剑桥大学临床医学院MRC流行病学中心的Ju-Sheng Zheng、Stephen J Sharp 和Fumiaki Imamura等人旨在调查血浆维生素C和类胡萝卜素作为水果和蔬菜摄入量的指标与罹患2型糖尿病风险的关系。
设 计
前瞻性病例队列研究。
背 景
来自8 个欧洲国家的人口。
参与者
9754名2型糖尿病患者、以及来自欧洲癌症与营养前瞻性调查（European Prospective Investigation into Cancer and Nutrition，EPIC）队列的340 234名参与者中的13662个人的子队列：EPIC-交互案例研究
主要评价指标
2型糖尿病。
结 果
在多变量校正模型中，血浆维生素C升高与罹患2型糖尿病的风险降低相关（每标准偏差的风险比0.82，95％置信区间0.76～0.89）。类胡萝卜素也显示出相似的负相关性（每标准偏差的风险比0.75，0.68～0.82）。由维生素C和个别种类的类胡萝卜素组成的生物标志物综合评分（分为5 个相等的组）与2型糖尿病的患病率呈负相关，与1 组（最低组）相比，2～5组的风险比为0.77、0.66、0.59和0.50 ）。生物标志物综合评分的第1、3和5组参与者的自评报告中水果和蔬菜的摄入量中位数分别为274克/天、396克/天和508克/天。综合生物标志物得分的一个标准偏差差异，等于水果和蔬菜摄入总量的66（95％置信区间 61～71）克/日差，与危险比0.75（0.67至0.83）相关。如果在整个人口中均达到本分析中包括的8 个欧洲国家的特征，则相当于后续每1 000人/年的绝对风险将降低0.95。
结 论
这些发现表明，在不同的欧洲国家，血浆维生素C、类胡萝卜素及其复合生物标志物评分与2型糖尿病的发生呈负相关。这些生物标志物是水果和蔬菜消费的客观指标，并表明富含水果和蔬菜的饮食甚至水果和蔬菜摄入量适当高一些都可以帮助预防2型糖尿病的发展 。
Abstract
Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries
Objective
To investigate the association of plasma vitamin C and carotenoids, as indicators of fruit and vegetable intake, with the risk of type 2 diabetes.
Design
Prospective case-cohort study.
Setting
Populations from eight European countries.
Participants
9754 participants with incident type 2 diabetes, and a subcohort of 13?662 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort of 340 234 participants: EPIC-InterAct case-cohort study.
Main outcome measure
Incident type 2 diabetes.
Results
In a multivariable adjusted model, higher plasma vitamin C was associated with a lower risk of developing type 2 diabetes (hazard ratio per standard deviation 0.82, 95% confidence interval 0.76 to 0.89). A similar inverse association was shown for total carotenoids (hazard ratio per standard deviation 0.75, 0.68 to 0.82). A composite biomarker score (split into five equal groups), comprising vitamin C and individual carotenoids, was inversely associated with type 2 diabetes with hazard ratios 0.77, 0.66, 0.59, and 0.50 for groups 2-5 compared with group 1 (the lowest group). Self-reported median fruit and vegetable intake was 274 g/day, 396 g/day, and 508 g/day for participants in categories defined by groups 1, 3, and 5 of the composite biomarker score, respectively. One standard deviation difference in the composite biomarker score, equivalent to a 66 (95% confidence interval 61 to 71) g/day difference in total fruit and vegetable intake, was associated with a hazard ratio of 0.75 (0.67 to 0.83). This would be equivalent to an absolute risk reduction of 0.95 per 1000 person years of follow up if achieved across an entire population with the characteristics of the eight European countries included in this analysis.
Conclusions
These findings indicate an inverse association between plasma vitamin C, carotenoids, and their composite biomarker score, and incident type 2 diabetes in different European countries. These biomarkers are objective indicators of fruit and vegetable consumption, and suggest that diets rich in even modestly higher fruit and vegetable consumption could help to prevent development of type 2 diabetes.
