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

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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.


  • A. J. Cooper
  • N. G. Forouhi
  • Z. Ye
  • B. Buijsse
  • L. Arriola
  • B. Balkau
  • A. Barricarte
  • J. W. J. Beulens
  • H. Boeing
  • F. L. Buchner
  • C. C. Dahm
  • B. de Lauzon-Guillain
  • G. Fagherazzi
  • C. Gonzalez
  • S. Grioni
  • R. Kaaks
  • T. J. Key
  • G. Masala
  • C. Navarro
  • P. Nilsson
  • K. Overvad
  • S. Panico
  • J. Ramon Quiros
  • O. Rolandsson
  • N. Roswall
  • C. Sacerdote
  • M-J Sanchez
  • 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 areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Nutrition and Dietetics


  • fruit, vegetables, type 2 diabetes mellitus, epidemiology, meta-analysis, review
Original languageEnglish
Pages (from-to)1082-1092
JournalEuropean Journal of Clinical Nutrition
Issue number10
Publication statusPublished - 2012
Publication categoryResearch