The association between a biomarker score for fruit and vegetable intake and incident type 2 diabetes: the EPIC-Norfolk study.
OBJECTIVE
Biomarkers for a mixed fruit and vegetable (FV) diet are needed to provide a better understanding of the association between FV intake and type 2 diabetes. We aimed to examine the prospective association between a composite score comprised of three biomarkers of FV intake in free-living populations and incident diabetes.


METHODS
A total of 318 incident diabetes cases and 926 controls from the EPIC (European Prospective Investigation of Cancer)-Norfolk study aged 40-79 years at baseline (1993-1997), completed 7-day prospective food diary and had plasma vitamin C and carotenoid measures. A composite biomarker score (CB-score) comprising the sum of plasma vitamin C, beta-carotene and lutein was derived. Odds ratios (ORs) and 95% confidence intervals (CIs) for incident diabetes were estimated using multivariable logistic regression.


RESULTS
A strong inverse association was found between the CB-score and incident diabetes. The ORs (95% CI) of diabetes comparing quartiles Q2, Q3 and Q4 of the CB-score with Q1 (reference category) were 0.70 (0.49, 1.00), 0.34 (0.23, 0.52) and 0.19 (0.12, 0.32), respectively, and 0.49 (0.40, 0.58) per s.d. change in CB-score in a model adjusted for demographic and lifestyle factors. The association was marginally attenuated after additionally adjusting for body mass index and waist circumference (0.60 (0.49 and 0.74) per s.d. change in CB-score).


CONCLUSIONS
A combination of biomarkers representing the intake of a mixed FV diet was strongly inversely associated with incident diabetes. These findings provide further support for measuring dietary biomarkers in studies of diet-disease associations and highlight the importance of consuming FV for the prevention of diabetes.
MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Cambridge, UK.
A J M
AJ
Cooper
MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Cambridge, UK.
S J
SJ
Sharp
Department of Public Health and Primary Care, Strangeways Research Laboratory, MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, University of Cambridge, Cambridge, UK.
R N
RN
Luben
Clinical Gerontology Unit, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Box 251, Cambridge, UK.
K-T
KT
Khaw
MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Cambridge, UK.
N J
NJ
Wareham
MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Cambridge, UK.
N G
NG
Forouhi
D000328:Adult; D000368:Aged; D001205:Ascorbic Acid / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D015992:Body Mass Index; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology*; D004032:Diet; D015930:Diet Records; D004739:England; D005260:Female; D005638:Fruit; D006801:Humans; D015994:Incidence; D008019:Life Style; D016015:Logistic Models; D014975:Lutein / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D014675:Vegetables; D055105:Waist Circumference; D014852:Wales; D019207:beta Carotene / Q000097:blood
D015415:Biomarkers; D019207:beta Carotene; D001205:Ascorbic Acid; D014975:Lutein