Dietary Total Vitamin A, [beta]-carotene, and Retinol Intake and the Risk of Diabetes in Chinese Adults with Plant-based Diets

Purpose: Epidemiologic evidence regarding the role of dietary vitamin A in the development of diabetes is limited and inconsistent. This study was to explore the association between vitamin A intake and diabetes risk in Chinese adults. Methods: A prospective cohort study was conducted among 17 111 adults (8537 men and 8577 women) who participated in the China Health and Nutrition Survey between 1989 and 2015. Dietary intakes were assessed by 3 consecutive 24-hour dietary recalls combined with a household food inventory. Diabetes was determined by self-reported diagnosis, diabetes medication use, or additional criterion in 2009 of fasting blood glucose or hemoglobin A1c. We analyzed the association of vitamin A intake (total, [beta]-carotene, retinol) with diabetes risk using Cox proportional hazards models. Results: A total of 519 men and 531 women developed diabetes during a median of 11 years of follow-up. Higher dietary total vitamin A intakes were associated with a lower risk of diabetes in both men (quintile 5 [Q5] vs Q1: hazard ratio [HR] = 0.69, 95% CI, 0.49-0.97, P-trend = 0.079) and women (Q5 vs Q1: HR = 0.63; 95% CI, 0.45-0.89; P-trend = 0.039). An inverse relation with diabetes risk was observed for dietary intakes of [beta]-carotene (Q5 vs Q1: HR = 0.71; 95% CI, 0.52-0.97) and retinol (Q5 vs Q1: HR = 0.58; 95% CI, 0.39-0.85) among men, but not women. Dose-response analyses showed the association of dietary intakes of total vitamin A, [beta]-carotene, and retinol with diabetes risk in men was L-shaped (P-nonlinearity = 0.043), reverse J-shaped (P-nonlinearity = 0.001), and linear, respectively. Conclusion: Our findings suggest that adequate intake of vitamin A may help protecting against diabetes, especially for men. Key Words: risk of diabetes; dietary intake; vitamin A; [beta]-carotene; retinol; prospective cohort study Abbreviations: BMI, body mass index; BMR, basal metabolic rate; CHNS, the China Health and Nutrition Survey; HR, hazard ratio; PAL, physical activity level; Q, quintile; RA, retinoic acid; RAE, retinol activity equivalent; RBP4, retinol-binding protein 4; RCS, restricted cubic splines; TE, total energy