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Substitution of water or fresh juice for bottled juice and type 2 diabetes incidence: The SUN cohort study

  • U. Fresan
    Affiliations
    University of Navarra, Medical School, Department of Preventive Medicine and Public Health, Irunlarrea 1, 31008 Pamplona, Spain
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  • A. Gea
    Affiliations
    University of Navarra, Medical School, Department of Preventive Medicine and Public Health, Irunlarrea 1, 31008 Pamplona, Spain

    Navarra Institute for Health Research (IdisNa), Pamplona, Spain

    CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Institute of Health, Madrid, Spain
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  • M. Bes-Rastrollo
    Affiliations
    University of Navarra, Medical School, Department of Preventive Medicine and Public Health, Irunlarrea 1, 31008 Pamplona, Spain

    Navarra Institute for Health Research (IdisNa), Pamplona, Spain

    CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Institute of Health, Madrid, Spain
    Search for articles by this author
  • F.J. Basterra-Gortari
    Affiliations
    University of Navarra, Medical School, Department of Preventive Medicine and Public Health, Irunlarrea 1, 31008 Pamplona, Spain

    Navarra Institute for Health Research (IdisNa), Pamplona, Spain

    Hospital Reina Sofia, Department of Internal Medicine (Endocrinology), Tudela, Spain
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  • S. Carlos
    Affiliations
    University of Navarra, Medical School, Department of Preventive Medicine and Public Health, Irunlarrea 1, 31008 Pamplona, Spain

    Navarra Institute for Health Research (IdisNa), Pamplona, Spain
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  • M.A. Martinez-Gonzalez
    Correspondence
    Corresponding author. University of Navarra, Medical School, Department of Preventive Medicine and Public Health, Irunlarrea 1, 31008 Pamplona, Spain.
    Affiliations
    University of Navarra, Medical School, Department of Preventive Medicine and Public Health, Irunlarrea 1, 31008 Pamplona, Spain

    Navarra Institute for Health Research (IdisNa), Pamplona, Spain

    CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Institute of Health, Madrid, Spain
    Search for articles by this author

      Highlights

      • A water serving/day instead of bottled juice could decrease diabetes incidence.
      • The same effect was observed when it is replaced by fresh juice.
      • Each additional serving per day of bottled juice would increase diabetes risk.
      • Energy coming from juices would not be associated with diabetes risk.

      Abstract

      Background and aims

      The relationship between juice consumption and type 2 diabetes (T2D) has not been widely evidenced. Our aims were to prospectively evaluate the associations with T2D incidence of: 1) isovolumetric substitution of a water serving/day for one of fruit juice (different types), and of fresh fruit juice for its bottled version; 2) consumption of total, fresh or bottled juice; 3) energy intake from juices.

      Methods and results

      We followed 17,518 adults without T2D at baseline. Beverage consumption was assessed at baseline through a validated food-frequency questionnaire. The outcome was T2D incidence, according to American Diabetes Association's criteria. During a median follow-up of 10.2 years, 142 incident cases of T2D were identified. In substitution models, the substitution of water for bottled juice was associated with a lower T2D incidence, and also if the replacement was done by fresh juice, or especially fresh orange juice [HR 0.75 (95% CI 0.57–0.99), 0.65 (95% CI 0.43–0.98) and 0.56 (95% CI 0.34–0.92); respectively]. Each additional serving/day of bottled juice was directly associated with T2D incidence [HR 1.33 (95% CI 1.01–1.75)]. No significant association was observed for energy coming for bottled juice [HR 1.74 (95% CI 0.94–3.20)].

      Conclusion

      Our results suggest that isovolumetric substitution of water or fresh juice for bottled juice was inversely associated with T2D incidence in a long-term prospective study. Thus, these substitutions could be useful to tackle the diabetes epidemic.

      Keywords

      Abbreviations:

      95% CI (95% confidence interval), BJ (bottled juice), BMI (body mass index), BMR (basal metabolic rate), FFQ (food frequency questionnaire), FJ (fresh juice), FNOJ (fresh non-orange fruit juice), FOJ (fresh orange juice), HR (hazard ratio), MET (metabolic equivalent of tasks), SENC (Spanish Society of Community Nutrition), SUN (Seguimiento Universidad de Navarra (University of Navarra follow-up)), T2D (type 2 diabetes)
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