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Carbohydrate quality and quantity and risk of type 2 diabetes in US women.
Am J Clin Nutr 2015; 102(6):1543-53AJ

Abstract

BACKGROUND

Carbohydrate quality may be an important determinant of type 2 diabetes (T2D); however, relations between various carbohydrate quality metrics and T2D risk have not been systematically investigated.

OBJECTIVE

The purpose of this study was to prospectively examine the association between carbohydrates, starch, fibers, and different combinations of these nutrients and risk of T2D in women.

DESIGN

We prospectively followed 70,025 women free of cardiovascular disease, cancer, and diabetes at baseline from the Nurses' Health Study (1984-2008). Diet information was collected with the use of a validated questionnaire every 4 y. Cox regression was used to evaluate associations with incident T2D.

RESULTS

During 1,484,213 person-years of follow-up, we ascertained 6934 incident T2D cases. In multivariable analyses, when extreme quintiles were compared, higher carbohydrate intake was not associated with T2D (RR = 0.98; 95% CI: 0.89, 1.08; P-trend = 0.84), whereas starch was associated with a higher risk (RR = 1.23; 95% CI: 1.12, 1.35; P-trend <0.0001). Total fiber (RR = 0.80; 95% CI: 0.72, 0.89; P-trend < 0.0001), cereal fiber (RR = 0.71, 95% CI: 0.65, 0.78; P-trend < 0.0001), and fruit fiber (RR = 0.79; 95% CI: 0.72, 0.85; P-trend < 0.0001) were associated with a lower T2D risk. The ratio of carbohydrate to total fiber intake was marginally associated with a higher risk of T2D (RR = 1.09; 95% CI: 1.00, 1.20; P-trend = 0.04). On the other hand, we found positive associations between the ratios of carbohydrate to cereal fiber (RR = 1.28; 95% CI: 1.17, 1.39; P-trend < 0.0001), starch to total fiber (RR = 1.12; 95% CI: 1.02, 1.23; P-trend = 0.03), and starch to cereal fiber (RR = 1.39; 95% CI: 1.27, 1.53; P-trend < 0.0001) and T2D.

CONCLUSIONS

Diets with high starch, low fiber, and a high starch-to-cereal fiber ratio were associated with a higher risk of T2D. The starch-to-cereal fiber ratio of the diet may be a novel metric for assessing carbohydrate quality in relation to T2D.

Authors+Show Affiliations

Departments of Nutrition.Departments of Nutrition.Departments of Nutrition.Department of Medicine, University of Massachusetts Medical School, Worcester, MA.Departments of Nutrition.Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and.Departments of Nutrition, Epidemiology, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and.Departments of Nutrition, Epidemiology, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Frank.hu@channing.harvard.edu.

Pub Type(s)

Journal Article
Observational Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

26537938

Citation

AlEssa, Hala B., et al. "Carbohydrate Quality and Quantity and Risk of Type 2 Diabetes in US Women." The American Journal of Clinical Nutrition, vol. 102, no. 6, 2015, pp. 1543-53.
AlEssa HB, Bhupathiraju SN, Malik VS, et al. Carbohydrate quality and quantity and risk of type 2 diabetes in US women. Am J Clin Nutr. 2015;102(6):1543-53.
AlEssa, H. B., Bhupathiraju, S. N., Malik, V. S., Wedick, N. M., Campos, H., Rosner, B., ... Hu, F. B. (2015). Carbohydrate quality and quantity and risk of type 2 diabetes in US women. The American Journal of Clinical Nutrition, 102(6), pp. 1543-53. doi:10.3945/ajcn.115.116558.
AlEssa HB, et al. Carbohydrate Quality and Quantity and Risk of Type 2 Diabetes in US Women. Am J Clin Nutr. 2015;102(6):1543-53. PubMed PMID: 26537938.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carbohydrate quality and quantity and risk of type 2 diabetes in US women. AU - AlEssa,Hala B, AU - Bhupathiraju,Shilpa N, AU - Malik,Vasanti S, AU - Wedick,Nicole M, AU - Campos,Hannia, AU - Rosner,Bernard, AU - Willett,Walter C, AU - Hu,Frank B, Y1 - 2015/11/04/ PY - 2015/06/02/received PY - 2015/09/25/accepted PY - 2015/11/6/entrez PY - 2015/11/6/pubmed PY - 2016/4/14/medline KW - carbohydrate quality KW - carbohydrate-to-fiber ratio KW - fiber KW - starch KW - type 2 diabetes SP - 1543 EP - 53 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 102 IS - 6 N2 - BACKGROUND: Carbohydrate quality may be an important determinant of type 2 diabetes (T2D); however, relations between various carbohydrate quality metrics and T2D risk have not been systematically investigated. OBJECTIVE: The purpose of this study was to prospectively examine the association between carbohydrates, starch, fibers, and different combinations of these nutrients and risk of T2D in women. DESIGN: We prospectively followed 70,025 women free of cardiovascular disease, cancer, and diabetes at baseline from the Nurses' Health Study (1984-2008). Diet information was collected with the use of a validated questionnaire every 4 y. Cox regression was used to evaluate associations with incident T2D. RESULTS: During 1,484,213 person-years of follow-up, we ascertained 6934 incident T2D cases. In multivariable analyses, when extreme quintiles were compared, higher carbohydrate intake was not associated with T2D (RR = 0.98; 95% CI: 0.89, 1.08; P-trend = 0.84), whereas starch was associated with a higher risk (RR = 1.23; 95% CI: 1.12, 1.35; P-trend <0.0001). Total fiber (RR = 0.80; 95% CI: 0.72, 0.89; P-trend < 0.0001), cereal fiber (RR = 0.71, 95% CI: 0.65, 0.78; P-trend < 0.0001), and fruit fiber (RR = 0.79; 95% CI: 0.72, 0.85; P-trend < 0.0001) were associated with a lower T2D risk. The ratio of carbohydrate to total fiber intake was marginally associated with a higher risk of T2D (RR = 1.09; 95% CI: 1.00, 1.20; P-trend = 0.04). On the other hand, we found positive associations between the ratios of carbohydrate to cereal fiber (RR = 1.28; 95% CI: 1.17, 1.39; P-trend < 0.0001), starch to total fiber (RR = 1.12; 95% CI: 1.02, 1.23; P-trend = 0.03), and starch to cereal fiber (RR = 1.39; 95% CI: 1.27, 1.53; P-trend < 0.0001) and T2D. CONCLUSIONS: Diets with high starch, low fiber, and a high starch-to-cereal fiber ratio were associated with a higher risk of T2D. The starch-to-cereal fiber ratio of the diet may be a novel metric for assessing carbohydrate quality in relation to T2D. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/26537938/Carbohydrate_quality_and_quantity_and_risk_of_type_2_diabetes_in_US_women_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.115.116558 DB - PRIME DP - Unbound Medicine ER -