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Nutritional Epidemiology
Intake of Vegetables, Legumes, and Fruit, and Risk for All-Cause, Cardiovascular, and Cancer Mortality in a European Diabetic Population1,2
Ute Nöthlings3,*, Matthias B. Schulze3, Cornelia Weikert3, Heiner Boeing3, Yvonne T. van der Schouw4, Christina Bamia5, Vasiliki Benetou5, Pagona Lagiou5, Vittorio Krogh6, Joline W. J. Beulens4, Petra H. M. Peeters4, Jytte Halkjær7, Anne Tjønneland7, Rosario Tumino8, Salvatore Panico9, Giovanna Masala10, Francoise Clavel-Chapelon11, Blandine de Lauzon11, Marie-Christine Boutron-Ruault11, Marie-Noël Vercambre11, Rudolf Kaaks12, Jakob Linseisen12, Kim Overvad13, Larraitz Arriola14, Eva Ardanaz15, Carlos A. Gonzalez16, Marie-Jose Tormo17, Sheila Bingham18, Kay-Tee Khaw19, Tim J. A. Key20, Paolo Vineis21, Elio Riboli21, Pietro Ferrari22, Paolo Boffetta22, H. Bas Bueno-de-Mesquita23, Daphne L. van der A23, Göran Berglund24, Elisabet Wirfält25, Göran Hallmans26, Ingegerd Johansson27, Eiliv Lund28 and Antonia Trichopoulo5
3 Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, 14558 Germany; 4 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 3508 The Netherlands; 5 Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, 11527 Greece; 6 Nutritional Epidemiology Unit, Istituto Nazionale dei Tumori, Milan, 20133 Italy; 7 Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, DK-2100 Denmark; 8 Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo", Ragusa, 97100 Italy; 9 Department of Clinical and Experimental Medicine, Federico II University, Naples, I-80131 Italy; 10 Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Florence, 50139 Italy; 11 Inserm, (Institut National de la Santé et de la Recherche Médicale), ERI 20, Villejuif, F-94805 France; 12 Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, 69120 Germany; 13 Institute of Epidemiology and Social Medicine, University of Aarhus, Aarhus, DK-9100 Denmark; 14 Department of Public Health of Guipuzkoa, San Sebastian, 4-20013 Spain; 15 Public Health Institute of Navarra, Pamplona, 31003 Spain; 16 Department of Epidemiology, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), 08907 Spain; 17 Epidemiology Department, Murcia Health Council, CIBER en Epidemiologia y Salud Publica (CIBERESP), E-30008 Spain; 18 Medical Research Council Dunn Human Nutrition Unit, Cambridge, CB1 8RN UK; 19 Department of Public Health and Primary Care, University of Cambridge, CB2 2QQ UK; 20 Cancer Epidemiology Unit, University of Oxford, Oxford, OX3 7LF UK; 21 Imperial College London, London, W2 1PG UK; 22 International Agency for Research on Cancer, Lyon, 69372 France; 23 National Institute for Public Health and the Environment, Bilthoven, 3720 The Netherlands; 24 Department of Medicine, Lund University, Malmö University Hospital, Malmö, 20502 Sweden; 25 Department of Clinical Sciences, Lund University, Malmö, SE-20502 Sweden; 26 Department of Public Health and Clinical Medicine, Nutritional Research, Umea University, Umea, 90187 Sweden; 27 Department of Odontology, Cariology, Umea University, Umea, 90187 Sweden; and 28 Department of Preventive Medicine, Institute of Community Medicine, University of Tromsø, Tromsø, 9037 Norway
We examined the associations of intake of vegetables, legumes and fruit with all-cause and cause-specific mortality in a population with prevalent diabetes in Europe. A cohort of 10,449 participants with self-reported diabetes within the European Prospective Investigation into Cancer and Nutrition study was followed for a mean of 9 y. Intakes of vegetables, legumes, and fruit were assessed at baseline between 1992 and 2000 using validated country-specific questionnaires. A total of 1346 deaths occurred. Multivariate relative risks (RR) for all-cause mortality were estimated in Cox regression models and RR for cause-specific mortality were derived in a competing risk model. An increment in intake of total vegetables, legumes, and fruit of 80 g/d was associated with a RR of death from all causes of 0.94 [95% CI 0.90â0.98]. Analyzed separately, vegetables and legumes were associated with a significantly reduced risk, whereas nonsignificant inverse associations for fruit intake were observed. Cardiovascular disease (CVD) mortality and mortality due to non-CVD/non-cancer causes were significantly inversely associated with intake of total vegetables, legumes, and fruit (RR 0.88 [95% CI 0.81â0.95] and 0.90 [0.82â0.99], respectively) but not cancer mortality (1.08 [0.99â1.17]). Intake of vegetables, legumes, and fruit was associated with reduced risks of all-cause and CVD mortality in a diabetic population. The findings support the current state of evidence from general population studies that the protective potential of vegetable and fruit intake is larger for CVD than for cancer and suggest that diabetes patients may benefit from a diet high in vegetables and fruit
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