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000157046 0247_ $$2doi$$a10.1136/bmj.m2194
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000157046 041__ $$aeng
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000157046 1001_ $$aZheng, Ju-Sheng$$b0
000157046 245__ $$aAssociation of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries.
000157046 260__ $$aLondon$$bBritish Medical Association56099$$c2020
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000157046 520__ $$aTo investigate the association of plasma vitamin C and carotenoids, as indicators of fruit and vegetable intake, with the risk of type 2 diabetes.Prospective case-cohort study.Populations from eight European countries.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.Incident type 2 diabetes.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.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.
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000157046 7001_ $$aSharp, Stephen J$$b1
000157046 7001_ $$aImamura, Fumiaki$$b2
000157046 7001_ $$aChowdhury, Rajiv$$b3
000157046 7001_ $$aGundersen, Thomas E$$b4
000157046 7001_ $$aSteur, Marinka$$b5
000157046 7001_ $$aSluijs, Ivonne$$b6
000157046 7001_ $$avan der Schouw, Yvonne T$$b7
000157046 7001_ $$aAgudo, Antonio$$b8
000157046 7001_ $$aAune, Dagfinn$$b9
000157046 7001_ $$aBarricarte, Aurelio$$b10
000157046 7001_ $$aBoeing, Heiner$$b11
000157046 7001_ $$aChirlaque, María-Dolores$$b12
000157046 7001_ $$aDorronsoro, Miren$$b13
000157046 7001_ $$aFreisling, Heinz$$b14
000157046 7001_ $$aEl-Fatouhi, Douae$$b15
000157046 7001_ $$aFranks, Paul W$$b16
000157046 7001_ $$aFagherazzi, Guy$$b17
000157046 7001_ $$aGrioni, Sara$$b18
000157046 7001_ $$aGunter, Marc J$$b19
000157046 7001_ $$aKyrø, Cecilie$$b20
000157046 7001_ $$0P:(DE-He78)fb68a9386399d72d84f7f34cfc6048b4$$aKatzke, Verena$$b21$$udkfz
000157046 7001_ $$0P:(DE-He78)0907a10ba1dc8f53f04907f54f6fdcfe$$aKühn, Tilman$$b22$$udkfz
000157046 7001_ $$aKhaw, Kay-Tee$$b23
000157046 7001_ $$aLaouali, Nasser$$b24
000157046 7001_ $$aMasala, Giovanna$$b25
000157046 7001_ $$aNilsson, Peter M$$b26
000157046 7001_ $$aOvervad, Kim$$b27
000157046 7001_ $$aPanico, Salvatore$$b28
000157046 7001_ $$aPapier, Keren$$b29
000157046 7001_ $$aQuirós, J Ramón$$b30
000157046 7001_ $$aRolandsson, Olov$$b31
000157046 7001_ $$aRedondo-Sánchez, Daniel$$b32
000157046 7001_ $$aRicceri, Fulvio$$b33
000157046 7001_ $$aSchulze, Matthias B$$b34
000157046 7001_ $$aSpijkerman, Annemieke M W$$b35
000157046 7001_ $$aTjønneland, Anne$$b36
000157046 7001_ $$aTong, Tammy Y N$$b37
000157046 7001_ $$aTumino, Rosario$$b38
000157046 7001_ $$aWeiderpass, Elisabete$$b39
000157046 7001_ $$aDanesh, John$$b40
000157046 7001_ $$aButterworth, Adam S$$b41
000157046 7001_ $$aRiboli, Elio$$b42
000157046 7001_ $$00000-0002-5041-248X$$aForouhi, Nita G$$b43
000157046 7001_ $$aWareham, Nicholas J$$b44
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