Intake of Fruit, Vegetables, and Fruit Juices and Risk of Diabetes in Women

Lydia A. Bazzano, MD, PHD; Tricia Y. Li, MD, MS; Kamudi J. Joshipura, BDS, MS, SCD; Frank B. Hu, MD, PHD


Diabetes Care. 2008;31(7):1311-1317. 

In This Article

Abstract and Introduction


Objective: The purpose of this study was to examine the association between fruit, vegetable, and fruit juice intake and development of type 2 diabetes.
Research Design And Methods: A total of 71,346 female nurses aged 38-63 years who were free of cardiovascular disease, cancer, and diabetes in 1984 were followed for 18 years, and dietary information was collected using a semiquantitative food frequency questionnaire every 4 years. Diagnosis of diabetes was self-reported.
Results: During follow-up, 4,529 cases of diabetes were documented, and the cumulative incidence of diabetes was 7.4%. An increase of three servings/day in total fruit and vegetable consumption was not associated with development of diabetes (multivariate-adjusted hazard ratio 0.99 [95% CI 0.94-1.05]), whereas the same increase in whole fruit consumption was associated with a lower hazard of diabetes (0.82 [0.72-0.94]). An increase of 1 serving/day in green leafy vegetable consumption was associated with a modestly lower hazard of diabetes (0.91 [0.84-0.98]), whereas the same change in fruit juice intake was associated with an increased hazard of diabetes (1.18 [1.10-1.26]).
Conclusions: Consumption of green leafy vegetables and fruit was associated with a lower hazard of diabetes, whereas consumption of fruit juices may be associated with an increased hazard among women.


The worldwide burden of type 2 diabetes has increased rapidly in tandem with increases in obesity. The most recent estimate for the number of people with diabetes worldwide in 2000 was 171 million, and this number is projected to increase to at least 366 million by the year 2030.[1] Fruit and vegetable consumption has been associated with decreased incidence of and mortality from a variety of health outcomes including obesity, hypertension, and cardiovascular diseases in epidemiological studies.[2,3,4] However, few prospective studies have examined the relationship between fruit and vegetable intake and risk of diabetes, and the results are not entirely consistent.[5,6,7,8,9,10]

Differences in the nutrient contents of fruits and vegetables by group could lead to differences in health effects. Furthermore, the role of fruit juices could be important and has not been well studied. Although fruit juices may have antioxidant activity,[11] they lack fiber, are less satiating, and tend to have high sugar content. To further explore the role of fruit and vegetable consumption in the development of diabetes, we examined the association between intake of all fruits and vegetables, specific groups of fruits and vegetables, and fruit juices among women enrolled in the Nurses' Health Study diet cohort.


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