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Am J Clin Nutr. 2015 Dec;102(6):1543-53. doi: 10.3945/ajcn.115.116558. Epub 2015 Nov 4.

Carbohydrate quality and quantity and risk of type 2 diabetes in US women.

Author information

1
Departments of Nutrition.
2
Department of Medicine, University of Massachusetts Medical School, Worcester, MA.
3
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.
4
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.
5
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.

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.

KEYWORDS:

carbohydrate quality; carbohydrate-to-fiber ratio; fiber; starch; type 2 diabetes

PMID:
26537938
PMCID:
PMC4658465
DOI:
10.3945/ajcn.115.116558
[Indexed for MEDLINE]
Free PMC Article

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