval) comparing the highest with lowest quartile of reported intake was 0.90 (0.80-1.01) for FVI; 0.89 (0.76-1.04) for fruit and 0.94 (0.84-1.05) for vegetables. Among FV subtypes, only root vegetables were inversely associated with diabetes 0.87 (0.77-0.99). In meta-analysis using pooled data from five studies including EPIC-InterAct, comparing the highest with lowest category for FVI was associated with a lower relative risk of diabetes (0.93 (0.87-1.00)). Fruit or vegetables separately were not associated with diabetes. Among FV subtypes, only green leafy vegetable (GLV) intake (relative risk: 0.84 (0.74-0.94)) was inversely associated with diabetes. Subtypes of vegetables, such as root vegetables or GLVs may be beneficial for the prevention of diabetes, while total FVI may exert a weaker overall effect.

Original languageEnglish
Pages (from-to)1082-1092
Number of pages11
JournalEuropean Journal of Clinical Nutrition
Issue number10
Publication statusPublished - Oct 2012


  • epidemiology
  • fruit
  • meta-analysis
  • review
  • type 2 diabetes mellitus
  • vegetables

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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