Can an apple a day ward off type 2 diabetes?

Fruits have long been considered part of a healthy diet due to their low glycemic load and their richness in soluble and insoluble fiber, vitamins, minerals and phytochemicals. Now, a longitudinal study has put a clearer picture on the matter: eating moderate amounts of whole fruit might even help prevent type 2 diabetes.

The study, published in The Journal of Clinical Endocrinology and Metabolism, examines associations between fruit and fruit juice consumption, and these findings: measures of glucose tolerance and insulin sensitivity, and diabetes at follow-up.

The study involved 7,675 Australian men and women aged 25 or older who completed a food frequency questionnaire indicating their usual consumption of 74 foods in the past 12 months, with 10 frequency response options ranging from ” never “to” three or more times a day. “The food items included 10 types of fruits, including apples, oranges and other citrus fruits and bananas, as well as unspecified fruit juices.

At baseline, the population had a mean age of 54 years and total fruit consumption was inversely associated with serum insulin and HOMA2-% β, and positively associated with HOMA2-% S.

Compared with participants with the lowest intakes, those with moderate total fruit intakes had a 36% chance of developing diabetes within five years, after adjusting for confounding factors related to diet and diet. way of life. Regarding the consumption of different types of fruit, the apparent inverse associations did not reach statistical significance after adjusting for potential confounding factors related to diet and lifestyle. The authors also examined associations with 12-year outcomes, but these were not statistically significant.

While a positive association between fruit juice consumption and type 2 diabetes was reported in a previous meta-analysis, the authors of this study reported no association between fruit juice consumption and insulin resistance and cell dysfunction or incident diabetes.

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“Insulin resistance, along with cell dysfunction and obesity, is a key factor in the pathophysiology” of type 2 diabetes, the study authors wrote. “HOMA2 is an approach to assess β cell function and insulin resistance (or insulin sensitivity) using fasting glucose and insulin values.”

They added that “higher total fruit consumption was associated with higher insulin sensitivity and lower β cell function in a dose-response manner. At first glance, the inverse association between fruit consumption and β cell function may seem counterintuitive. However, the HOMA2 of the measure of cell function actually reflects insulin secretion (or “activity” of cells) rather than “function” of cells; in this context, lower values ​​probably reflect higher insulin sensitivity.

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“Fruit juices tend to have a relatively high glycemic load – simpler carbohydrates that are quickly digestible – and can also make people less full than whole fruit, which may be why they don’t have the same preventative value that whole fruits seem to have. have, ”said Kate Kirley, MD, director of chronic disease prevention at AMA.

Take-home messages, Dr Kirley said, are: “When you want something sweet, eat fruit instead of other things” and “the less you do with your fruit, the better. “

“In other words, you don’t have to squeeze or mix it, just take a piece of fruit and eat it! She added. “If it’s hard to keep fresh fruit, frozen fruit with no added sugar is also a great option. “

The authors noted several limitations of their study, including the fact that they could not infer causation or rule out residual confusion, and did not study associations for the consumption of all fruits captured in the questionnaire.

WADA’s Guide to Diabetes Prevention helps physicians and healthcare organizations define and implement evidence-based diabetes prevention strategies. This comprehensive, personalized approach helps clinical practices and healthcare organizations identify patients with prediabetes and manage the risk of developing type 2 diabetes, including referring at-risk patients to a mode-switching program. of the National Diabetes Prevention Program according to their individual needs.


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