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Topical Area: Nutritional Epidemiology

Nutritional Epidemiology (II) (Poster Session)

(P29-001-23) Food Forms and Sources of Fructose and Risk of Type 2 Diabetes Among US Women and Men

Monday, July 24, 2023

12:45 PM – 1:45 PM ET

Location: Poster Board 128

Presenting Author(s)

Hala Alessa, ScD

Visiting Scientist
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States

Co-Author(s)

Edward L. Giovannucci, PhD

Professor of Nutrition and Epidemiology
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
SS

Scott G. Smith

Harvard T.H. Chan School of Public Health
WW

Walter c. Willett, DrPH, MPH, MD

Professor
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
KW

Kana Wu

Harvard T.H. Chan School of Public Health
Frank B. Hu, MD, PhD

Professor and Chair
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
VM

Vasanti S. Malik, MSc, ScD

Assistant Professor
University of Toronto
Toronto, Ontario, Canada

Disclosure(s):

Hala Alessa, ScD: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: The associations between fructose from different food forms and sources and risk of type 2 diabetes are not well known. Therefore, we aimed to assess the relation between various forms and sources of fructose and incident T2D.

Methods: We investigated the associations between fructose variables and risk of type 2 diabetes among 211,490 US adults in the ongoing Nurses’ Health Study (NHS), Health Professionals Follow-up Study (HPFS), and Nurses’ Health Study II (NHSII), using Cox proportional hazards regression models. Medical, lifestyle, and dietary data were collected at baseline (NHS: 1984, HPFS: 1986, and NHSII: 1991) and every 2 – 4 y until end of follow-up (NHS and HPFS: 2016 and NHSII: 2017).

Results: After adjusting for age, lifestyle and other dietary behaviors, and BMI, total fructose intake was marginally associated with risk of type 2 diabetes (for 25g increase in intake, RR = 1.05, 95% confidence interval [CI]: 1.01, 1.09, P-trend=0.007). Liquid fructose intake, primarily as sugar-sweetened beverages and fruit juices, was positively associated with risk of type 2 diabetes (for 25g increase in intake, RR:1.40, 95% CI:1.33, 1.48, P-trend < 0.001), and solid fructose intake was inversely associated (RR:0.78, 95% CI:0.74, 0.83, P-trend < 0.001). Sugar-sweetened beverage and fruit juice fructose intakes were each positively associated with risk of type 2 diabetes (for 25g increase in intake, RR:1.51, 95% CI:1.39, 1.64 and RR:1.30, 95% CI:1.17, 1.44; both P-trend < 0.001, respectively), while whole fruit fructose and non-fruit solid fructose were inversely associated with risk of type 2 diabetes (RR: 0.71, 95% CI: 0.66, 0.77 and RR:0.80, 95% CI: 0.74, 0.86; both P-trend < 0.001, respectively).

Conclusions: Diets high in liquid fructose, whether from sugar-sweetened beverages or fruit juice, and low in whole fruit fructose intake were associated with a higher risk of type 2 diabetes.

Funding Sources: Funding provided by NIH grants UM1 CA186107, UM1 CA167552, HL34594, HL35464, P30 DK46200, and DK112940; the 2017 Faculty Research grant awarded to FH and HBA at the Middle East Initiative, Harvard Kennedy School by the Kuwait Foundation for the Advancement of Sciences; Cardiovascular Health Research Grant by the Kuwait Heart Foundation.