Evidence map›Paper›PMID 32641421›Full record

ArticleBMJ (Clinical research ed.)2020

Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries.

Ju-Sheng Zheng, Stephen J Sharp, Fumiaki Imamura, Rajiv Chowdhury, Thomas E Gundersen, Marinka Steur, Ivonne Sluijs, Yvonne T van der Schouw, Antonio Agudo, Dagfinn Aune and 35 more

Open access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 70 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
70citing papers in PubMed, 3 pooled it
22.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

70 citing papers in PubMed, 3 syntheses or guidelines pooled it, 160 citations in OpenAlex.

  1. Sustainable dietary recommendations for the Spanish population.European journal of clinical nutrition · 2026
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  13. The associations of plasma carotenoids andThe British journal of nutrition · 2026
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10 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

45 authors at 20 institutions in 11 countries.

Ju-Sheng ZhengMRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
Stephen J SharpMRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
Fumiaki ImamuraMRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
Rajiv ChowdhuryMRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Thomas E GundersenVitas AS, Oslo, Norway.
Marinka SteurMRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
Ivonne SluijsJulius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Yvonne T van der SchouwJulius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Antonio AgudoUnit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Group of Research on Nutrition and Cancer, Bellvitge Biomedical Research Institute, L'Hospitalet of Llobregat, Barcelona, Spain.
Dagfinn AuneSchool of Public Health, Imperial College London, London, UK.
Aurelio BarricarteNavarra Public Health Institute, Pamplona, Spain.
Heiner BoeingDepartment of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
María-Dolores ChirlaqueDepartment of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain.
Miren DorronsoroPublic Health Division of Gipuzkoa, San Sebastian, Spain.
Heinz FreislingInternational Agency for Research on Cancer, Lyon, France.
Douae El-FatouhiCentre of Research in Epidemiology and Population Health, UMR 1018 Inserm, Institut Gustave Roussy, Paris-Sud Paris-Saclay University, Villejuif, France.
Paul W FranksDepartment of Clinical Sciences, Lund University, Malmö, Sweden.
Guy FagherazziCentre of Research in Epidemiology and Population Health, UMR 1018 Inserm, Institut Gustave Roussy, Paris-Sud Paris-Saclay University, Villejuif, France.
Sara GrioniEpidemiology and Prevention Unit, Milan, Italy.
Marc J GunterInternational Agency for Research on Cancer, Lyon, France.
Cecilie KyrøDanish Cancer Society Research Centre, Copenhagen, Denmark.
Verena KatzkeDivision of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany.
Tilman KühnDivision of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany.
Kay-Tee KhawDepartment of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Nasser LaoualiCentre of Research in Epidemiology and Population Health, UMR 1018 Inserm, Institut Gustave Roussy, Paris-Sud Paris-Saclay University, Villejuif, France.
Giovanna MasalaCancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy.
Peter M NilssonDepartment of Clinical Sciences, Lund University, Malmö, Sweden.
Kim OvervadDepartment of Public Health, Aarhus University, Aarhus, Denmark.
Salvatore PanicoDepartment of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
Keren PapierCancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
J Ramón QuirósPublic Health Directorate, Asturias, Spain.
Olov RolandssonDepartment of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
Daniel Redondo-SánchezCIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
Fulvio RicceriDepartment of Clinical and Biological Sciences, University of Turin, Turin, Italy.
Matthias B SchulzeDepartment of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
Annemieke M W SpijkermanNational Institute for Public Health and the Environment, Bilthoven, Netherlands.
Anne TjønnelandDanish Cancer Society Research Centre, Copenhagen, Denmark.
Tammy Y N TongCancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Rosario TuminoCancer Registry and Histopathology Department, Azienda Sanitaria Provinciale, Ragusa, Italy.
Elisabete WeiderpassInternational Agency for Research on Cancer, Lyon, France.
John DaneshMRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Adam S ButterworthMRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Elio RiboliSchool of Public Health, Imperial College London, London, UK.
Nita G ForouhiMRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK nita.forouhi@mrc-epid.cam.ac.uk.ORCID 0000-0002-5041-248X
Nicholas J WarehamMRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
University of Cambridge · GBCentre international de recherche sur le cancer · FRInserm · FRDanish Cancer Society · DKGerman Cancer Research Center · DELund University · SEUniversity of Oxford · GBUtrecht University · NLAarhus University · DKAgenzia Regionale Sanitaria della Puglia · ITFederico II University Hospital · ITGerman Institute of Human Nutrition · DEGobierno del Principado de Asturias · ESImperial College London · GBInstitut d'Investigació Biomédica de Bellvitge · ESInstituto de Investigación Biosanitaria de Granada · ESInstituto de Salud Pública de Navarra · ESInstituto Murciano de Investigación Biosanitaria · ESNational Centre for Disease Prevention and Control · ITNational Institute for Public Health and the Environment · NL

Funding

Medical Research Council MC_UU_00006/1Medical Research Council MC_UU_00006/3Medical Research Council MC_UU_12015/1Medical Research Council MC_UU_12015/5Medical Research Council MR/L003120/1World Health Organization 001
6 · The paper itself

Abstract

objectiveTo investigate the association of plasma vitamin C and carotenoids, as indicators of fruit and vegetable intake, with the risk of type 2 diabetes.

designProspective case-cohort study.

settingPopulations from eight European countries.

participants9754 participants with incident type 2 diabetes, and a subcohort of 13 662 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort of 340 234 participants: EPIC-InterAct case-cohort study.

main outcome measureIncident type 2 diabetes.

resultsIn a multivariable adjusted model, higher plasma vitamin C was associated with a lower risk of developing type 2 diabetes (hazard ratio per standard deviation 0.82, 95% confidence interval 0.76 to 0.89). A similar inverse association was shown for total carotenoids (hazard ratio per standard deviation 0.75, 0.68 to 0.82). A composite biomarker score (split into five equal groups), comprising vitamin C and individual carotenoids, was inversely associated with type 2 diabetes with hazard ratios 0.77, 0.66, 0.59, and 0.50 for groups 2-5 compared with group 1 (the lowest group). Self-reported median fruit and vegetable intake was 274 g/day, 396 g/day, and 508 g/day for participants in categories defined by groups 1, 3, and 5 of the composite biomarker score, respectively. One standard deviation difference in the composite biomarker score, equivalent to a 66 (95% confidence interval 61 to 71) g/day difference in total fruit and vegetable intake, was associated with a hazard ratio of 0.75 (0.67 to 0.83). This would be equivalent to an absolute risk reduction of 0.95 per 1000 person years of follow up if achieved across an entire population with the characteristics of the eight European countries included in this analysis.

conclusionsThese findings indicate an inverse association between plasma vitamin C, carotenoids, and their composite biomarker score, and incident type 2 diabetes in different European countries. These biomarkers are objective indicators of fruit and vegetable consumption, and suggest that diets rich in even modestly higher fruit and vegetable consumption could help to prevent development of type 2 diabetes.

Indexed as

FruitVegetablesAscorbic AcidBiomarkersCarotenoidsCase-Control StudiesDiabetes Mellitus, Type 2DietEuropeFemaleHumansMaleProspective StudiesAscorbic AcidBiomarkersCarotenoids

Identifiers

PMID32641421
PMCPMC7341350
OpenAlexW3038186772

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.