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

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

216 Citations (Scopus)


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
Externally publishedYes


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


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