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PLOSONE:AssociationsofGreenTeaandRockTeaConsumptionwithRiskofImpairedFastingGlucoseandImpairedGlucoseToleranceinChi

Associations of Green Tea and Rock Tea Consumption with Risk of

Impaired Fasting Glucose and Impaired Glucose Tolerance in
Chinese Men and Women
HuibinHuang, QiuxuanGuo, ChangshengQiu, BaoyingHuang, XianguoFu, JinYao, JixingLiang, LiantaoLi, LingChen,
KakaTang, LixiangLin, JieliLu, YufangBi, GuangNing, JunpingWen, CaijingLin
Published:November18,2013

, GangChen

DOI:10.1371/journal.pone.0079214

Abstract
Objective

Toexploretheassociationsofgreenteaandrockteaconsumptionwithriskofimpairedfastingglucose(IFG)andimpairedglucose
tolerance(IGT).
Methods

Amultistage,stratified,cluster,randomsamplingmethodwasusedtoselectarepresentativesamplefromFujianProvincein
China.Intotal,4808subjectswithoutcardiovasculardisease,hypertension,cancer,orpancreatic,liver,kidney,orgastrointestinal
diseaseswereenrolledinthestudy.Astandardquestionnairewasusedtogatherdataontea(green,rock,andblack)consumption
andotherrelevantfactors.Theassessmentofimpairedglucoseregulation(IGR)wasusing75goralglucosetolerancetest
(OGTT),thediagnosticcriteriaofnormalglucosetolerancewasaccordingtoAmericanDiabetesAssociation.
Results

GreenteaconsumptionwasassociatedwithalowerriskofIFG,whilerockteaconsumptionwasassociatedwithalowerriskof
IGT.TheadjustedoddsratiosforIFGforgreenteaconsumptionof<1,115,1630,and>30cupsperweekwere1.0(reference),
0.42(95%confidenceintervals(CI)0.270.65),0.23(95%CI,0.120.46),and0.41(95%CI,0.170.93),respectively.Theadjusted
oddsratiosforIGTforrockteaconsumptionof<1,115,1630,and>30cupsperweekwere1.0(reference),0.69(95%CI,0.48
0.98),0.59(95%CI,0.390.90),and0.64(95%CI,0.430.97),respectively.AUshapedassociationwasobserved,subjectswho
consumed1630cupsofgreenorrockteaperweekhavingthelowestoddsratiosforIFGorIGT.
Conclusions

Consumptionofgreenorrockteamayprotectagainstthedevelopmentoftype2diabetesmellitusinChinesemenandwomen,
particularlyinthosewhodrink1630cupsperweek.
Citation:HuangH,GuoQ,QiuC,HuangB,FuX,etal.(2013)AssociationsofGreenTeaandRockTeaConsumptionwith
RiskofImpairedFastingGlucoseandImpairedGlucoseToleranceinChineseMenandWomen.PLoSONE8(11):e79214.
doi:10.1371/journal.pone.0079214
Editor:JianpingYe,PenningtonBiomedicalResearchCenter,UnitedStatesofAmerica
Received:June8,2013Accepted:September18,2013Published:November18,2013
Copyright:2013Huangetal.ThisisanopenaccessarticledistributedunderthetermsoftheCreativeCommons
AttributionLicense,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalauthor
andsourcearecredited.
Funding:ThisstudywassupportedbygrantsfromtheChineseMedicalAssociationandChineseEndocrineSociety.The
fundershadnoroleinstudydesign,datacollectionandanalysis,decisiontopublish,orpreparationofthemanuscript.
Competinginterests:Theauthorshavedeclaredthatnocompetinginterestsexist.
Introduction

Teaisconsumedasabeverageworldwide,especiallyinAsia.Becauseofthehighprevalenceofteaconsumption,evensmall
effectsofteaatapopulationlevelmayhavealargeimpactonpublichealth.Tea,originatesfromtheleavesoftheplantCamellia
sinensis,canbeclassifiedintothreemajortypesaccordingtotheleveloffermentation:greentea(notfermented),oolongtea
(partiallyfermented),andblacktea(fullyfermented)[1].RockteaisakindofoolongteaproducedintheMountWuyiregion,Fujian,
China,andisfamousforitsfragrance[2].
Inrecentyears,teahasbeenstudiedforitspotentialtoinfluenceinsulinactivity,plasmaglucoseconcentration,andtheincidence
ofdiabetes.However,evidenceonthepotentialofteatoinfluencethedevelopmentofdiabetesiscontroversial.Ametaanalysis
reportedthatpeoplewhodrankfourormorecupsofteaperdayhadalowerriskoftype2diabetes[3].Aretrospectivecohortstudy
of17413Japaneseadultsalsodemonstratedthatgreenteaconsumptionwasassociatedwithalowerriskofdiabetes,whereas
consumptionofoolongorblackteawasnot[4].AnotherprospectivestudyconductedintenEuropeancountriesobservedalinear
inverseassociationbetweenteaconsumptionandincidenceoftype2diabetes[5].Incontrast,otherstudiesfoundnorelationship
betweenteaconsumptionanddiabetesrisk[6],[7].
Oftheseresearchstudies,onlyafewexaminedtheassociationbetweenteaconsumptionandimpairedglucoseregulation,theso
calledprediabeticstate,whichisidentifiedashavingimpairedfastingglucose(IFG)and/orimpairedglucosetolerance(IGT)[8].
Studieshaveshownthatpeoplewithimpairedglucoseregulationhaveasignificantlyincreasedriskfordiabetesmellitus[9],[10].

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However,littleisknownontheeffectofteaconsumptiononimpairedglucoseregulation.Wethereforeinvestigatedtheassociation
ofteaconsumption(greenandrocktea)withriskofimpairedglucoseregulation,usingdatafromacrosssectionalstudyon
ChineseHanpeopleinFujianprovince.
Methods
Studypopulation

Thiswasacrosssectionalstudywhichwasconductedbetween20112012.Subjectsregisteredwerepermanentresidentsof
Fujianprovince.Amultistage,stratified,clusterrandomsamplingmethodwasusedtoselectarepresentativesample.Atotalof
9995peoplewereregisteredinthestudy.Subjectswereexcludediftheyhadanyofthefollowingconditions:cardiovascular
disease(i.e.,myocardialinfarction,heartfailure,orstroke),hypertension,cancer,andpancreatic,liver,kidney,orgastrointestinal
diseases,andwhosedatawerenotcompleted,sincethepresenceofthesediseasescouldhaveaffectedtheirdiet,lifestyleandthe
absorptionoftea.Wealsoexcludedparticipantswhowerediabetesorwhodrankblackteaorothertypesoftea,becauseofthe
smallsamplesize.Intheend,4808subjectswereenrolled.Alltheinvestigatorsreceivedprofessionaltrainingbeforethe
investigations.ThestudyreceivedapprovalfromtheEndocrinologyBranchoftheChineseMedicalAssociationandallparticipants
gavewritteninformedconsent.
Datacollection

Theparticipantswereaskedtocompleteastandardquestionnaireincludingage,gender,familyhistoryofdiabetes,aswellas
medicalhistories,suchascardiovasculardisease,hypertension,diabetes,cancer,andpancreatic,liver,kidney,andgastrointestinal
diseases.Lifestylefactorswerealsorecorded,forinstance,diet,smokinghabits,dailyalcoholintake,physicalactivity,andsleep
status.Dietaryfactorswereassessedprimarilybyaskingtheparticipantswhetherandhowtheyhadconsumedteaandother
beveragessuchasmilk,soybeanmilk,coffee,soda,andjuiceduringthepreviousyear.Inparticular,theparticipantswereasked
aboutteaconsumptionincludingthetypeofteatheydrank(green,rock,orblack)andhowmanycupsofteatheyconsumedeach
dayandhowmanydaystheyconsumedteaeachweek.Thevolumeofonecupofteawasestimatedtobeequalto150mL.The
cupsconsumedperdayweremultipliedbythenumberofdaysthatteawasconsumedeachweektodeterminehowmanycupsof
teawereconsumedeachweek.Fourcategoriesforfrequencyofteaconsumptionwerecreated:<1cup/week,115cups/week,
1630cups/week,and>30cups/week.Milk,soybeanmilk,coffee,sodaandjuicedrinkersweredefinedasthosewhodrankonce
ormoreeachweek.Smokingstatuswasassessedbasedonwhethertheparticipantwasapastorpresentsmoker,thenumberof
cigarettessmokeddaily,andthenumberofyearsthatcigaretteshadbeensmoked.Currentsmokerswerethosewhosmokedat
leastonecigaretteperday.Formersmokerswerethosewhohadsmokedpreviously,buthadnotsmokedforoneyearormore.
Alcoholintakewasassessedbyaskingtheparticipantsabouttheirpastandpresentdrinkinghabits,includingthequantityofdrinks
consumedeachdayandthenumberofyearsthattheyhadbeendrinkingalcohol.Theparticipantswereclassifiedasnever,former
orcurrentdrinkers.Currentdrinkersweredefinedasthosewhohadconsumedalcoholonceormoreeachweekoveraperiodof
oneyearorlonger.Formerdrinkersweredistinguishedfromlifelongnondrinkers.Physicalactivitywasmeasuredbyaskingthe
participantswhethertheypracticedleisuretimephysicalactivityforatleast2030mintwiceormoreeachweek.Sleepstatuswas
assessedbasedonwhethertheparticipantshadinsomniaorwereusingsleepingpills.Bodyweightandheightweremeasured
withoutshoesandinlightclothing,andbodymassindex(BMI)calculatedasweight(kg)/height(m)2.Waistcircumferencewas
measuredatthemiddlepointbetweenthecostalmarginandiliaccrest,andhipcircumferencewasmeasuredatthelevelofthe
trochanters.Waisttohipratio(WHR)wascalculatedastheratioofwaisttohipcircumference.Bloodpressurewasmeasuredtwice
intherightarm,inthesittingposition,usingamanualsphygmomanometer,afterthesubjectshadbeenrestingfor30min.The
meanofthetworeadingswasusedintheanalyses.
Laboratorymeasurements

5mlbloodwithandwithoutanticoagulant(sodiumfluoride+potassiumoxalate,1:3)weretakenfromsubjectswhohadfastedforat
least10h.Allsubjectswereadministered75goralglucosetolerancetest(OGTT).After30and120min,5mlbloodwith
anticoagulantwasdrawnfromsubjects.Levelsofbloodglucose,totalcholesterol(TC),triglycerides(TG)andhighdensity
lipoproteincholesterol(HDLC)weretestedusingtheglucoseoxidasemethod,colorimetricenzymeassays,glycerolphosphate
enzymaticoxidationassay,andendpointcolorimetry,respectively.Lowdensitylipoproteincholesterol(LDLC)wascalculatedby
theformulaofFriedewaldetal[11].
Diagnosticcategories

AccordingtothediagnosticcriteriaoftheAmericanDiabetesAssociation[8],normalglucosetolerancewasdefinedasfasting
plasmaglucose(FPG)<5.6mmol/Land2hpostloadplasmaglucose(2hPG)<7.8mmol/Lwithnopreviousdiagnosisofdiabetes
orimpairedglucoseregulation.Impairedfastingglucose(IFG)wasdefinedas5.6FPG<7.0mmol/L.Impairedglucosetolerance
(IGT)wasdefinedas7.82hPG<11.1mmol/L.DiagnosisofdiabeteswasbasedonFPG7.0mmol/Land/or2hPG11.1
mmol/L.Hypertensionwasdefinedassystolicbloodpressure140mmHgand/ordiastolicbloodpressure90mmHgorhaving
beendiagnosedwithhypertensionortakingantihypertensiontreatment.Dyslipidemiawasdefinedasselfreportedcurrent
treatmentwithcholesterolloweringmedicationorhavingoneormoreofthefollowing:TC5.17mmol/L,TG1.69mmol/L,HDLC
1.03mmol/L,orLDLC3.38mmol/L[12].Fourcategoriesforthefrequencyofgreenorrockteaconsumptionwerecreated:<1
cup/week,115cups/week,1630cups/week,and>30cups/week.Basedonthesmokingstatus,subjectswereclassifiedas
never,former,andcurrentsmokers,andbasedonthealcoholintake,theywereclassifiedasnever,former,andcurrentdrinkers.
Subjectswerecategorizedasinactiveandactivebasedonthelevelofphysicalactivityandbasedonthesleepstatus,subjects
wereclassifiedasthosewhosleptwellandthosewhodidnot.BMIwasclassifiedasnormal,overweight(25.029.9kg/m2),and
obesity(30.0kg/m2)accordingtotheWHOcriteria[13].
Statisticanalysis

EpiDatasoftware(EpiDataAssociation,Odense,Denmark)wasusedtoestablishthedatabaseandthestatisticalprogramSPSS
19.0(SPSSInc.,Chicago,IL,USA)usedforthestatisticalanalyses.Continuousvariableswereexpressedasmean(standard
deviation)fornormallydistributedvariablesandasmedian(interquartileranges)forvariableswithanonnormaldistribution.
Categoricalvariableswereexpressedasapercentage.Differencesinmeans,mediansandpercentageofbaselinevariables
acrossthegreenteaandrockteaconsumptioncategorieswerestatisticallytestedbyonewayANOVA,theKruskalWallistestand
thechisquaretestrespectively.Univariateanalysesofgenerallinearmodelswereusedtocomparedifferencesinthemean
concentrationsoffastingand2hpostloadplasmaglucoseaccordingtotheconsumptionofeachteainsubjectswithnormal
glucosetolerance.Asgreenandrockteaconsumptiondidnotoverlap,wedidnotmutuallyadjustfortheirconsumption.Theodds
ratios(OR)and95%confidenceintervalsofIFGandIGTinrelationtolevelsofgreenandrockteaconsumptionwereobtainedby
multiplelogisticregressionanalysisadjustedforconfoundingvariables,usingnormalglucosetoleranceasthereferencegroup.An
ORvalue<1wasregardedasaprotectivefactor.Allpvalues<0.05fromtwosidedhypotheseswereconsideredasstatistically
significant.

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Results

Ofthe4808subjects,1242(25.83%)hadIFGand648(13.48%)hadIGT.Thebaselinecharacteristicsofthesubjectsgrouped
accordingtothelevelofgreenandrockteaconsumptionareshowninTables1and2,respectively.Subjectswhodrankgreentea
wereolderthanthosewhodidnot,whilesubjectswhodrankrockteawereyoungerthanthosewhodidnot.Subjectswho
consumedbothteasweremorelikelytobemen,withthepercentageofmenincreasingwithhigherteaconsumption.The
percentageofformersmokers,currentsmokers,andsubjectswhodrankalcoholwassignificantlyhigherforbothteaconsumptions
thanthatofsubjectswhodidnotconsumetea.Subjectswhodrankrockteaalsohadahigherpercentageforafamilyhistoryof
diabetes,weremorelikelytodrinkmilkandsoybeanmilk,andlesslikelytoparticipateinphysicalactivity.Althoughconsumptionof
thetwoteasdidnotcausesignificantimprovementsinlipidmetabolism,BMI,orwaisthipratio,theeffectofanunhealthylifestyle
shouldnotbeexcluded.Thepercentageofsubjectswhoconsumedcoffee,soda,orjuicewasverylow,andbecausetherewasno
significantdifferencebetweenthegroups,wedidnotadjustforthesevariablesinthelateranalyses.

Table1.Baselinecharacteristicsgroupedaccordingtoweeklyconsumptionofgreentea.

doi:10.1371/journal.pone.0079214.t001

Table2.Baselinecharacteristicsgroupedaccordingtoweeklyconsumptionofrocktea.

doi:10.1371/journal.pone.0079214.t002
NextweusedunivariateanalysesofgenerallinearmodelstocomparedifferencesinthemeanconcentrationofFPGand2hPG
glucoseaccordingtotheconsumptionofeachteainsubjectswithnormalglucosetolerance(Table3).Model1(adjustedforage
andgender)andmodel2(adjustedforage,gender,serumlipids,familyhistoryofdiabetes,consumptionofmilk,consumptionof
soybeanmilk,smokingstatus,alcoholintake,sleepstatus,physicalactivity,BMI,andwaisthipratio),bothshowedthatsubjects
whoconsumedgreenteaonaweeklybasishadlowerFPGlevels,whilesubjectswhoconsumedrockteaonaweeklybasishad
lower2hPGlevels.ThereductionsinFPGand2hPGweremorepronouncedinsubjectswhoconsumed1630cupsofgreenor
rockteaperweek.

Table3.Plasmaglucoseconcentrationsgroupedaccordingtoweeklyconsumptionofgreenteaorrocktea.

doi:10.1371/journal.pone.0079214.t003

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Tables4and5showthemultivariableadjustedORsand95%confidenceinterval(CI)forIFGandIGTaccordingtothelevelof
greenorrockteaconsumption,withnormalglucosetoleranceactingasthereferencegroup.Twodifferentmodelswere
constructedrespectively.Thefirstmodelwasadjustedforage,gender,andlevelofteaconsumption.Thesecondmodelincluded
thevariablesinmodel1,inadditiontobeingadjustedfordyslipidemia,familyhistoryofdiabetes,consumptionofmilk,consumption
ofsoybeanmilk,smokingstatus,alcoholintake,physicalactivity,sleepstatus,BMI,andwaisthipratio.Comparedwithsubjects
whoneverconsumedtea,subjectswhoconsumedgreenteahadareducedriskofIFG,withtheadjustedORsforIFGinthegreen
teaconsumptioncategoriesof<1,115,1630,and>30cupsperweekbeing1.0(reference),0.42(95%CI,0.270.65),0.23
(95%CI,0.120.46),and0.41(95%CI,0.170.93),respectively(seeinTabel4).Subjectswhoconsumedrockteahadareduced
riskforIGT,withtheadjustedORsofIGTintherockteaconsumptioncategoriesof<1,115,1630,and>30cupsperweekbeing
1.0(reference),0.69(95%CI,0.480.98),0.59(95%CI,0.390.90),and0.64(95%CI,0.430.97)(seeninTabel5).AUshaped
associationwasobservedrespectively,subjectswhoconsumed1630cupsofgreenorrockteaperweekhavingthelowestORs
forIFGorIGT.

Table4.Oddsratioforglucosetolerancestatusgroupedaccordingtothelevelofgreenteaconsumption.

doi:10.1371/journal.pone.0079214.t004

Table5.Oddsratioforglucosetolerancestatusgroupedaccordingtothelevelofrockteaconsumption.

doi:10.1371/journal.pone.0079214.t005

Discussion

ThisstudydemonstratedtheinverseassociationsbetweengreenteaconsumptionandIFG,andbetweenrockteaconsumption
andIGT.Theseinverseassociationsappearedtobemoreevidentwhensubjectsconsumed1630cupsofteaperweek.People
withIFGandIGThaveahigherriskofdevelopingdiabetesmellitus.Ourstudyaddstoincreasingevidencethatteaconsumption
mayprovideprotectionagainstthedevelopmentoftype2diabetes.However,todate,therelationshipbetweenteaconsumption
anddiabeteshasbeeninconsistent.Recentepidemiologicstudieshavesuggestedthatteaconsumptionreducestheriskoftype2
diabetes[5],[14],[15],whereasotherstudieshaveshownnoeffect[6],[7]Studieshavealsobeenconductedondifferenttypesof
tea(green,oolong,andblack),althoughthesestudieshavealsoproducedconflictingresults.Aretrospectivecohortstudyof17413
Japaneseadultsshowedthatgreenteaconsumptionwasassociatedwithalowerdiabetesrisk,whereasoolongorblacktea
consumptionwasnot[4].However,Yamajietal.reportednoclearassociationbetweengreenteaconsumptionanddiabetes[16].A
clinicaltrialreportedthatconsumptionofoolongteadecreasedtheplasmaglucoselevelinpatientswithtype2diabetes[17].
Whereasanotherstudyreportedlongtermconsumptionofoolongteamaybeapredictivefactorfornewonsetdiabetes[18].The
SingaporeChineseHealthStudyalsodemonstratedthatregularconsumptionofblacktea,butnotofgreentea,wasassociated
withalowerriskoftype2diabetes[19].Forassessmentoftype2diabetes,themajorityofthesestudiesusedselfreported
questionnairesand/orregistersofdiabeticpatientsreceivingtreatment,withonlyafewstudiesadoptedastandardOGTT.
Althoughteacontainsnumerouscompounds,itsmainbiologicaleffectsareattributabletopolyphenols,especiallyflavonoids[20].
Catechins,theaflavins,andthearubiginsarethemostprominentflavonoidsintea[5],[20].Teaalsocontainscaffeine,whichisalso
oneoftheimportantcomponentsofit[17].Accordingtotheleveloffermentation,itcanbeclassifiedintogreentea(notfermented),
oolongtea(partiallyfermented)andblacktea(fullyfermented)[1].Thecomponentsofthesethreetypesofteasaredifferentand
havevariablebioactivities.Greenteacomesfromsteamedfreshleaves,whichcontainaclassofflavonoidsknownascatechins,
comprisedofepigallocatechingallate(EGCG),epicatechingallate,andgallocatechingallate.EGCGisthoughttobethemost
pharmacologicallyactiveofthesecatechins[21],[22].Rockteaisakindofoolongtea,whichissemifermented.Duringthe
productionofrocktea,themajorityofcatechinsaretransformedtotheaflavinsandthearubigins[2],[22].Arecentcomparative
studyofdifferentteasrevealsimportantfindings:thelevelsofEGCGandtotalcatechinsareintheorderofgreentea>oolongtea
>blackteathelevelofcaffeineindifferentteasisintheorderofblacktea>oolongtea>greenteatheinductionofapoptosisisin
theorderofgreentea>oolongtea>blacktea[22].
OurresultsshowthatconsumptionofgreenteasignificantlydecreasedFPGconcentrations,andconsumptionofrocktea
significantlydecreased2hPGconcentrations,andthesameresultswereobservedinsubjectswithnormalglucosetoleranceafter
adjustmentforconfoundingvariables.Theseresultsmaybeexplainedbythelevelofteafermentationandthedifferentmechanism
ofIFGandIGT.Thechemicalcompositionandbioactivityoftheteasisknowntochangewiththeleveloffermentation,IFGandIGT
arealsotwodifferentstatesininsulinresistanceandinsulinsecretion[23].IFGhaveseverehepaticinsulinresistancewithnormal
ornearnormalmuscleinsulinresistance,whileIGThavemarkermuscleinsulinresistancewithonlymildhepaticinsulinresistance.
Bothofthemarecharacterizedbyareductioninearlyphaseinsulinsecretion,whilesubjectwithIGTalsohaveimpairedlatephase
insulinsecretion.Bothconditionscontributetodisturbancesinglucosehomeostasisandthedevelopmentoftype2diabetes[24].In
ourstudy,greenteaparticularlyloweredtheriskofIFG,probablyasaresultofitshighcatechincontent,especiallyEGCG.EGCG
hasinsulinmimeticeffect,itdecreaseshepaticglucoseproduction,andincreasestyrosinephosphorylationoftheinsulinreceptor
andinsulinreceptorsubstrate1(IRS1).Inaddition,itcontrolsgluconeogenesisbyinhibitingtheexpressionofgenessuchas

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phosphoenolpyruvatecarboxykinase(PEPCK)andglucose6phosphatase(G6Pase),anditcanalsoamelioratecytokineinduced
celldamageandimproveinsulinsensitivity[3],[25][27].Studiesinratshaveshowngreenteaextractsalsoreducefasting
hyperglycemia[28],regulatetheexpressionofgenesinvolvedinglucoseuptakeandtheinsulinsignaltransductionpathways[29],
scavengefreeradicals,reduceoxidativestress,andhaveanantidiabeticeffect[30].Comparedwithgreentea,rockteaissemi
fermented,andduringfermentation,themajorityofcatechinsaretransformedtotheaflavinsandthearubigins[2],[22].Inourstudy,
rockteaparticularlyloweredtheriskofIGT,itcouldbespeculatedthatitmayinhibitpostprandialhyperglycemiaandprotectagainst
thedevelopmentoftype2diabetes.Matsuietal.reportedthattheaflavinshaveanantihyperglycemiceffect,anditmaydelayor
inhibitglucoseproductionattheintestinethroughtheinhibitionofglucosidaseactivity[31].Williamsonetal.alsoshowedthat
extractsfromtea,especiallytheaflavins,butnotEGCG,wereeffectivelyinhibithumansalivaryamylasebyanoncompetitive
mechanism[32].ThecomparativestudyofdifferentteasfromTaiwanmentionedabovealsoshowedthatrocktea(akindofoolong
tea)containsmorecaffeinethangreentea.Ithasbeenreportedthatcaffeineisinvolvedintheregulationofglucosemetabolismin
theskeletalmuscle[33],increasesglucosetransporterIVexpression[34],andhasantidiabeticactivity[35].Epidemicallystudies
alsorevealedtheinverseassociationbetweencaffeineintakeandriskofdiabetes[4],[16].However,thespecificmechanismofthe
antihyperglycemiceffectofrocktearemainsunclearandrequiresfurtherstudy.
Inpresentstudy,wealsoobservedthattheinverseassociationsbetweengreenteaconsumptionandIFG,androcktea
consumptionandIGTweremorepronouncedwhensubjectsdrank1630cupsofteaperweek.However,theleveloftea
consumptionrequiredtoreducetheriskoftype2diabetesremainscontroversial.Ametaanalysisreportedthatsubjectswhodrank
fourormorecupsofteaperdayhada20%lowerriskofdevelopingdiabetesthanthosewhodranklessornone[3].Another
prospectivestudyreportedalinearinverseassociationbetweenteaconsumptionandincidenceoftype2diabetes,althoughthis
protectiveeffectwasnotrestrictedtosubjectswhodrank>4cupsofteaperday,withlowerdosesalsoreducingtheriskofdiabetes
[5].Anothercrosssectionalstudyrevealedthatlongtermteaconsumption(12cupsperday)wasassociatedwithalowerriskof
diabetes[15].Itispossiblethatdifferencesinstudydesign,thetypeofteaconsumed,thecupsizeused,thesamplesizeunder
investigation,andlifestylemayhavecontributedtotheseconflictingresults.Inaddition,areviewarticlesuggestedthatalthoughtea
hasnumerousbenefits,itisnecessarytoconsidertheadverseeffectsthatmayaccompanyheavyconsumptionofteaorcatechins
[36].Forexample,ithasbeenreportedthathighdosesofEGCGactasprooxidants,whichcanleadtonormalcellapoptosis[37],
[38].
Thestrengthsofthepresentstudyincludetheuseoforalglucosetoleranceteststoevaluatetherelationshipbetweentea
consumptionandimpairedglucoseregulation,andspecificassessmentsofgreenandrocktea,whereasotherstudieshave
typicallygroupedtheteatypesintotheonecategory.Thestudyhadseverallimitations.First,becauseofthecrosssectionaldesign
ofthestudy,wewereunabletodeterminecauseandeffectrelationships.Second,teaconsumptionwasassessedusingself
reportedquestionnaires,andtherefore,misclassificationsmayhaveoccurred.However,thesemisclassificationswouldtendto
underestimatetheeffectofteaconsumption.Third,theyearofteaconsumptionmayinfluencetheeffectofteaonglucose
regulation,butthesefactorswerenotcontrolledinourstudies.Forth,wedidnotdistinguishbetweendrinkingteabeforeorafter
meals,whichmayaffectthebioactivitiesofthecompoundsinteaandchangeappetiteandabsorptionofnutrients.However,almost
alloftheearlierstudiesthatexploredtherelationshipbetweenteaanddiabetesdidnotadjustedforthisfactor,andinChina,the
majorityofpeopledrinkteaaftermeals.Fifth,wedidnotuseavalidatedfoodfrequencyquestionnairetoevaluatefoodanddrink
intake.Sixth,thestudypopulationincludedChinesemenandwomenlivinginFujian,whoselifestyleisdifferentfrompeopleliving
inWesterncountries.Forexample,theconsumptionofcoffee,soda,andjuiceisrelativelylowinChinacomparedwiththatin
Westerncountries.Therefore,whetherornotourresultscanbegeneralizedtootherpopulationsrequiresfurtherstudy.
Inconclusion,thisstudyfoundinverseassociationsbetweengreenteaconsumptionandIFG,andbetweenrockteaconsumption
andIGT,inChinesewomenandmen.Theseinverseassociationsweremorepronouncedinsubjectswhodrank1630cupsoftea
eachweek.Thesefindingsareimportantbecauseoftheprevalentconsumptionofteaandthegrowingepidemicoftype2diabetes.
Furtherhumanstudies,especiallyclinicaltrials,areneededtoinvestigatetheroleofgreenandrockteaconsumptioninrelationship
totheriskofglucoseintolerance.
Acknowledgments

Wethankallsubjectswhoparticipatedinthisstudy.
AuthorContributions

Conceivedanddesignedtheexperiments:GCHHCL.Performedtheexperiments:QGCQBHXFJYJWJ.LiangL.LiLCKTL.
Lin.Analyzedthedata:GCHHCLQGCQBHXFJYJ.LiangL.LiLCKTL.LinJ.LuYBGN.Wrotethepaper:HH.
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