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Nutr Metab Cardiovasc Dis. 2019 Nov 16. pii: S0939-4753(19)30413-2. doi: 10.1016/j.numecd.2019.11.001. [Epub ahead of print]

Carbohydrate restriction in midlife is associated with higher risk of type 2 diabetes among Australian women: A cohort study.

Author information

1
Nutrition and Dietetics, School of Allied Health, Griffith University, Queensland, Australia.
2
Nutrition and Dietetics, School of Allied Health, Griffith University, Queensland, Australia; Integrated Primary Care and Partnerships, Western New South Wales Local Health District, NSW, Australia.
3
Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
4
School of Medicine, Faculty of Science, Medicine and Health, and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia; The Robinson Research Institute and Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia; Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia. Electronic address: danis@uow.edu.au.

Abstract

BACKGROUND AND AIMS:

Low-carbohydrate diets (LCDs) are increasingly popular but may be nutritionally inadequate. We aimed to examine if carbohydrate restriction in midlife is associated with risk of developing type 2 diabetes (T2DM), and if this association differs by previous gestational diabetes (GDM) diagnosis.

METHODS AND RESULTS:

Dietary intake was assessed for 9689 women from the Australian Longitudinal Study on Women's Health in 2001 (aged 50-55) and 2013 (aged 62-67) via validated food frequency questionnaires. Average long-term carbohydrate restriction was assessed using a low-carbohydrate diet score (highest quartile (Q4) indicating lowest proportion of energy from carbohydrates). Incidence of T2DM between 2001 and 2016 was self-reported at 3-yearly surveys. Log-binomial regression was used to estimate relative risks (RR) and 95% CIs. During 15 years of follow-up, 959 women (9.9%) developed T2DM. Carbohydrate restriction was associated with T2DM after adjustment for sociodemographic factors, history of GDM diagnosis and physical activity (Q4 vs Q1: RR 1.27 [95% CI 1.10, 1.48]), and this was attenuated when additionally adjusted for BMI (1.10 [0.95, 1.27]). Carbohydrate restriction was associated with lower consumption of fruit, cereals and high-fibre bread, and lower intakes of these food groups were associated with higher T2DM risk. Associations did not differ by history of GDM (P for interaction >0.15).

CONCLUSION:

Carbohydrate restriction was associated with higher T2DM incidence in middle-aged women, regardless of GDM history. Health professionals should advise women to avoid LCDs that are low in fruit and grains, and to consume a diet in line with current dietary recommendations.

KEYWORDS:

Carbohydrates; Cohort study; Gestational diabetes; Nutrition; Type 2 diabetes

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