Daily Diet of Fresh Fruit Linked to Lower Diabetes Risk

“Eating fresh fruit daily could cut risk of diabetes by 12%,” the Mail Online reports.

A study of half a million people in China found those who ate fruit daily were 12% less likely to get type 2 diabetes than those who never or rarely ate it.

It was also found that people with diabetes at the start of the study who ate fruit regularly were slightly less likely to die, or to get complications of diabetes, such as eye problems (diabetic retinopathy), during the study than those who ate fruit rarely or never.

Many people with diabetes in China avoid eating fruit, because they are told it raises blood sugar. However, the study suggests fresh fruit may actually be beneficial for people with and without diabetes.

Fruits which release sugars more slowly into the blood, such as apples, pears and oranges, are the most popular in China, according to the researchers. So this may be the preferred option if you are worried about diabetes risk, or have been diagnosed with diabetes.

The study doesn’t show that fruit directly prevents diabetes or diabetes complications, as an inherent limitation of this type of study is that other factors could be involved. And it doesn’t tell us how much fruit might be too much.

Overall, the research suggests fresh fruit can be part of a healthy diet for everyone.

Where did the story come from?

The study was carried out by researchers from the University of Oxford, and Peking University, Chinese Academy of Medical Sciences, China National Center for Food Safety Risk Assessment, Non-communicable Disease Prevention and Control Department, and Pengzhou Center for Disease Control and Prevention, all in China. It was funded by the Kadoorie Charitable Foundation.

The study was published in the peer-reviewed journal PLOS Medicine on an open-access basis, so it’s free to read online.

The Mail’s report was basically accurate, although it did not point out that this type of study cannot prove cause and effect. The report confused some readers by saying that fruit does not raise blood sugar because it is metabolised differently to refined sugar.

However, what the study found was that fruit-eaters’ blood sugar was not on average higher than that of non-fruit eaters. Like most food, the rise in sugar levels after eating fruit is usually temporary.

The Sun’s report was poorly written and contained some basic grammatical errors.

What kind of research was this?

This was a large-scale prospective cohort study. Researchers wanted to look for associations between fruit eating, diabetes and complications of diabetes.

However, while this type of study is good for spotting links, it cannot prove that one factor causes another.

What did the research involve?

Researchers used information from a big ongoing cohort study called the China Kadoorie Biobank Study, which recruited half a million adults aged 30 to 79 between 2004 and 2008.

Participants filled in questionnaires about their health, diet and lifestyle and had measurements taken of their blood sugar, blood pressure, cholesterol and other health-related factors. The diet questionnaires were repeated over the course of the study. After an average seven years of follow-up, researchers looked to see how fruit consumption related to diabetes.

Some people in the study (almost 6%) had diabetes at the start of the study. While not actually specified in the study, we assume the majority of these cases were type 2 diabetes. Type 1 diabetes usually begins in childhood and is less common than type 2.

About half of them had previously been diagnosed, and half were diagnosed due to their blood sugar readings taken during the study. China’s Disease Surveillance Points system was used to identify any deaths and cause of death during the study. Disease registries and health insurance claims were used to look into diabetes-related health complications.

The researchers took the average responses from the diet questionnaires to establish how regularly people ate fruit, to account for possible changes in dietary habits.

They adjusted the figures to take account of potential confounding factors including age, age at diabetes diagnosis, gender, smoking, alcohol consumption, physical activity and body mass index.

What were the basic results?

Only 18.8% of people surveyed reported eating fruit daily, and 6.4% said they never or rarely ate fruit. Some 30,300 people had diabetes at the start of the study, and there were 9,504 new cases of diabetes in the seven years of follow up, or 2.8 for each 1,000 people each year.

  • People who ate fresh fruit daily were 12% less likely to develop diabetes than those who never or rarely ate fresh fruit (hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.83 to 0.93).
  • Of the people with diabetes at the start of the study, 11.2% died during follow up (16.5 for every 1,000 people each year).
  • People with diabetes who ate fresh fruit on three days a week or more were 14% less likely to die of any cause, compared to those who ate fresh fruit less than one day a week (HR 0.86, 95% CI 0.80 to 0.94). They were also less likely to die from diabetes-related causes or cardiovascular disease, specifically.
  • People with diabetes who ate fresh fruit daily were also 14% less likely to have complications of damage to their large blood vessels (such as heart attack or stroke) than those who ate fresh fruit never or rarely (HR 0.86, 95% CI 0.82 to 0.90). They were also 28% less likely to have small blood vessel complications, such as eye or kidney disease (HR 0.72, 95% CI 0.63 to 0.83).

How did the researchers interpret the results?

The researchers say their results “provide strong evidence in support of current dietary guidelines that fresh fruit consumption should be recommended for all, including those with diabetes.”

They say that people with diabetes in China eat much less fruit than people without diabetes, because of concerns about sugar in fruit. They say the study shows that better health education is “urgently needed” in China and other Asian countries where diabetes is common, and many people misunderstand the effects of eating fresh fruit.

They speculate that “natural sugars in fruit may not be metabolised in the same way as refined sugars,” although their paper did not investigate this.

Conclusion

The study findings – that eating fresh fruit every day does not raise the risk of diabetes, and may reduce it – are reassuring and in line with dietary advice in the UK. It’s also helpful to see evidence that people who already have diabetes are likely to benefit from fresh fruit as well, because there has not been much research into fruit-eating for people with diabetes.

However, it’s a step too far to say that fresh fruit prevents diabetes or diabetes complications. Fresh fruit is just one part of a healthy diet, and diet is just one of the things that may affect someone’s risk of getting diabetes. This type of study can’t tell us whether fresh fruit actually protects against diabetes, because it can’t account for all the other health and lifestyle factors involved.

Though it would be expected that the results of this large scale study should be applicable to other populations, there may be differences between people from China and other populations. This could include differences in prevalence of diabetes and its risk factors, differences in healthcare (for example, diagnostic criteria and methods for coding health outcomes in databases), and other environmental and lifestyle differences, including fruit consumption.

The study didn’t ask people which types of fruit they ate, but the researchers say the most commonly eaten fruits in China are apples, pears and oranges, which release sugars more slowly into the blood stream than bananas, grapes and tropical fruits.

It’s important to make a distinction between whole fresh fruit, which contains lots of fibre, and fruit juice, which is very high in sugar. Previous research that we reported on in 2013 found that fruit may lower diabetes risk, but fruit juice may raise it.

The most effective method of reducing your diabetes risk is to achieve or maintain a healthy weight, through a combination of regular exercise and healthy eating.

Source: NHS Choices


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The Consumption of Legumes is Associated with a Lower Risk of Diabetes

Recent results from the PREDIMED (Prevención con Dieta Mediterranea) study show a protective association between total legumes consumption, especially lentils, and the risk of developing subsequent type 2 diabetes after more than 4 years of follow-up of 3349 participants at high cardiovascular risk. Moreover, the present study shows that replacing a half a serving/day of eggs, bread, rice or baked potato with a half a serving/day of legumes was also associated with a lower risk of type 2 diabetes.

Legumes are a food group rich in B vitamins, contain different beneficial minerals (calcium, potassium and magnesium) and sizeable amounts of fibre and are regarded as a low-glycemic index food, which means that blood glucose levels increase only slowly after consumption. Due to these unique nutritional qualities, eating legumes regularly can help improve human health. In fact, the Food and Agriculture Organization of the United Nations (FAO) declared 2016 as the international year of legumes to raise people’s awareness of their nutritional benefits.

Although legumes have long been though to offer protection against type 2 diabetes (which is a significant health problem worldwide affecting more than 400 million adults in 2015), to date there has been little research to confirm this association.

To increase the general level of knowledge in this area, researchers from the URV’s Human Nutrition Unit in collaboration with other research groups in the PREDIMED study evaluated the association between the consumption of the different sub-types of non-soy legumes and the risk of type 2 diabetes among individuals at high cardiovascular risk. They also evaluated the effect of replacing other protein- and carbohydrate-rich foods with legumes on the development of the disease.

Researchers analysed 3349 participants at high risk of cardiovascular disease but without type 2 diabetes at the beginning of the PREDIMED study. After 4 years of follow-up, the results have revealed that compared to individuals with a lower consumption of total legumes – lentils, chickpeas, beans and peas- (12.73 grams/day, approximately equivalent to 1.5 servings per week of 60g of raw legumes), individuals with a higher consumption (28.75 grams/day, equivalent to 3,35 servings/week) had a 35% lower risk of developing type 2 diabetes. Of the different subtypes of legume, lentils in particular were associated with a lower risk of type 2 diabetes. Those participants who had a higher consumption of lentils during the follow-up (nearly 1 serving/week) compare to those individuals with a lower consumption (less than half a serving per week), had a 33% lower risk of developing the disease. The researchers also found that the effect of replacing half a serving/day of foods rich in protein or carbohydrates, including eggs, bread, rice and baked potato, for half a serving/day of legumes was also associated with a lower risk of type 2 diabetes incidence.

The researchers highlight the importance of consuming legumes to prevent chronic diseases such as diabetes, but state that further research must be conducted in other populations to confirm these results.

The study, published in the scientific journal Clinical Nutrition.

Source: Universitat Rovira i Virgili


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Downside to Gluten-Free Diets: Diabetes Risk

Amy Norton wrote . . . . .

“Gluten-free” may be the latest diet fad, but new research casts some doubt on its presumed health benefits.

In a large study of U.S. health professionals, scientists found that those with the least gluten in their diets actually had a slightly higher risk of developing type 2 diabetes over a few decades.

The findings do not prove that a low-gluten diet somehow contributes to diabetes. But the study raises questions about the long-term benefits of avoiding gluten, which many people assume to be a healthy move.

Some people — namely, those with the digestive disorder celiac disease — do have to shun gluten, said lead researcher Geng Zong.

But there is little research on whether other people stand to gain from going gluten-free, said Zong. He is a research fellow in nutrition at Harvard T.H. Chan School of Public Health, in Boston.

That’s a big evidence gap, according to Zong — given the popularity and expense of gluten-free foods.

Gluten is a protein found in grains such as wheat, rye and barley. Gluten-free diets are a must for people with celiac disease — an autoimmune disorder in which gluten-containing foods cause the immune system to attack the small intestine.

But gluten-free, or at least gluten-light, diets have caught on as a way for anyone to lose weight and improve their health.

One recent study found that the number of Americans who say they’ve gone gluten-free tripled between 2009 and 2014.

The new findings are based on nearly 200,000 U.S. health professionals whose health and lifestyle habits were followed over three decades.

The low-gluten fad did not exist when the study period began, in the 1980s, Zong pointed out. But participants’ gluten intake naturally varied, based on how often they ate foods like bread, cereal and pasta.

Over 30 years, just under 16,000 study participants developed type 2 diabetes — a disease in which blood sugar levels are persistently too high. Obesity is one of the major risk factors.

When Zong’s team looked at people’s gluten intake, the investigators found study participants who ate the least of it actually had a somewhat higher risk of developing diabetes over time.

Most people consumed no more than 12 grams of gluten each day, with the average being 6 to 7 grams. Those in the top 20 percent for gluten intake were 13 percent less likely to develop type 2 diabetes, versus those in the bottom 20 percent — who typically ate fewer than 4 grams of gluten each day, the findings showed.

Zong’s team did try to account for other factors, including people’s exercise habits, weight, typical calorie intake and family history of diabetes.

However, lower gluten intake was still tied to a higher type 2 diabetes risk.

Zong was scheduled to present the findings Thursday at a meeting of the American Heart Association, in Portland, Ore.

The study does not prove that limiting gluten somehow causes diabetes, according to Lauri Wright, a spokeswoman for the Academy of Nutrition and Dietetics.

Even though the researchers weighed other factors, she said it’s still possible that people at heightened risk of diabetes tried to avoid the types of food that often contain gluten.

Wright, who was not involved in the study, is also director of the doctorate in clinical nutrition program at the University of North Florida, in Jacksonville.

The bottom line, according to Wright, is this: Unless you have celiac disease, focusing on the quality of your carbohydrates — rather than gluten avoidance — is the way to go.

Wright advised eating vegetables, fruit and fiber-rich whole grains, as opposed to refined carbohydrates.

“But be aware of the portion sizes, and be careful about what you add,” Wright said. Cream sauces and butter, she noted, are examples of “additions” that can thwart your good intentions.

One concern with going low-gluten is that it could cut out major sources of dietary fiber — which, research suggests, helps ward off type 2 diabetes and other chronic ills.

In this study, people with low gluten intakes did eat less grain-based fiber. And that seemed to partly account for their higher diabetes risk, Zong said.

He agreed that it’s important to focus on eating a range of nutrient-rich whole foods, rather than obsessing over gluten.

Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

Source: HealthDay


Read also:

Is going gluten-free giving you diabetes? New study links diet with the disease . . . . .

Findings Suggest Causal Association between Abdominal Fat and Development of Type 2 Diabetes, Coronary Heart Disease

A genetic predisposition to higher waist-to-hip ratio adjusted for body mass index (a measure of abdominal adiposity [fat]) was associated with an increased risk of type 2 diabetes and coronary heart disease, according to a study appearing in the February 14 issue of JAMA.

Obesity, typically defined on the basis of body mass index (BMI), is a leading cause of type 2 diabetes and coronary heart disease (CHD). However, for any given BMI, body fat distribution can vary substantially; some individuals store proportionally more fat around their visceral organs (abdominal adiposity) than on their thighs and hip. In observational studies, abdominal adiposity has been associated with type 2 diabetes and CHD. Whether these associations represent causal relationships remains uncertain.

Sekar Kathiresan, M.D., of Massachusetts General Hospital, Harvard Medical School, Boston, and colleagues examined whether a genetic predisposition to increased waist-to-hip ratio adjusted for BMI was associated with cardiometabolic quantitative traits (i.e., lipids, insulin, glucose, and systolic blood pressure), type 2 diabetes and CHD.

Estimates for cardiometabolic traits were based on a combined data set consisting of summary results from 4 genome-wide association studies conducted from 2007 to 2015, including up to 322,154 participants, as well as individual-level, cross-sectional data from the UK Biobank collected from 2007-2011, including 111,986 individuals.

The researchers found that genetic predisposition to higher waist-to-hip ratio adjusted for BMI was associated with increased levels of quantitative risk factors (lipids, insulin, glucose, and systolic blood pressure) as well as a higher risk for type 2 diabetes and CHD.

“These results permit several conclusions. First, these findings lend human genetic support to previous observations associating abdominal adiposity with cardiometabolic disease,” the authors write.

“Second, these results suggest that body fat distribution, beyond simple measurement of BMI, could explain part of the variation in risk of type 2 diabetes and CHD noted across individuals and subpopulations. … Third, waist-to-hip ratio adjusted for BMI might prove useful as a biomarker for the development of therapies to prevent type 2 diabetes and CHD.”

Source: EurekAlert!


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American College of Physicians Updates Recommendations for Treatment of Type 2 Diabetes

Physicians should prescribe metformin to patients with type 2 diabetes when medication is needed to improve high blood sugar, the American College of Physicians (ACP) recommends in an evidence-based clinical practice guideline published today in Annals of Internal Medicine.

If a second oral medication is needed to improve high blood sugar, ACP recommends that physicians consider adding either a sulfonylurea, thiazolidinedione, SGLT-2 inhibitor, or DPP-4 inhibitor to metformin.

The American Academy of Family Physicians has endorsed the guideline.

“Metformin, unless contraindicated, is an effective treatment strategy because it has better effectiveness, is associated with fewer adverse effects, and is cheaper than most other oral medications,” said Nitin S. Damle, MD, MS, MACP, president. ACP. “The escalating rates of obesity in the U.S. are increasing the incidence and prevalence of diabetes substantially. Metformin has the added benefit of being associated with weight loss.”

ACP updated its 2012 guideline on the comparative effectiveness and safety of oral medications for the treatment of type 2 diabetes because of several new studies evaluating medications for type 2 diabetes as well as recent FDA approvals of several new medications.

“Adding a second medication to metformin may provide additional benefits,” Dr. Damle said. “However, the increased cost may not always support the added benefit, particularly for the more expensive, newer medications. ACP recommends that clinicians and patients discuss the benefits, adverse effects, and costs of additional medications.”

Diabetes is a leading cause of death in the U.S. The disease can affect other areas of the body and can cause retinopathy, nephropathy, neuropathy, and coronary artery, cerebrovascular, and peripheral vascular disease complications. Type 2 diabetes is the most common form of the disease (affecting 90 to 95 percent of persons with diabetes), affecting about 29.1 million people in the U.S.

ACP’s Guideline Development Process ACP’s guideline is based on a systematic review of randomized controlled trials and observational studies on the comparative effectiveness of oral medications for type 2 diabetes. Evaluated interventions include metformin, thiazolidinediones, sulfonylureas, and dipeptidyl peptidase-4 inhibitors. Evaluated outcomes included: intermediate outcomes of hemoglobin A1c, weight, systolic blood pressure, and heart rate; all-cause mortality, cardiovascular and cerebrovascular morbidity and mortality; retinopathy, nephropathy, neuropathy; and harms.

ACP’s clinical practice guidelines are developed through a rigorous process based on an extensive review of the highest quality evidence available, including randomized control trials and data from observational studies. ACP also identifies gaps in evidence and direction for future research through its guidelines development process.

Source: EurekAlert!


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