Vegetable, but Not Potato, Intake Is Associated With a Lower Risk of Type 2 Diabetes in the Danish Diet, Cancer and Health Cohort

Longitudinal Association Between the Consumption of Vegetables, Fruits, and Red Meat and Diabetes Disease Burden: An Analysis of Multiple Global Datasets

Background: Dietary factors, such as vegetable, fruit, and red meat consumption, have varying effects on the disease burden of diabetes, the world's third leading health concern. This study aims to evaluate the global impact of vegetable/fruit/red meat consumption on disease burdens. Methods: Diabetes disease burden, vegetable/fruit/red meat consumption, and covariates data were obtained from the Global Burden of Disease Study (GBD) 2021, Food and Agriculture Organization (FAO), and WHO, respectively, and matched by country/region and year. Global vector maps assessed the status of diabetes disease burden and the consumption of three dietary factors in 2021, and their trends from 2010 to 2021 were illustrated through local regression curves. Generalized additive mixed models (GAMMs) were used to analyze relationships, with weights assigned based on log-transformed values relative to the mean population of each country. Results: A comprehensive dataset spanning 2010-2021, encompassing 175 countries/regions, was successfully matched and utilized in the analysis. In 2021, Oceania had the highest diabetes burden, whereas East Asia had a lower one. Globally, the disease burden increased from 2010 to 2021, accompanied by rising per capita vegetable and fruit consumption but declining red meat consumption. Vegetable consumption was inversely correlated with the age-standardized incidence rate (ASIR) and exhibited a "J-shaped" curve with the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year (DALY) rate (ASDR) (nadir at approximately 80 kcal/capita/day (kcal/cap/day). Fruit consumption had a "U-shaped" relationship with ASDR (nadir at approximately 100 kcal/cap/day). Red meat consumption was negatively correlated to ASIR and had a "U-shaped" relationship with ASMR and ASDR (nadir at 200 kcal/cap/day). Conclusions: The global diabetes disease burden is heavy, and dietary consumption varies widely. Vegetable-related risks differ between diabetics and non-diabetics. Proper fruit consumption decreases ASDR. Moderate red meat increases can reduce the disease burden, but excessive consumption increases ASMR and ASDR.

Dietary carbohydrate intake and risk of type 2 diabetes: a 16-year prospective cohort study

Despite considerable research underscoring the importance of carbohydrate intake in relation to the risk of type 2 diabetes (T2D), a comprehensive assessment of this relationship is currently lacking. We aimed to examine the associations of various types and food sources of dietary carbohydrate intake with the risk of T2D, to evaluate potential effect modification by other factors, including genetic susceptibility, and to explore the potential mediators for such associations. The present study included 161,872 participants of the UK Biobank who were free of prevalent cancer, cardiovascular disease, or diabetes, and had at least one validated 24-h dietary recall assessment. Multivariable-adjusted age-stratified Cox proportional hazard regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for the associations of various types and food sources of dietary carbohydrate intake with risk of T2D. During a median follow-up of 13.6 years, 4,176 incident cases of T2D were identified. In the multivariable-adjusted models, a greater intake of fiber, carbohydrates from whole grains, and carbohydrates from non-starchy vegetables was significantly associated with a lower risk of T2D (highest vs. lowest quantile, HR [95% CI]=0.70 [0.62-0.79], 0.74 [0.67-0.82], and 0.83 [0.75-0.92], respectively, all P for trend <0.005). In contrast, a higher intake of starch and carbohydrate from starchy vegetables was associated with an increased risk of T2D (highest vs. lowest quantile, HR [95% CI]=1.31 [1.16-1.48] and 1.19 [1.09-1.31], respectively, both P for trend <0.005). Replacing one serving of refined grains or starchy vegetables with an equal amount of whole grains or non-starchy vegetables was associated with 4% to 10% lower risk of T2D (all P values <0.001). The observed associations were generally similar across population subgroups, including individuals with different genetic susceptibility to T2D. Mediation analyses of the inverse association between T2D risk and isocaloric substitution of carbohydrates from refined grains with carbohydrate from whole grains demonstrated that 39.6%, 43.4%, 44.0%, 27.8%, and 34.9% were mediated through body mass index, waist-to-hip ratio, glycosylated hemoglobin, high-density lipoprotein cholesterol, and C-reactive protein, respectively. In addition, the inverse association between the isocaloric substitution of carbohydrates from starchy vegetables with carbohydrates from non-starchy vegetables and T2D was partially mediated through high-density lipoprotein cholesterol (15.9%). These findings underscore the importance of dietary modifications of carbohydrates, particularly considering types and food sources of carbohydrate intake, in the primary prevention of T2D.

Associations of Vegetable and Potato Intakes With Markers of Type 2 Diabetes Risk in the AusDiab Cohort

CONTEXT

The associations of vegetable and potato intakes with type 2 diabetes (T2D) appear to be nuanced, depending on vegetable types and preparation method, respectively.

OBJECTIVE

We investigated the associations of total vegetable, vegetable subgroup, and potato intakes with (1) markers of T2D at baseline and (2) incident T2D cumulative over a 12-year follow-up period in Australian adults.

METHODS

Using data from the Australian Diabetes, Obesity and Lifestyle Study, intakes of vegetables and potatoes were assessed via a food frequency questionnaire at baseline. Associations between vegetable intake and (1) fasting plasma glucose (FPG), 2-hour postload plasma glucose (PLG), updated homeostasis model assessment of β-cell function (HOMA2-%β), HOMA2 of insulin sensitivity (HOMA2-%S), and fasting insulin levels at baseline; and (2) cumulative incident T2D at the end of 12-year follow-up were examined using generalized linear and Cox proportional hazards models, respectively.

RESULTS

In total, 8009 participants were included having median age of 52 years, and vegetable intake of 132 g/day. Higher intake of total vegetable, green leafy, yellow/orange/red, and moderate intakes of cruciferous vegetables was associated with lower PLG. Additionally, higher green leafy vegetable intake was associated with lower HOMA2-%β and serum insulin. Conversely, higher potato fries/chips intakes were associated with higher FPG, HOMA2-%β, serum insulin, and lower HOMA2-%S. Participants with moderate cruciferous vegetables intake had a 25% lower risk of T2D at the end of 12 years of follow-up.

CONCLUSION

A higher intake of vegetables, particularly green leafy vegetables, may improve while consuming potato fries/chips, but not potatoes prepared in a healthy way, may worsen glucose tolerance and insulin sensitivity. Our findings suggest a nuanced relationship between vegetable subgroups and their impact on glucose tolerance.

Potato Intake and the Risk of Overweight/Obesity, Hypertension, Diabetes, and Cardiovascular Disease: A Systematic Review and Meta-analysis of Observational Studies

CONTEXT

Results from observational studies and meta-analyses examining the relationship between total, fried, and nonfried potato intake and cardiometabolic disease remain conflicted.

OBJECTIVE

The aim was to synthesize existing evidence on the relationships between total potato intake and specific types of potato intake with the risk of overweight/obesity, hypertension, diabetes, gestational diabetes mellitus (GDM), cardiovascular disease (CVD), coronary heart disease (CHD), and stroke.

DATA SOURCES

Systematic searches were conducted in PubMed, Embase, and Web of Science until July 13, 2023.

DATA EXTRACTION

Data extracted from studies included first author, publication year, location, data source, follow-up duration (cohort studies only), demographics, sample size, cases, outcomes, exposure and outcome types, measurements, adjustments, study design, potato intake categories, and adjusted risk estimates (odds ratio, relative risk [RR], hazard ratio) with 95% CIs.

DATA ANALYSIS

Random-effects models were applied to estimate the summary RRs and 95% CIs.

RESULTS

Fifty-one articles (103 studies) were identified in the current meta-analysis. Comparing the highest with the lowest categories of total potato intake, total potato intake was not associated with hypertension (summary RR = 1.07; 95% CI: 0.95, 1.21), diabetes (1.08; 95% CI: 0.96, 1.22), GDM (1.16; 95% CI: 0.86, 1.57), CHD (1.00; 95% CI: 0.99, 1.02), CVD (0.97; 95% CI: 0.91, 1.03), or stroke (0.97; 95% CI: 0.88, 1.06); fried potato intake was not associated with overweight/obesity (1.24; 95% CI: 0.90, 1.70) or GDM (1.03; 95% CI: 0.97, 1.09) but was significantly associated with increased diabetes risk (1.16; 95% CI: 1.04, 1.30); nonfried potato intake was significantly associated with increased diabetes risk (1.05; 95% CI: 1.01, 1.10) but not hypertension (1.06; 95% CI: 0.97, 1.15).

CONCLUSION

Total potato intake was not associated with an increased risk of hypertension, diabetes, GDM, or cardiometabolic disease, but both fried and nonfried potato intake may increase the risk of diabetes but not other cardiometabolic diseases. Future cohort studies are needed to explore the association between different types of potato intake and cardiometabolic disease. In addition, the limited number of studies on total potato intake and overweight/obesity/heart failure, fried potato intake and CHD/stroke/heart failure, and nonfried potato intake and overweight/obesity/GDM/CHD/CVD/heart failure prevented us from conducting an analysis.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. RD42023454244.

Substituting Potatoes with Other Food Groups and Type 2 Diabetes Risk: Findings from the Diet, Cancer, and Health Study

BACKGROUND

Although potatoes are considered a dietary staple in some cultures, evidence suggests that their impact on type 2 diabetes (T2D) risk is nuanced, with preparation methods and dietary patterns playing crucial roles. Investigating the substitution effects of replacing potatoes with other foods is required to inform dietary recommendations for lowering T2D risk.

OBJECTIVE

The objective of this was to investigate associations between the substitution of potatoes (excluding fries/chips) with other food groups (vegetables, whole grains, refined grains, red meat, processed meat, poultry, fish, and dairy) and the risk of T2D.

METHODS

The diet of participants from the prospective Danish Diet, Cancer, and Health study (DCH) was measured at baseline (1993-1997) by a food frequency questionnaire. Participants were followed up for incident T2D from baseline until 2012. Associations between the substitution of potatoes (total, boiled, and mashed) with other food groups and incident T2D was assessed by multivariable Cox proportional hazards model.

RESULTS

In 54,793 DCH study participants, during a median follow-up of 16.3 y, 7693 incident T2D cases were recorded. A 26% lower risk of T2D was observed when 50 g/d of potatoes were substituted with the same amount of whole grains [hazard ratio and 95% confidence interval (CI): 0.74 (0.70, 0.79)]. Similarly, a lower risk of T2D was observed upon substituting 25 g/d of potatoes with an equivalent amount of green leafy [HR (95% CI): 0.79 (0.74, 0.83)], cruciferous [HR (95% CI): 0.87 (0.83, 0.92)], and yellow/orange/red vegetables [HR (95% CI): 0.97 (0.96, 0.99)]. Conversely, a higher risk of T2D was observed when potatoes were substituted with poultry [HR (95% CI): 1.08 (1.02, 1.15)], red meat [HR (95% CI): 1.06 (1.02, 1.10)], and processed meat [HR (95% CI): 1.17 (1.11, 1.23)]. Replacing boiled potatoes with red meat or poultry was associated with a higher risk of T2D compared with replacing mashed potatoes.

CONCLUSIONS

Substituting potatoes with whole grains and most types of vegetables was associated with a lower risk of T2D, whereas substituting potatoes with poultry, red meat, and processed meat was associated with a higher risk.

All-in-One Self-Powered Microneedle Device for Accelerating Infected Diabetic Wound Repair

Diabetic wound healing remains a significant clinical challenge due to the complex microenvironment and attenuated endogenous electric field. Herein, a novel all-in-one self-powered microneedle device (termed TZ@mMN-TENG) is developed by combining the multifunctional microneedle carried tannin@ZnO microparticles (TZ@mMN) with the self-powered triboelectric nanogenerator (TENG). In addition to the delivery of tannin and Zn2+, TZ@mMN also effectively conducts electrical stimulation (ES) to infected diabetic wounds. As a self-powered device, the TENG can convert biomechanical motion into exogenous ES to accelerate the infected diabetic wound healing. In vitro experiment demonstrated that TZ@mMN shows excellent conductive, high antioxidant ability, and effective antibacterial properties against both Staphylococcus aureus and Escherichia coli (>99% antibacterial rates). Besides, the TZ@mMN-TENG can effectively promote cell proliferation and migration. In the diabetic rat full-thickness skin wound model infected with Staphylococcus aureus, the TZ@mMN-TENG can eliminate bacteria, accelerate epidermal growth (regenerative epidermis: ≈303.3 ± 19.1 µm), enhance collagen deposition, inhibit inflammation (lower TNF-α and IL-6 expression), and promote angiogenesis (higher CD31 and VEGF expression) to accelerate infected wound repair. Overall, the TZ@mMN-TENG provides a promising strategy for clinical application in diabetic wound repair.

Effects and mechanisms of anti-diabetic dietary natural products: an updated review

Diabetes is a global public health issue, characterized by an abnormal level of blood glucose. It can be classified into type 1, type 2, gestational, and other rare diabetes. Recent studies have reported that many dietary natural products exhibit anti-diabetic activity. In this narrative review, the effects and underlying mechanisms of dietary natural products on diabetes are summarized based on the results from epidemiological, experimental, and clinical studies. Some fruits (e.g., grape, blueberry, and cherry), vegetables (e.g., bitter melon and Lycium barbarum leaves), grains (e.g., oat, rye, and brown rice), legumes (e.g., soybean and black bean), spices (e.g., cinnamon and turmeric) and medicinal herbs (e.g., Aloe vera leaf and Nigella sativa), and vitamin C and carotenoids could play important roles in the prevention and management of diabetes. Their underlying mechanisms include exerting antioxidant, anti-inflammatory, and anti-glycation effects, inhibiting carbohydrate-hydrolyzing enzymes, enhancing insulin action, alleviating insulin resistance, modulating the gut microbiota, and so on. This review can provide people with a comprehensive knowledge of anti-diabetic dietary natural products, and support their further development into functional food to prevent and manage diabetes.

Prospective association between fruit and vegetable intake and the risk of type 2 diabetes amongst Chinese adults: the China Health and Nutrition Survey

This study aimed to prospectively explore the relationship between fruit and vegetable intake (FVI) and type 2 diabetes (T2D) risk amongst 13,175 Chinese adults. Cox proportional hazards models were used to estimate the hazard ratios (HRs) of T2D events in relation to FVI. Results showed that the highest quintile of FVI was inversely associated with T2D risk in men (HR = 0.72, 95% CI: 0.50, 0.98) and women (HR = 0.74, 95% CI: 0.55, 0.97), whereas no such associations were observed between total vegetable intake and T2D in either men (HR = 0.92, 95% CI: 0.65, 1.26) or women (HR = 1.02, 95% CI: 0.77, 1.38). In addition, greater fruit intake was inversely associated with T2D risk in men (HR = 0.42, 95% CI: 0.28, 0.63) and women (HR = 0.64, 95% CI: 0.45, 0.90). Overall, FVI and total fruit intake were inversely associated with T2D risk amongst Chinese adults.

Associations between food consumption/dietary habits and the risks of obesity, type 2 diabetes, and hypertension: a cross-sectional study in Jakarta, Indonesia

BACKGROUND/OBJECTIVES

This study aimed to assess the current mean daily intake of 10 food groups, analyze the sociodemographic factors associated with food consumption, and determine the associations between food consumption/dietary intake and the prevalence rates of obesity, type 2 diabetes (T2D), and hypertension (HTN) in Jakarta, Indonesia.

SUBJECTS/METHODS

A total of 600 participants aged 20-85 yrs were included in this cross-sectional study. Food consumption and dietary habits were assessed using a food frequency questionnaire. To determine the association between food consumption/dietary habits and the abovementioned diseases, logistic regression analysis was performed.

RESULTS

The average vegetable and fruit intake was lower, while sugar and salt consumption were higher than that recommended by Indonesia's national dietary guidelines. A high intake of ultra-processed foods (UPFs) was associated with young age, men, "single" status, a high education level, and employment with a high monthly income. Obesity and T2D were positively correlated with high intakes of cereals and tubers, UPFs, sugars, fats, and oils. Conversely, an inverse association was found between legume, vegetable, and fruit consumption and obesity risk. An inverse correlation was also observed between vegetable consumption and T2D risk. Moreover, a high salt intake was inversely correlated with fruit consumption in terms of HTN risk. Non-indulgence in habitual late-night snacking and refrainment from consuming more than one dish at each meal were also negatively related to the prevalence of obesity, T2D, and HTN. Inverse correlations were also observed between the prevalence rates of T2D and HTN and abstaining from adding sugar to beverages.

CONCLUSION

Foods high in fat, sugar, and sodium were strongly associated with the risks of obesity, T2D, and HTN. Additionally, poor eating habits were also associated with disease development.

Dietary Nitrate from Plant Foods: A Conditionally Essential Nutrient for Cardiovascular Health

Under specific conditions, such as catabolic stress or systemic inflammation, endogenous nutrient production becomes insufficient and exogenous supplementation (for example, through dietary intake) is required. Herein, we propose consideration of a dietary nitrate from plant foods as a conditionally essential nutrient for cardiovascular health based on its role in nitric oxide homeostasis. Nitrate derived from plant foods may function as a conditionally essential nutrient, whereas nitrate obtained from other dietary sources, such as drinking water and cured/processed meats, warrants separate consideration because of the associated health risks. We have surveyed the literature and summarized epidemiological evidence regarding the effect of dietary nitrate on cardiovascular disease and risk factors. Meta-analyses and population-based observational studies have consistently demonstrated an inverse association of dietary nitrate with blood pressure and cardiovascular disease outcomes. Considering the available evidence, we suggest 2 different approaches to providing dietary guidance on nitrate from plant-based dietary sources as a nutrient: the Dietary Reference Intakes developed by the National Academies of Sciences, Engineering, and Medicine, and the dietary guidelines evaluated by the Academy of Nutrition and Dietetics. Ultimately, this proposal underscores the need for food-based dietary guidelines to capture the complex and context-dependent relationships between nutrients, particularly dietary nitrate, and health.

Perspective: Potatoes, Quality Carbohydrates, and Dietary Patterns

Potatoes have long been a staple food in many cultures and cuisines, but they have gained a reputation as a low-quality carbohydrate source that should be avoided in the diet. Historically, this view has been justified by citing the glycemic index of potatoes as the main indicator of their quality. However, their nutrient composition should also be considered. The association of potatoes with energy-dense Western dietary patterns has also contributed to a perception that potatoes are inherently unhealthy. Although some studies have suggested an association between potato consumption and increased risk of health problems, such as type 2 diabetes, these associations may be confounded by fried potato intake and are strongest at intake levels higher than average consumption rates. Epidemiologic data suggest total potato intake is not a health risk in Eastern populations and can be consumed as part of a healthy diet. Furthermore, clinical trial data demonstrate that potatoes' health impact, irrespective of preparation, is similar to legumes and comparable with refined grains, with few deleterious effects found. These findings highlight the importance of moving beyond the glycemic index and adopting a more nuanced evaluation of the epidemiologic data to better understand the health impact of potato intake. Ultimately, the negative reputation of potatoes stems from an overinterpretation of their glycemic index and association with unhealthy Western dietary patterns, as well as oversimplification of the epidemiologic data. By considering carbohydrate quality, it becomes clear that potatoes can be part of a healthy diet given the proper consideration.

Association between the number of teeth and incident pre-diabetes among middle-aged adults with periodontal disease: a retrospective cohort analysis of Japanese claims data

OBJECTIVES

To investigate the association between the number of teeth and the new onset of pre-diabetes.

DESIGN

Retrospective cohort study.

SETTING

The National Database of Health Insurance Claims and Specific Health Checkups of Japan, which holds information from both the yearly health check-up programme known as the 'Specific Health Checkup' and health insurance claims data.

PARTICIPANTS

1 098 371 normoglycaemic subjects who participated in the Specific Health Checkup programme every year from fiscal year (FY) 2015 to FY 2018 and had dental insurance claims data with a diagnosis of periodontal disease during FY 2016.

OUTCOME MEASURES

Incidence of pre-diabetes or diabetes observed at the Specific Health Checkup during FY 2018.

RESULTS

Among the participants, 1 77 908 subjects developed pre-diabetes, and 579 developed diabetes at the check-up during the subsequent follow-up year. Compared with the subjects with 26-28 teeth, those with 20-25, 15-19 or 1-14 teeth were associated with an increased likelihood of developing pre-diabetes or diabetes onset with adjusted ORs of 1.03 (95% CI: 1.02 to 1.05), 1.06 (1.03 to 1.09) and 1.07 (1.04 to 1.11), respectively. No clear modifications were observed for age, sex, body mass index or current smoking.

CONCLUSIONS

Having fewer teeth was associated with a higher incidence of pre-diabetes. Due to the limitations of this study, however, causality remains undetermined.

Vitamin K1 Intake and Incident Diabetes in the Danish Diet, Cancer, and Health Study

CONTEXT

Observational studies have reported lower risks of type 2 diabetes with higher vitamin K1 intake, but these studies overlook effect modification due to known diabetes risk factors.

OBJECTIVE

To identify subgroups that might benefit from vitamin K1 intake, we examined associations between vitamin K1 intake and incident diabetes overall and in subpopulations at risk of diabetes.

METHODS

Participants from the prospective cohort, the Danish Diet, Cancer, and Health Study, with no history of diabetes were followed up for diabetes incidence. The association between intake of vitamin K1, estimated from a food frequency questionnaire completed at baseline, and incident diabetes was determined using multivariable-adjusted Cox proportional-hazards models.

RESULTS

In 54 787 Danish residents with a median (interquartile range) age of 56 (52-60) years at baseline, 6700 individuals were diagnosed with diabetes during 20.8 (17.3-21.6) years of follow-up. Vitamin K1 intake was inversely and linearly associated with incident diabetes (P < .0001). Compared to participants with the lowest vitamin K1 intake (median:57 µg/d), participants with the highest intakes (median:191 µg/d) had a 31% lower risk of diabetes (HR; 95% CI, 0.69; 0.64-0.74) after multivariable adjustments. The inverse association between vitamin K1 intake and incident diabetes was present in all subgroups (namely, men and women, ever and never smokers, low and high physical activity groups, and in participants who were normal to overweight and obese), with differences in absolute risk between subgroups.

CONCLUSION

Higher intake of foods rich in vitamin K1 was associated with a lower risk of diabetes. If the associations observed are causal, our results indicate that more cases of diabetes would be prevented in subgroups at higher risk (men, smokers, participants with obesity, and those with low physical activity).