The Habit of Eating Vegetables First Is Linked with a Lower Risk of Diabetic Retinopathy and Nephropathy: Cross-Sectional Study in Japanese Diabetic Patients.

Purpose: Although eating habits of "vegetables first" have been reported to be effective in suppressing postprandial hyperglycemia, its association with complications in diabetic patients remains unknown. This study aimed to examine the relationship between the habit of eating vegetables first and complications in diabetic patients. Patients and Methods: This cross-sectional study included diabetic patients who were examined as outpatients at the Ise Red Cross Hospital from June to August 2023 and from June to August 2024. The complications were diagnosed according to the clinical guidelines of the Japan Diabetes Society. Participants completed a questionnaire about their eating order, classified into four groups: no order, vegetables first, protein first, and carbohydrates first. Logistic regression analysis was used to calculate odds ratios for complications based on eating order. Results: The results revealed that 204 patients ate in no order, 438 patients ate vegetables first, 59 patients ate protein first, and 131 patients ate carbohydrates first. The adjusted odds ratios for diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, and cardiovascular disease for vegetables first with no order of eating as the reference were 0.64 (95% confidence interval [CI], 0.41-0.98; P = 0.043), 0.80 (95% CI, 0.53-1.20; P = 0.289), 0.47 (95% CI, 0.30-0.71; P < 0.001), and 1.28 (95% CI, 0.76-2.15; P = 0.351), respectively. Neither the protein first nor carbohydrates first groups showed a significant association with complications. Conclusion: In diabetic patients, the habit of eating vegetables first may indicate a reduced risk of diabetic retinopathy and nephropathy.