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http://www.bmj.com/content/347/bmj.f5001

Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5001 (Published 29 August 2013) Cite this as: BMJ 2013;347:f5001

Fruits are rich in fibre, antioxidants, and phytochemicals that may have beneficial health effects. Increasing fruit consumption has been recommended for the primary prevention of many chronic diseases, including type 2 diabetes,1although epidemiologic studies have generated somewhat mixed results regarding the link with risk of type 2 diabetes.2 3 4 5 6 7 8 9 10 The inconsistency among these studies may be explained by differences in types of fruits consumed in different study populations as well as difference in participants’ characteristics, study design, and assessment methods, although a meta-analysis did not show that the associations differed by sex, study design, or location.10 Furthermore, in a recent study, the greater variety, but not quantity, of fruits consumed was associated with a lower risk of type 2 diabetes.4 This finding suggested that individual fruits might not be equally associated with risk of type 2 diabetes in that fruits have highly variable contents of fibre, antioxidants, other nutrients, and phytochemicals that jointly may influence the risk.11 12 Additionally, the glycemic index, which represents the quality of carbohydrate, or glycemic load, which represents the quality and quantity of carbohydrate and their interaction, vary substantially for individual fruits.13

We examined the associations of individual fruit consumption in relation to risk of type 2 diabetes using data from three prospective cohort studies in US adults. Moreover, we estimated substitution effects of individual fruits for fruit juice in relation to risk of type 2 diabetes. Secondarily, we examined the associations of fruit groups based on their glycemic index and glycemic load values with risk of type 2 diabetes.