Table 3.
Pooled hazard ratios (95% confidence intervals) of type 2 diabetes for individual whole fruit consumption in Nurses’ Health Study, Nurses’ Health Study II, and Health Professionals Follow-up Study
| Variables | Consumption levels | Linear trend* | P value | ||||||
|---|---|---|---|---|---|---|---|---|---|
| <1 serving/month | 1-3 servings/month | 1 serving/week | 2-4 servings/week | ≥5 servings/week | For trend | For heterogeneity | |||
| Grapes and raisins | |||||||||
| Nurses’ Health Study†: | 2307/406 031 | 2489/546 881 | 922/234 102 | 508/160 446 | 132/46 667 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.91 (0.86 to 0.97) | 0.88 (0.80 to 0.95) | 0.80 (0.72 to 0.88) | 0.77 (0.64 to 0.92) | 0.84 (0.78 to 0.91) | |||
| Nurses’ Health Study II†: | 1288/408 297 | 1175/575 319 | 396/225 712 | 241/167 194 | 53/39 589 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.81 (0.74 to 0.88) | 0.85 (0.75 to 0.96) | 0.83 (0.72 to 0.97) | 0.88 (0.66 to 1.16) | 0.91 (0.81 to 1.02) | |||
| Health Professionals Follow-up Study†: | 984/207 158 | 937/225 458 | 366/94 345 | 292/89 649 | 108/37 793 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.95 (0.87 to 1.05) | 0.95 (0.84 to 1.08) | 0.87 (0.76 to 1.01) | 0.84 (0.69 to 1.04) | 0.91 (0.82 to 0.99) | |||
| Pooled resultsठ| 1.00 | 0.89 (0.85 to 0.93) | 0.88 (0.83 to 0.94) | 0.82 (0.77 to 0.89) | 0.81 (0.72 to 0.92) | 0.88 (0.83 to 0.93) | <0.001 | 0.42 | |
| Peaches, plums, and apricots | |||||||||
| Nurses’ Health Study†: | 1551/306 337 | 2215/487 935 | 1648/377 266 | 779/181 418 | 165/41 171 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.99 (0.93 to 1.07) | 1.00 (0.92 to 1.08) | 1.04 (0.94 to 1.14) | 0.92 (0.78 to 1.09) | 1.00 (0.93 to 1.07) | |||
| Nurses’ Health Study II†: | 847/323 168 | 1181/520 561 | 683/337 730 | 369/198 848 | 73/35 804 | ||||
| Adjusted hazard ratio‡ | 1.00 | 1.07 (0.97 to 1.18) | 1.03 (0.91 to 1.16) | 0.99 (0.86 to 1.14) | 1.01 (0.78 to 1.31) | 0.97 (0.87 to 1.08) | |||
| Health Professionals Follow-up Study†: | 832/184 896 | 1077/264 314 | 483/119 655 | 251/70 773 | 44/14 766 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.98 (0.88 to 1.08) | 1.03 (0.90 to 1.18) | 0.88 (0.75 to 1.04) | 0.75 (0.55 to 1.04) | 0.87 (0.77 to 0.99) | |||
| Pooled resultsठ| 1.00 | 1.01 (0.96 to 1.06) | 1.01 (0.95 to 1.07) | 0.99 (0.92 to 1.06) | 0.91 (0.80 to 1.04) | 0.97 (0.92 to 1.02) | 0.21 | 0.17 | |
| Prunes | |||||||||
| Nurses’ Health Study†: | 5108/1 056 374 | 957/241 136 | 150/47 746 | 143/48 871 | |||||
| Adjusted hazard ratio‡ | 1.00 | 0.99 (0.92 to 1.07) | 0.86 (0.73 to 1.02) | 0.89 (0.75 to 1.06) | 0.87 (0.74 to 1.03) | ||||
| Nurses’ Health Study II†: | 2746/1 160 917 | 296/188 256 | 57/34 465 | 54/32 473 | |||||
| Adjusted hazard ratio‡ | 1.00 | 0.85 (0.75 to 0.96) | 1.00 (0.77 to 1.31) | 1.16 (0.88 to 1.53) | 1.03 (0.79 to 1.34) | ||||
| Health Professionals Follow-up Study†: | 1425/304 005 | 270/67 738 | 54/14 390 | 61/18 301 | |||||
| Adjusted hazard ratio‡ | 1.00 | 0.92 (0.80 to 1.06) | 0.83 (0.63 to 1.10) | 0.86 (0.66 to 1.12) | 0.82 (0.63 to 1.07) | ||||
| Pooled resultsठ| 1.00 | 0.95 (0.89 to 1.00) | 0.89 (0.78 to 1.00) | 0.94 (0.82 to 1.06) | 0.89 (0.79 to 1.01) | 0.07 | 0.47 | ||
| Bananas | |||||||||
| Nurses’ Health Study†: | 555/127 955 | 1690/346 214 | 1 470/305 869 | 1 869/432 632 | 774/181 457 | ||||
| Adjusted hazard ratio‡ | 1.00 | 1.08 (0.98 to 1.19) | 1.05 (0.95 to 1.17) | 1.04 (0.94 to 1.15) | 1.08 (0.96 to 1.21) | 1.01 (0.96 to 1.06) | |||
| Nurses’ Health Study II†: | 363/132 406 | 956/362 359 | 731/318 389 | 827/440 879 | 276/162 077 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.95 (0.84 to 1.07) | 0.95 (0.83 to 1.08) | 0.82 (0.72 to 0.94) | 0.80 (0.67 to 0.94) | 0.87 (0.81 to 0.94) | |||
| Health Professionals Follow-up Study†: | 328/75 340 | 734/150 847 | 469/106 383 | 757/194 466 | 399/127 368 | ||||
| Adjusted hazard ratio‡ | 1.00 | 1.09 (0.95 to 1.25) | 1.01 (0.87 to 1.18) | 0.93 (0.80 to 1.07) | 0.86 (0.73 to 1.01) | 0.89 (0.83 to 0.95) | |||
| Pooled resultsठ| 1.00 | 1.04 (0.97 to 1.11) | 1.01 (0.94 to 1.09) | 0.95 (0.88 to 1.02) | 0.95 (0.87 to 1.03) | 0.95 (0.91 to 0.98) | 0.002 | <0.001 | |
| Cantaloupe | |||||||||
| Nurses’ Health Study†: | 1231/250 261 | 2292/516 604 | 2098/458 752 | 737/168 509 | |||||
| Adjusted hazard ratio‡ | 1.00 | 1.00 (0.93 to 1.08) | 1.06 (0.98 to 1.15) | 1.07 (0.96 to 1.19) | 1.08 (0.98 to 1.18) | ||||
| Nurses’ Health Study II†: | 890/345 001 | 1257/595 757 | 773/364 046 | 233/111 307 | |||||
| Adjusted hazard ratio‡ | 1.00 | 0.99 (0.90 to 1.09) | 1.05 (0.94 to 1.17) | 1.11 (0.94 to 1.30) | 1.12 (0.96 to 1.32) | ||||
| Health Professionals Follow-up Study†: | 655/165 084 | 1230/292 381 | 562/137 179 | 240/59 759 | |||||
| Adjusted hazard ratio‡ | 1.00 | 1.15 (1.03 to 1.27) | 1.17 (1.03 to 1.34) | 1.19 (1.01 to 1.40) | 1.14 (0.98 to 1.34) | ||||
| Pooled resultsठ| 1.00 | 1.03 (0.98 to 1.08) | 1.08 (1.02 to 1.14) | 1.10 (1.02 to 1.19) | 1.10 (1.02 to 1.18) | 0.01 | 0.77 | ||
| Apples and pears | |||||||||
| Nurses’ Health Study†: | 584/102 327 | 1375/275 896 | 1418/288 494 | 1861/437 158 | 1120/290 252 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.94 (0.84 to 1.04) | 0.94 (0.84 to 1.05) | 0.85 (0.77 to 0.95) | 0.82 (0.73 to 0.92) | 0.91 (0.87 to 0.95) | |||
| Nurses’ Health Study II†: | 334/98 142 | 835/322 737 | 688/303 354 | 881/463 781 | 415/228 096 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.83 (0.72 to 0.95) | 0.83 (0.72 to 0.96) | 0.79 (0.68 to 0.91) | 0.76 (0.64 to 0.90) | 0.93 (0.86 to 0.99) | |||
| Health Professionals Follow-up Study†: | 251/50 846 | 631/144 067 | 527/123 440 | 786/203 567 | 492/132 482 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.91 (0.78 to 1.06) | 0.98 (0.83 to 1.16) | 0.91 (0.77 to 1.07) | 0.93 (0.78 to 1.11) | 0.98 (0.92 to 1.06) | |||
| Pooled resultsठ| 1.00 | 0.90 (0.83 to 0.96) | 0.92 (0.85 to 0.99) | 0.85 (0.78 to 0.92) | 0.83 (0.76 to 0.90) | 0.93 (0.90 to 0.96) | <0.001 | 0.19 | |
| Oranges | |||||||||
| Nurses’ Health Study†: | 1081/214 635 | 1772/384 598 | 1460/310 026 | 1459/351 173 | 586/133 695 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.96 (0.89 to 1.04) | 1.03 (0.94 to 1.13) | 0.96 (0.87 to 1.05) | 1.03 (0.92 to 1.15) | 1.00 (0.95 to 1.06) | |||
| Nurses’ Health Study II†: | 774/295 675 | 1132/514 849 | 640/308 088 | 489/244 557 | 118/52 943 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.94 (0.85 to 1.04) | 0.93 (0.82 to 1.05) | 0.93 (0.81 to 1.07) | 0.97 (0.78 to 1.21) | 0.99 (0.89 to 1.09) | |||
| Health Professionals Follow-up Study†: | 491/102 463 | 738/176 033 | 523/129 393 | 640/169 083 | 295/77 431 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.89 (0.79 to 1.01) | 0.91 (0.79 to 1.04) | 0.89 (0.78 to 1.03) | 0.89 (0.76 to 1.05) | 0.97 (0.90 to 1.05) | |||
| Pooled resultsठ| 1.00 | 0.94 (0.89 to 1.00) | 0.98 (0.91 to 1.04) | 0.94 (0.87 to 1.00) | 0.98 (0.90 to 1.07) | 0.99 (0.95 to 1.03) | 0.68 | 0.78 | |
| Grapefruit | |||||||||
| Nurses’ Health Study†: | 2225/411 039 | 1873/426 864 | 1177/269 719 | 813/212 965 | 270/73 539 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.91 (0.85 to 0.97) | 0.95 (0.88 to 1.03) | 0.88 (0.80 to 0.96) | 0.86 (0.75 to 0.98) | 0.92 (0.87 to 0.98) | |||
| Nurses’ Health Study II†: | 1667/682 234 | 881/438 763 | 350/166 255 | 202/104 317 | 53/24 543 | ||||
| Adjusted hazard ratio‡ | 1.00 | 1.00 (0.91 to 1.09) | 1.06 (0.94 to 1.20) | 0.97 (0.83 to 1.14) | 0.91 (0.69 to 1.21) | 0.97 (0.86 to 1.09) | |||
| Health Professionals Follow-up Study†: | 933/215 578 | 816/201 584 | 414/100 589 | 365/97 276 | 159/39 377 | ||||
| Adjusted hazard ratio‡ | 1.00 | 1.03 (0.93 to 1.14) | 1.09 (0.96 to 1.24) | 0.93 (0.81 to 1.06) | 1.08 (0.90 to 1.30) | 0.99 (0.91 to 1.08) | |||
| Pooled resultsठ| 1.00 | 0.96 (0.91 to 1.00) | 1.00 (0.94 to 1.06) | 0.91 (0.85 to 0.97) | 0.93 (0.84 to 1.03) | 0.95 (0.91 to 0.99) | 0.02 | 0.42 | |
| Strawberries | |||||||||
| Nurses’ Health Study†: | 1255/227 188 | 2539/570 535 | 1920/429 463 | 555/145 069 | 89/21 870 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.94 (0.87 to 1.01) | 0.98 (0.90 to 1.07) | 0.87 (0.77 to 0.98) | 0.99 (0.79 to 1.25) | 0.94 (0.85 to 1.03) | |||
| Nurses’ Health Study II†: | 602/212 384 | 1257/566 425 | 836/414 673 | 393/190 675 | 65/31 954 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.97 (0.87 to 1.08) | 1.01 (0.89 to 1.15) | 1.09 (0.93 to 1.27) | 1.08 (0.81 to 1.43) | 1.09 (0.97 to 1.22) | |||
| Health Professionals Follow-up Study†: | 895/194 981 | 1186/305 273 | 419/109 618 | 161/39 477 | 26/5054 | ||||
| Adjusted hazard ratio‡ | 1.00 | 0.95 (0.85 to 1.05) | 0.98 (0.85 to 1.13) | 1.16 (0.95 to 1.42) | 1.51 (1.00 to 2.28) | 1.22 (1.03 to 1.43) | |||
| Pooled resultsठ| 1.00 | 0.95 (0.90 to 1.00) | 0.99 (0.93 to 1.05) | 0.98 (0.90 to 1.07) | 1.09 (0.92 to 1.28) | 1.03 (0.96 to 1.10) | 0.46 | 0.01 | |
| Blueberries | |||||||||
| Nurses’ Health Study†: | 3711/720 706 | 1798/448 560 | 693/176 252 | 156/48 609 | |||||
| Adjusted hazard ratio‡ | 1.00 | 0.90 (0.85 to 0.96) | 0.89 (0.82 to 0.98) | 0.82 (0.69 to 0.98) | 0.77 (0.66 to 0.91) | ||||
| Nurses’ Health Study II†: | 2021/761 856 | 757/435 865 | 280/153 746 | 95/64 644 | |||||
| Adjusted hazard ratio‡ | 1.00 | 0.83 (0.76 to 0.91) | 0.90 (0.79 to 1.04) | 0.69 (0.55 to 0.87) | 0.67 (0.54 to 0.83) | ||||
| Health Professionals Follow-up Study†: | 1687/383 033 | 779/207 202 | 165/45 628 | 56/18 540 | |||||
| Adjusted hazard ratio‡ | 1.00 | 0.94 (0.85 to 1.03) | 0.96 (0.80 to 1.15) | 0.74 (0.55 to 1.00) | 0.75 (0.58 to 0.98) | ||||
| Pooled resultsठ| 1.00 | 0.89 (0.85 to 0.93) | 0.91 (0.84 to 0.97) | 0.77 (0.67 to 0.87) | 0.74 (0.66 to 0.83) | <0.001 | 0.57 | ||
*Estimated based on every three servings/week increment.
†Cases/person years of observation.
‡Adjusted for age (years), ethnicity (white, African American, Hispanic, or Asian), body mass index (<23, 23.0-24.9, 25.0-26.9, 27.0-28.9, 29.0-30.9, 31.0-32.9, 33.0-34.9, 35.0-36.9, 37.0-38.9, 39.0-40.9, 41.0-42.9, 43.0-44.9, ≥45.0, or missing), smoking status (never, former, current (1–14, 15–24, or ≥25 cigarettes/day), or missing), multivitamin use (yes or no), physical activity (<3, 3.0-8.9, 9.0-17.9, 18.0-26.9, ≥27.0 MET (metabolic equivalent of task) hours/week, or missing), family history of diabetes (yes or no), menopausal status and post-menopausal hormone use (premenopause, post-menopause (never, former, or current hormone use), or missing, for women), oral contraceptive use (yes, no, or missing, for Nurses’ Health Study II) total energy intake (kcal/day), fruit juice consumption (<1, 1, 2-4, or 5-6 servings/week, or ≥1 serving/day) and the modified alternate healthy eating index score (fifths). Individual fruit consumption was mutually adjusted.
§Study estimates from three cohorts were pooled using a fixed effects model.