Association of fruit and vegetable intake with all-cause and cardio-cerebrovascular mortality among type 2 diabetes mellitus patients in Huaian city – a 9-year retrospective follow-up study

  Objective  To investigate the relationship between fruit and vegetable intake and all-cause and cardio-cerebrovascular mortality in patients with type 2 diabetes mellitus (T2DM) for providing evidence to improve the survival of the patients.

  Methods  The participants of the study were 10 086 T2DM patients recruited with multistage random cluster sampling from community chronic disease sufferers under the management of basic public health services in Huaian city, Jiangsu province. A baseline survey including questionnaire interview, physical examination and laboratory tests were conducted and fruit and vegetable intake during previous one year were estimated using a standardized semiquantitative Food Frequency Questionnaire among the participants during January 2013. All-cause and cardio-cerebrovascular mortality up to December 31, 2021 among the participants were identified using municipal vital registration information system. Univariate analysis and multivariate Cox proportional risk regression model were adopted to analyze the association of fruit and vegetable intake with all-cause and cardio-cerebrovascular mortality for the 4 977 T2DM patients with complete data.

  Results  During the 9-year period among the 4 977 T2DM patients, totally 617 all-cause and 238 cardio-cerebrovascular deaths were observed; for the patients reporting the average daily fruit and vegetable intake of < 200, 200 – 249, 250 – 349, and ≥ 350 grams, the cumulative mortality of all-cause were 14.37%, 11.57%, 11.29%, and 11.55% and the cumulative cardio-cerebrovascular mortality were 5.79%, 5.04%, 3.71%, and 4.05%, respectively. After adjusting for gender, age, education, marital status, annual household income, smoking, alcohol consumption, duration of diabetes, body mass index, hypertension, dyslipidemia, coronary heart disease and stroke, the results of multivariate Cox proportional risk regression model showed that the patients with the average daily fruit and vegetable intake of 250 – 349 grams were at a decreased risk of cardio-cerebrovascular mortality (hazard risk = 0.67, 95% confidence interval: 0.47 – 0.95) compared to those with the intake of < 200 grams.

  Conclusion  Appropriate intake of fruit and vegetable could reduce the risk of cardio-cerebrovascular mortality in community T2DM patients.