Fruit juice, fruit and type 2 diabetes

We will study the association of pure fruit juice and fruit consumption with type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) cohort. Furthermore, we examine whether pure fruit juice consumption has a different effect on the risk of type 2 diabetes for low or high fruit consumers, Cox proportional hazards models will be used to estimate hazard ratios (HRs) and 95% confidence intervals (CI).

Three sources for identification of possible type 2 diabetes cases were used: self-report, linkage with the national hospital discharge register (HDR) and urinary glucose strip test. Firstly, self-reported occurrence of diabetes was collected with two follow-up questionnaires at 3 – 5 years intervals. Secondly, diagnoses of diabetes were also obtained from the HDR that holds a hospital discharge diagnosis database from 1990 onwards. Thirdly, for the Prospect cohort only, incident type 2 diabetes cases were also identified via a urinary glucose strip test, sent out with the first follow-up questionnaire, for detection of glucosuria

Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for the association of fruit juice consumption and fruit consumption with diabetes. The first model was adjusted for age and sex. The second model was adjusted for age, sex, educational level, physical activity, smoking, family history of diabetes, alcohol, DHD15-index and fruit/fruit juice consumption. In the third model energy intake and in the fourth model BMI and waist circumference were added as covariates, considering these as potential intermediate factors.