Evidence for Association Between Type 2 Diabetes Essay

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¶ … Type 2 Diabetes

and intake of Fruits and Vegetables

Diabetes Mellitus has become one of the major chronic diseases affecting more than 220 million people around the world. [WHO, 2009] In Australia too the incidence of diabetes is on the rise with current estimates indicating that more than 1.7 million people are affected by the condition. Of these more than 85 to 90% are type 2 diabetes and on an average 275 people are diagnosed with diabetes everyday. [Diabetes Australia, (2010)] What is more alarming is the increasing prevalence of type 2 diabetes among younger generation. However, it is believed that healthy eating habits, active lifestyles and effective blood glucose control can help prevent up to 60% of type 2 diabetes cases. [Diabetes Australia] Healthy eating, in particular, regular consumption of fruits and vegetables have been regarded as highly protective of type 2 diabetes. This paper focuses on several studies pertaining to this association between fruits and vegetables intake and its effect on Type 2 diabetes. A brief overview and analysis of the studies would provide more insight into this important health topic.

Sargeant et.al (2001)

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Sargeant et.al (2001) is one of the rare cross sectional studies to analyze the relationship between the frequency of fruits and vegetable intake and glycosylated Hemoglobin HbA1C levels. This study was conducted from 1993 to 1998 and all the subjects were asked to complete a comprehensive Health and Lifestyle questionnaire. The study subjects were recruited from the European Prospective Investigation into Cancer (EPIC Norfolk ) database. A total of 6089 subjects who completed HbA1C assessment were asked to answer the health and lifestyle questionnaires. Statistical analysis including variance analysis (ANOVA), t-tests comparisons and chi-square tests were performed on the gathered data.

TOPIC: Essay on Evidence for Association Between Type 2 Diabetes Assignment

It was deduced that participants who reported very low or no consumption of fruits and vegetables had the highest mean HbA1C values of 5.49 (0.67) among men and 5.40 (0.63) among women. The similar ratios for those reporting high consumption (5 or more times per week) are 5.34 (0.75) for men and 5.31(0.64) for women. Plasma vitamin C levels are also significantly different between the high and low consumption groups for both sexes. 50.9 (18.1) vs. 33.9 (19.2) for men and 61.3 (19.0) vs. 41.7 (23.3) for women. The mean HbA1C values calculated based on the vegetable consumption also reflected a similar pattern. The HbA1C values for those consuming five or more times was 5.36 (0.71) vs. 5.49 (0.60) for the low or no consumption group. Overall it was obvious that participants with the least intake of fruits and vegetables had the highest mean HbA1C values. Even after adjusting for dietary supplements, age, BMI, alcohol and smoking habits, etc. The differences in HbA1C was significant at 5.35 (0.01) for the high consumption group vs. 5.47 (0.05) for the low or no consumption group. Overall, this cross sectional study suggests that fruits and vegetables have a positive effect on glucose metabolism. The higher plasma vitamin C levels (50.9 (18.1) vs. 33.9 (19.2)) and dietary fiber levels (20.1 (6.2) vs. 13.3 (4.8)) in the high consumption group suggests that these may have a role to play. [Sargeant et.al (2001)]

The study authors did not find a significant difference in HbA1C values even after adjusting for vitamin C and dietary fibers and so Vitamin C and dietary fibers could not clearly explain the results. The authors conclude that other components in fruits and vegetables (flavanoids and other secondary metabolites) may be involved in the protective role. This study is significant because of the large sample size and for the proven association between fruits and vegetable intake on reducing glycosylated Hemoglobin levels which is a marker for type 2 diabetes.

Montonen Et.al (2005)

This cohort study recruited participants from the Finnish mobile clinic health examination survey. In all, a total of 4304 men and women aged between 40 and 69 from 30 different communities in Finland were followed up for a period of 23 years. In this population group, the researchers studied the effects of different foods such as Green vegetables, fruits and berries, oil and margarine and poultry and their effect on the incidence of type 2 diabetes. Dietary patterns were gathered using dietary history interview by trained interviewers. Cox Model was used to calculate the relative risk RR for the different quartiles of consumption of the different food items. The following were the data for the RR of developing diabetes between the highest and lowest consumption. 0.69 (95% confidence interval (CI)1/40.50 -- 0.93; P. For trend (P)1/40.02) for green vegetables, 0.69 (CI1/40.51 -- 0.92; P1/40.03) for fruit and berries, 0.71 (CI1/40.52 -- 0.98; P1/40.01) for margarine and oil, and 0.71 (CI1/40.54 -- 0.94; P1/40.01) for poultry. [Montonen Et.al (2005)] The study also revealed that RR for consumption of potatoes was high at RR = (1.42). This study clearly shows an inverse relationship between the prudent diet choice of green vegetables, fruits and berries, oil and margarine and poultry with the risk of developing T2D. The only major shortcoming of the study is that there is no way of identifying diabetics undergoing only dietary therapy in its subject pool. This would have affected the estimation of the relationship between food intake and diabetes risk.

Villegas et.al (2008)

This population-based prospective cohort study analyzed 64,191 women in the age group of 40 to 70 drawn from the Shanghai Women's Health Study (SWHS) database. The participants were evaluated for their intake of vegetables and fruits using baseline food frequency questionnaires. (FFQ) The dietary information was again gathered at the follow up survey. During the follow up after 4.6 years 1608 participants reported diagnosis of diabetes. The researchers applied the Cox proportional hazards model to understand the association between fruit and vegetable intake and the incidence of type2 diabetes. Confounding variables such as age, BMI, WHR, total energy, meat intake, smoking status, physical activity etc. were adjusted for.

The relative risk (RR) comparing the lowest intake of vegetables across the various intake levels of vegetables was found to be 1.00, 0.74, 0.68, 0.72, and 0.72 (P-trend < 0.001) . The RR comparing the lowest intakes of fruit across the various intake levels was 1.00, 0.76, 0.79, 0.87, and 1.05 (P-trend 0.30). After adjusting for antioxidants, fiber, magnesium, etc. The RR for T2D across the different quintiles of vegetable consumption were 1.00, 0.71, 0.63, 0.63, and 0.56 (P-trend <.001). Thus study authors concluded that higher intake of vegetables was inversely associated with increased risk for T2D. The fact that adjusting for vitamin C, fiber, Magnesium and other confounding variables did not significantly alter the RR value for vegetable intake indicates these factors alone cannot explain the protective effect of vegetables. The authors presume that other vegetable components such as phytates, lignans, and isoflavones, etc. may also play an important role in T2D control action of vegetables. Like the previous study, this study also could not clearly define the mechanism of action by which vegetables impact glucose tolerance.

Anne et.al (2008)

Anne et.al (2008) studied the intake of fruits and vegetables and the related plasma Vitamin C levels and tried to ascertain if Plasma vitamin C level could be associated with the risk of T2D. This prospective population-based study also utilized the (European Prospective Investigation of Cancer -- Norfolk) EPIC database and a total of 21,831 subjects were recruited. Semi-quantitative food frequency questionnaires were used to gather data pertaining to the participants' intake of fruits and vegetables. The study participants were between 40 and 75 years of age (male and female). Their plasma vitamin C levels were measured at baseline and they were regularly followed up to analyze their fruit and vegetable intake. This exhaustive longitudinal study began in Feb 1993 and ended in Dec 2005. During this period a total of 735 clinical cases of diabetes were identified. Statistical analysis of the gathered information revealed some interesting facts. After adjusting for demographic and anthropometric variables it was found that the odds ratio of diabetes and the Plasma vitamin C levels was 0.38 (95% confidence interval, 0.28-0.52) clearly suggesting that Plasma vitamin C level is inversely associated with the risk for T2D. Similarly the Odds ratio of diabetes and highest intake levels of fruits and vegetables was 0.78 (95% confidence interval, 0.60-1.00) implying that fruits and vegetables intake have a protective effect. This study had a large sample size and so the results can be generalized across the population.

Bazzano et.al (2008)

A longitudinal cohort study by Bazzano et.al (2008) focused on the relationship between the consumption of fruits, vegetables and fruit juices on the development of Type 2 Diabetes. This study which began in 1984 followed 71, 346 healthy, non-diabetic, nurses over a period of 18 years and their dietary information was collected every 4 years using the Semi-quantitative Frequent food questionnaire. During the entire follow up period, a total of 4529 nurses in the subject pool reported as being diabetic. The Cox regression model was used to study the linear trends. The multivariate adjusted hazard ratio (HR)… [END OF PREVIEW] . . . READ MORE

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