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The association of substituting carbohydrates with total fat and different types of fatty acids with mortality and weight change among diabetes patients.
Clin Nutr. 2016 10; 35(5):1096-102.CN

Abstract

BACKGROUND

Substitution of carbohydrates with fat in a diet for type 2 diabetes patients is still debated.

OBJECTIVE

This study aimed to investigate the association between dietary carbohydrate intake and isocaloric substitution with (i) total fat, (ii) saturated fatty acids (SFA), (iii) mono-unsaturated fatty acids (MUFA) and (iv) poly-unsaturated fatty acids (PUFA) with all-cause and cardiovascular (CVD) mortality risk and 5-year weight change in patients with type 2 diabetes.

METHODS

The study included 6192 patients with type 2 diabetes from 15 cohorts of the European Prospective Investigation into Cancer and Nutrition (EPIC). Dietary intake was assessed at recruitment with country-specific food-frequency questionnaires. Cox and linear regression were used to estimate the associations with (CVD) mortality and weight change, adjusting for confounders and using different methods to adjust for energy intake.

RESULTS

After a mean follow-up of 9.2 y ± SD 2.3 y, 791 (13%) participants had died, of which 268 (4%) due to CVD. Substituting 10 g or 5 energy% of carbohydrates by total fat was associated with a higher all-cause mortality risk (HR 1.07 [1.02-1.13]), or SFAs (HR 1.25 [1.11-1.40]) and a lower risk when replaced by MUFAs (HR 0.89 [0.77-1.02]). When carbohydrates were substituted with SFAs (HR 1.22 [1.00-1.49]) or PUFAs (HR 1.29 [1.02-1.63]) CVD mortality risk increased. The 5-year weight was lower when carbohydrates were substituted with total fat or MUFAs. These results were consistent over different energy adjustment methods.

CONCLUSIONS

In diabetes patients, substitution of carbohydrates with SFAs was associated with a higher (CVD) mortality risk and substitution by total fat was associated with a higher all-cause mortality risk. Substitution of carbohydrates with MUFAs may be associated with lower mortality risk and weight reduction. Instead of promoting replacement of carbohydrates by total fat, dietary guideline should continue focusing on replacement by fat-subtypes; especially SFAs by MUFAs.

Authors+Show Affiliations

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: M.J.E.Campmans-Kuijpers@Umcutrecht.nl.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Food Sciences and Nutrition, University of Bonn, Bonn, Germany.International Agency for Research on Cancer (IARC-WHO), Lyon, France.Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany.Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy.Cancer Registry and Histopathology Unit, "Civic - M.P-Arezzo" Hospital, ASP Ragusa, Italy.Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.Institutionen för odontologi, Umeå university, Umeå, Sweden.Intitutionen för medicin, Göteborgs universitet, Göteborg, Sweden.Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, Bilthoven, The Netherlands.Public Health Division of Gipuzkoa, Instituto BIO-Donostia, San Sebastian, Spain.Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza-University of Turin and Center for Cancer Prevention, Turin, Italy; Human Genetics Foundation, Turin, Italy.Navarre Public Health Institute, Pamplona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26342536

Citation

Campmans-Kuijpers, Marjo J., et al. "The Association of Substituting Carbohydrates With Total Fat and Different Types of Fatty Acids With Mortality and Weight Change Among Diabetes Patients." Clinical Nutrition (Edinburgh, Scotland), vol. 35, no. 5, 2016, pp. 1096-102.
Campmans-Kuijpers MJ, Sluijs I, Nöthlings U, et al. The association of substituting carbohydrates with total fat and different types of fatty acids with mortality and weight change among diabetes patients. Clin Nutr. 2016;35(5):1096-102.
Campmans-Kuijpers, M. J., Sluijs, I., Nöthlings, U., Freisling, H., Overvad, K., Boeing, H., Masala, G., Panico, S., Tumino, R., Sieri, S., Johansson, I., Winkvist, A., Katzke, V. A., Kuehn, T., Nilsson, P. M., Halkjær, J., Tjønneland, A., Spijkerman, A. M., Arriola, L., ... Beulens, J. W. (2016). The association of substituting carbohydrates with total fat and different types of fatty acids with mortality and weight change among diabetes patients. Clinical Nutrition (Edinburgh, Scotland), 35(5), 1096-102. https://doi.org/10.1016/j.clnu.2015.08.003
Campmans-Kuijpers MJ, et al. The Association of Substituting Carbohydrates With Total Fat and Different Types of Fatty Acids With Mortality and Weight Change Among Diabetes Patients. Clin Nutr. 2016;35(5):1096-102. PubMed PMID: 26342536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association of substituting carbohydrates with total fat and different types of fatty acids with mortality and weight change among diabetes patients. AU - Campmans-Kuijpers,Marjo J, AU - Sluijs,Ivonne, AU - Nöthlings,Ute, AU - Freisling,Heinz, AU - Overvad,Kim, AU - Boeing,Heiner, AU - Masala,Giovanna, AU - Panico,Salvatore, AU - Tumino,Rosario, AU - Sieri,Sabina, AU - Johansson,Ingegerd, AU - Winkvist,Anna, AU - Katzke,Verena A, AU - Kuehn,Tilman, AU - Nilsson,Peter M, AU - Halkjær,Jytte, AU - Tjønneland,Anne, AU - Spijkerman,Annemieke M, AU - Arriola,Larraitz, AU - Sacerdote,Carlotta, AU - Barricarte,Aurelio, AU - May,Anne M, AU - Beulens,Joline W, Y1 - 2015/08/28/ PY - 2015/02/24/received PY - 2015/07/06/revised PY - 2015/08/16/accepted PY - 2015/9/7/entrez PY - 2015/9/8/pubmed PY - 2018/2/1/medline KW - Body weight KW - Carbohydrates KW - Fatty acids KW - Mortality risk KW - Substitution KW - Type 2 diabetes SP - 1096 EP - 102 JF - Clinical nutrition (Edinburgh, Scotland) JO - Clin Nutr VL - 35 IS - 5 N2 - BACKGROUND: Substitution of carbohydrates with fat in a diet for type 2 diabetes patients is still debated. OBJECTIVE: This study aimed to investigate the association between dietary carbohydrate intake and isocaloric substitution with (i) total fat, (ii) saturated fatty acids (SFA), (iii) mono-unsaturated fatty acids (MUFA) and (iv) poly-unsaturated fatty acids (PUFA) with all-cause and cardiovascular (CVD) mortality risk and 5-year weight change in patients with type 2 diabetes. METHODS: The study included 6192 patients with type 2 diabetes from 15 cohorts of the European Prospective Investigation into Cancer and Nutrition (EPIC). Dietary intake was assessed at recruitment with country-specific food-frequency questionnaires. Cox and linear regression were used to estimate the associations with (CVD) mortality and weight change, adjusting for confounders and using different methods to adjust for energy intake. RESULTS: After a mean follow-up of 9.2 y ± SD 2.3 y, 791 (13%) participants had died, of which 268 (4%) due to CVD. Substituting 10 g or 5 energy% of carbohydrates by total fat was associated with a higher all-cause mortality risk (HR 1.07 [1.02-1.13]), or SFAs (HR 1.25 [1.11-1.40]) and a lower risk when replaced by MUFAs (HR 0.89 [0.77-1.02]). When carbohydrates were substituted with SFAs (HR 1.22 [1.00-1.49]) or PUFAs (HR 1.29 [1.02-1.63]) CVD mortality risk increased. The 5-year weight was lower when carbohydrates were substituted with total fat or MUFAs. These results were consistent over different energy adjustment methods. CONCLUSIONS: In diabetes patients, substitution of carbohydrates with SFAs was associated with a higher (CVD) mortality risk and substitution by total fat was associated with a higher all-cause mortality risk. Substitution of carbohydrates with MUFAs may be associated with lower mortality risk and weight reduction. Instead of promoting replacement of carbohydrates by total fat, dietary guideline should continue focusing on replacement by fat-subtypes; especially SFAs by MUFAs. SN - 1532-1983 UR - https://www.unboundmedicine.com/medline/citation/26342536/The_association_of_substituting_carbohydrates_with_total_fat_and_different_types_of_fatty_acids_with_mortality_and_weight_change_among_diabetes_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0261-5614(15)00224-1 DB - PRIME DP - Unbound Medicine ER -