Study reveals avocado may lower diabetes risk in women, not men

By Dr. Sushama R. Chaphalkar, PhD.Apr 23 2024Reviewed by Susha Cheriyedath, M.Sc.

In a recent cross-sectional study published in the Journal of the Academy of Nutrition and Dietetics, researchers from Mexico investigated the potential association between avocado consumption and diabetes in Mexican adults. They found that compared to those who did not consume avocados, avocado-consuming women showed a lower risk of diabetes, while no significant association was observed among men.

Study: Association between avocado consumption and diabetes in Mexican adults: Results from the 2012, 2016, and 2018 Mexican National Health and Nutrition Surveys. Image Credit: Deckar 007 / Shutterstock

Background

The global prevalence of diabetes has tripled since 2000, prompting a focus on dietary modifications to mitigate the risk of the disease. Fruits and vegetables, rich in vitamins and phytochemicals, are known for their potential to combat insulin resistance and related conditions. While the collective benefits of dietary patterns like the Mediterranean diet are recognized, understanding the specific impact of individual foods is crucial.

Avocados, increasingly popular globally, offer essential nutrients and have been associated with metabolic health benefits. However, the research on their relationship with diabetes risk is limited, often characterized by small sample sizes and acute outcome assessments. Considering the influence of biological sex on diabetes pathogenesis, particularly noted among Mexican women, the present study investigated the potential link between avocado consumption and diabetes, analyzing data from the Mexico National Survey of Health and Nutrition (ENSANUT).

About the study

The present study involved a secondary analysis of a subset of the Mexican population aged ≥20 years from the 2012, 2016, and 2018 versions of the ENSANUT survey. The surveys followed a nationally representative sampling design with probabilistic multistage and cluster sampling, stratified by area of residence. Pregnant or lactating women were excluded. The initial sample sizes were 2,824 individuals from the 2012 survey, 8,530 from the 2016 survey, and 16,885 from the 2018 survey. During the study, 2,599 participants were excluded due to missing diabetes data or implausible energy or avocado intakes, resulting in a final analysis of 25,640 participants. Approximately 59% of them were female. A majority of them were overweight or obese, with over 60% with abdominal obesity.

Following established protocols, the surveys employed a validated semiquantitative food-frequency questionnaire (SFFQ) to collect dietary information from adults. Implausible data were excluded, and avocado consumption was assessed using the SFFQ, with participants classified as consumers or non-consumers based on reported intake.

Diabetes was determined by participants reporting whether a doctor had diagnosed them with diabetes or high blood sugar. In the primary analysis, self-reported diagnosis was utilized. A subset of the participants (n=15,349) underwent a sensitivity analysis using laboratory data. Diabetes was defined as glycated hemoglobin (HbA1c) ≥ 6.5% or fasting plasma glucose (FPG) ≥ 126 mg/dL.

Various covariates, including age, sex, indigenous status, socioeconomic level, education, residence area, geographic region, marital status, body mass index (BMI), abdominal obesity, physical activity, healthy eating index (HEI-2015) score, energy intake, smoking, alcohol consumption, hypertension, and acute myocardial infarction were considered. The weight, height, and waist circumference were measured. The socioeconomic level was determined through principal component analysis and categorized into low, medium, and high levels. The study employed descriptive statistics, logistic regression (adjusted and unadjusted models), sensitivity analysis using FBG or HbA1c, and assessment for multicollinearity.

Results and discussion

Of the participants from the three surveys, about 45% were avocado consumers, with an average daily consumption of 34.7 grams for men and 29.8 grams for women. Avocado consumers tended to have higher socioeconomic status and education levels compared to non-consumers. Avocado consumption was found to be associated with lower odds of diabetes among women in both unadjusted (OR: 0.762) and adjusted (OR: 0.792) models but not among men (p-value >0.05 for both). This association remained consistent when using laboratory measurements for diabetes diagnosis (FPG or Hb1AC). These findings highlight the potential protective role of avocado consumption against diabetes, particularly among women.

The study benefits from a large, nationally representative dataset in Mexico, where avocado consumption is culturally significant, and uses a validated survey tool to assess intake accurately, controlling for relevant covariates and conducting sensitivity analysis. However, the reliance on self-reported avocado consumption may introduce measurement bias, and the cross-sectional design limits the ability to establish causation, highlighting the need for longitudinal studies to explore the long-term effects. Additionally, while the large sample size enhances statistical power, replication in other cohorts is crucial to confirm these findings.

Conclusion

In conclusion, the present study identifies a link between avocado consumption and reduced diabetes risk, which is particularly significant among women even after adjusting for relevant factors. The findings suggest the potential role of avocados as a beneficial component of dietary interventions targeting diabetes risk reduction, particularly in women. They highlight the need for further research in personalized nutrition in diabetes prevention and management and dietary recommendations based on individual characteristics.