Last updated May 16, 2026
Key finding
Eating vegetables first may reduce diabetes eye and kidney damage, but we cannot prove causality.
This study looked at whether eating vegetables before other foods affects diabetes complications. Researchers surveyed 832 adults with diabetes in Japan about their eating habits. About half ate vegetables first, while others had no particular order or ate protein or carbs first. People who ate vegetables first had lower rates of eye damage and kidney problems compared to those with no eating pattern. The link was strongest for kidney damage, with about 50% lower odds. No clear connection was found for nerve damage or heart disease. Because this study only observed patterns at one point in time, it cannot prove that eating vegetables first prevents complications.
Quick read
The essential study design details in one scan.
EvidenceScore™
Moderate
Study type
Cross-Sectional
Risk of bias
Some Concerns
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Plain-language summary
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Study focus
Eating vegetables first may reduce diabetes eye and kidney damage, but we cannot prove causality.
Published in
Publication details and source links for this paper.
Imataka K, Ida S, Tanaka T, Azuma K, Murata K. The Habit of Eating Vegetables First Is Linked with a Lower Risk of Diabetic Retinopathy and Nephropathy: Cross-Sectional Study in Japanese Diabetic Patients. Diabetes Metab Syndr Obes. 2026;19:555812. doi:10.2147/DMSO.S555812
Kidney damage → ↓ (strong association, 53% lower odds)
Eye damage → ↓ (moderate association, 36% lower odds)
Nerve damage and heart disease → → (no clear link)
Evidence network
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This study contributes evidence to Vegetables-first eating pattern and Diabetic retinopathy incidence, Nephropathy progression.
This study contributes evidence to
Primary intervention
Vegetables-first eating pattern
Primary outcomes
Primary intervention
Primary outcomes
Intervention and outcome relationships this study adds to the evidence network.
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Evidence network role
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Related topics
2
Evidence pairs
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Related studies
Core evidence
The primary outcomes reported in this study.
Vegetables-first eating pattern → Diabetic retinopathy incidence
Vegetables-first eating pattern → Diabetic retinopathy incidence
Vegetables-first eating pattern → Nephropathy progression
Vegetables-first eating pattern → Nephropathy progression
Evidence Library
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Adults with type 1 or type 2 diabetes, particularly those in Asian populations where meals are naturally structured with vegetables as separate dishes
The study design cannot prove eating vegetables first prevents complications; the cause and effect relationship is uncertain
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Relationships organized using the Dediabetes Evidence Intelligence™ framework.
Generated from the study's connected evidence using Evidence Intelligence™.
Vegetables-first eating pattern appears to improve Nephropathy progression.
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
Nephropathy progression
EvidenceScore™ Limited | EvidenceScore™ 39.8 | strong positive | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
Current evidence does not show a clear benefit of Vegetables-first eating pattern for Diabetic retinopathy incidence.
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
Diabetic retinopathy incidence
EvidenceScore™ Limited | EvidenceScore™ 39.8 | neutral | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
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