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.
Background: Healthful dietary patterns have been associated with lower risks of type 2 diabetes and coronary artery disease, but their relations with intermediate markers of cardiometabolic and endocrine health are less established. Objective: We evaluated the Dietary Approaches to Stop Hypertension (DASH), the alternate Mediterranean diet (aMED), and the Alternate Healthy Eating Index (aHEI) diet-quality scores with cardiometabolic and endocrine plasma biomarkers in US women. Design: The trial was a cross-sectional analysis of 775 healthy women in the Women's Lifestyle Validation Study that was conducted within the NHS (Nurses' Health Study) and NHS II longitudinal cohorts. Multiple linear regression models adjusted for potential confounders were used to estimate associations between quartiles of dietary pattern-adherence scores that were derived from a food-frequency questionnaire and plasma biomarker concentrations that were collected simultaneously. Results: In multivariable models in which highest and lowest quartiles of dietary pattern scores were compared, 1) DASH was significantly associated with higher concentrations of high-density lipoprotein (9%) and sex-hormone binding globulin (SHBG) (21%), and lower concentrations of leptin (28%), triglycerides (19%), and C-peptide (4%) (all P-trend # 0.04); 2) the aMED was associated with 19% higher SHBG and 16% lower triglycerides (P-trend = 0.02 and 0.003, respectively); and 3) the aHEI was associated with significantly higher concentrations of insulin (16%) and SHBG (19%) and lower concentrations of leptin (18%) (all P-trend # 0.02). Further adjustment for body mass index (BMI) attenuated these associations but remained significant for 1) DASH with leptin and triglycerides and 2) the aMED with triglycerides (all P-trend # 0.03). Conclusions: Adherence to healthful dietary patterns is associated with favorable concentrations of many cardiometabolic and endocrine biomarkers. These relations are mediated in part by BMI. Am J Clin Nutr 2017;105:432-41.
Dietary cereal fiber appears to be an important component of carbohydrate quality. The carbohydrate-to-cereal fiber ratio and the starch-to-cereal fiber ratio, but not the carbohydrate-to-fiber ratio, was associated with an increased risk for incident CHD. Future research should focus on how various measures of carbohydrate quality are associated with CHD prevention. This trial was registered at clinicaltrials.gov as NCT03214861.
Purpose Although physical activity is an established risk factor for chronic disease prevention, the specific mechanisms underlying these relationships are poorly understood. We examined the associations between total activity counts (TAC) and moderate-vigorous physical activity (MVPA) measured by accelerometer, and physical activity energy expenditure (PAEE) measured by doubly-labeled water, with plasma levels of pro-insulin, insulin, c-peptide, IGFBP-3, IGF-1, adiponectin, leptin and leptin-sR. Methods We conducted a cross-sectional analysis of 526 healthy US women in the Women’s Lifestyle Validation Study, 2010–2012. We performed multiple linear regression models adjusting for potential lifestyle and health-related confounders to assess the associations between physical activity, measured in quartiles (Q) and biomarkers. Results Participants in Q4 vs. Q1 of TAC had lower proinsulin (−20%), c-peptide (−7%), insulin (−31%) and leptin (−46%) levels, and higher adiponectin (55%), leptin-sR (25%) and IGF-1 (9.6%) levels (all P-trend≤0.05). Participants in Q4 vs Q1 of MVPA had lower proinsulin (−26%), c-peptide (−7%), insulin (−32%) and leptin (−40%) levels, and higher adiponectin (31%) and leptin-sR (22%) levels (all P-trend≤0.05). Further adjustment for body mass index attenuated these associations, but the associations with adipokines remained significant. Those in Q4 vs. Q1 of PAEE had lower leptin (−21%) and higher leptin-sR (10%) levels (all P-trend ≤0.05), after additional adjustment for body mass index. In the sensitivity analysis, the associations were similar but attenuated when physical activity was measured using the subjective physical activity questionnaire. Conclusion Our data suggests greater physical activity is modestly associated with favorable levels of cardiometabolic and endocrine biomarkers, where the strongest associations were found with accelerometer-measured physical activity. These associations may be only partially mediated through BMI, further supporting the role of physical activity in the reduction of cardiometabolic and endocrine disease risk, independent of adiposity.
A greater fiber intake and a lower starch-to-fiber intake ratio are favorably associated with adiponectin and HbA1c, but only cereal fiber intake was associated with CRP in women. Further research is warranted to understand the potential mechanism of these associations in early progression of T2D.
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