Carbohydrate quality and quantity and risk of coronary heart disease among US women and men

AlEssa, Hala B; Cohen, Randy; Malik, Vasanti; Adebamowo, Sally N.; Rimm, Eric B.; Manson, JoAnn E.; Willett, Walter C.; Hu, Frank B.

doi:10.1093/ajcn/nqx060

Cited by 55 publications

(43 citation statements)

References 40 publications

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“…The reasons for this correlation were as follows. Firstly, the quality of carbohydrate intake and the low glycemic index (GI) of whole grains, vegetables may be the mechanism for the observed benefits (27,28). Secondly, it has already been demonstrated that a high fiber intake may improve IR and decrease the risk of developing T2DM (29).…”

Section: Discussionmentioning

confidence: 99%

Association of Dietary Patterns with Type 2 Diabetes Mellitus among Middle-Aged Adults in Uygur Population of Xinjiang Region

Cai

Nuli

Zhang

et al. 2019

J Nutr Sci Vitaminol

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Observational and interventional studies have showed associations between dietary patterns and the risk of type 2 diabetes (T2DM). The aim of the present study was to identify dietary patterns and examine their association with incident of T2DM and physiopathologic mechanism in the Uygur population of Xinjiang, China. A community-based case control study in Urumqi, Xinjiang Uygur Autonomous Region, China. We enrolled 836 Uygur adults (345 newly diagnosed T2DM and 491 healthy controls) receiving physical examination in community health service centers. Dietary patterns were evaluated using a validated 121 items semi-quantitative food frequency questionnaire (SQFFQ). Dietary patterns were identified by exploratory factor analysis. Data on demographic, anthropometric, socioeconomic characteristics were collected. Homeostasis model assessment index for insulin resistance (HOMA-IR) and for b cell function (HOMA-b) were calculated. Multivariate logistic regression were used to estimate the associations between dietary patterns and the risk of T2DM and multiple linear regression were used to evaluate the association between dietary patterns and fasting plasm glucose (FPG), fasting insulin (FINS), HOMA-IR and HOMA-b, adjusting for confounding factors. Five major dietary patterns were identified: (1) the "vegetable and tubes" pattern; (2) the "fruit and nut" pattern; (3) the "refined grains and meat" pattern; (4) the "dairy, legume and egg" pattern; and (5) the "oil and salt" pattern. Logistic regression results demonstrated that the "vegetable and tubes" dietary pattern and the "fruit and nut" dietary pattern were related to T2DM, OR values were 0.223 (95% CI: 0.135-0.371), 0.160 (95% CI: 0.093-0.275), respectively. The "refined grains and meat" dietary pattern and the "oil and salt" dietary pattern were related to T2DM, OR values were 6.146 (95% CI: 3.217-11.739), 9.554 (95% CI: 5.668-16.104), respectively. Multiple linear regression analysis showed that the above five dietary patterns were related to log (FPG), b values were 20.040, 20.039, 0.028, 20.010 and 0.036, respectively, all p,0.05. The "vegetable and tubes" pattern, the "fruit and nut" pattern, the "refined grains and meat" pattern and the "oil and salt" pattern were related to log (HOMA-IR), b values were 20.061, 20.060, 0.045, and 0.042, and were related to log (HOMA-b), b values were 0.071, 0.063, 20.035 and 20.070, respectively, all p,0.05. The "refined grains and meat" dietary pattern and the "oil and salt" dietary pattern may be the important reason for the rapid increase of T2DM incidence among Chinese Uygur residents. Our findings suggest that modifying dietary patterns could reduce T2DM incidence in the adult Uygur population.

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Section: Discussionmentioning

confidence: 99%

Association of Dietary Patterns with Type 2 Diabetes Mellitus among Middle-Aged Adults in Uygur Population of Xinjiang Region

Cai

Nuli

Zhang

et al. 2019

J Nutr Sci Vitaminol

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“…However, average SFA intake in the UK (13.5% of energy intake) remains more than a third higher than recommended [4]. Similar high SFA intakes are observed in the USA and other high- and middle- income countries [5, 6], and progress in reducing SFA through public education programs has been slow. Hence, novel approaches are needed to achieve this target at the population level.…”

Section: Introductionmentioning

confidence: 99%

Prominent positioning and food swaps are effective interventions to reduce the saturated fat content of the shopping basket in an experimental online supermarket: a randomized controlled trial

Koutoukidis

Jebb

Ordóñez‐Mena

et al. 2019

Int J Behav Nutr Phys Act

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Background Interventions to reduce the saturated fat (SFA) content of food purchases may help reduce SFA consumption and lower cardiovascular risk. This factorial RCT aimed to examine the effect of altering the default order of foods and being offered a swap on the SFA content of food selected during an online shopping experiment. Methods UK adults who were the primary grocery shoppers for their household were recruited online and invited to select items in a custom-made experimental online supermarket using a 10-item shopping list. Participants were randomly allocated to one of four groups (i) to see products within a category ranked in ascending order of SFA content, (ii) receive an offer to swap to a product with less SFA, (iii) a combination of both interventions, or (iv) no intervention. The primary outcome was the difference in percentage energy from SFA in the shopping basket between any of the four groups. The outcome assessors and statistician were blinded to intervention allocation. Results Between March and July 2018, 1240 participants were evenly randomised and 1088 who completed the task were analysed (88%). Participants were 65% female and aged 38y (SD 12). Compared with no intervention ( n = 275) where the percentage energy from SFA was 25.7% (SD 5.6%), altering the order of foods ( n = 261) reduced SFA by [mean difference (95%CI)] -5.0% (− 6.3 to − 3.6) and offering swaps ( n = 279) by − 2.0% (− 3.3 to − 0.6). The combined intervention ( n = 273) was significantly more effective than swaps alone (− 3.4% (− 4.7 to − 2.1)) but not different than altering the order alone (− 0.4% (− 1.8 to 0.9)), p = 0.04 for interaction. Conclusions Altering the default order to show foods in ascending order of SFA and offering a swap with lower SFA reduced percentage energy from SFA in an experimental online supermarket. Environmental-level interventions, such as altering the default order, may be a more promising way to improve food purchasing than individual-level ones, such as offering swaps. Trial registration ISRCTN13729526 10.1186/ISRCTN13729526 26th February 2018. Electronic supplementary material The online version of this article (10.1186/s12966-019-0810-9) contains supplementary material, which is available to authorized users.

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“…Previous studies point to the fact that the carbohydrate metrics reflected by similar ratios of total carbohydrates, dietary fibre and/or free sugars may be associated with multiple benefits, as they may help identify more nutritious products [27,28], or improve diet quality [23], thus contributing to chronic disease reduction when calculated on a diet level [6,19]. Findings of the current analysis are consistent with these studies, showing that packaged foods from Southeast Asia and Australia that met the carbohydrate metrics reported a higher nutritional quality, having higher levels of health-promoting nutrients (e.g., dietary fibre, protein, various vitamins and minerals) and lower levels of nutrients of public health concern (e.g., calories, free sugars, trans fat, cholesterol).…”

Section: Discussionmentioning

confidence: 99%

“…As there is a general consensus that dietary fibre intake, in particular from whole grain sources, should be promoted [6,7,19,20], and free sugars intake be limited [21,22], novel alternative metrics of carbohydrate quality beyond absolute recommendations of these nutrients have emerged. These are expressed as ratios of total carbohydrates and/or starch to dietary fibre.…”

Section: Introductionmentioning

confidence: 99%

“…These are expressed as ratios of total carbohydrates and/or starch to dietary fibre. AlEssa and team reported that diets with low total carbohydrates-to-cereal fibre ratios are associated with lower risk for type 2 diabetes mellitus (T2DM) and coronary heart disease in the United States of America (USA) [6,19]. Recently, Blumfield et al, 2020, showed that diets compliant with similar carbohydrate metrics but integrating a free sugar threshold had an improved overall nutritional intake in the Australian population, reflected by a higher Healthy Eating Index score [23].…”

Section: Introductionmentioning

confidence: 99%

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An Assessment of Three Carbohydrate Metrics of Nutritional Quality for Packaged Foods and Beverages in Australia and Southeast Asia

et al. 2020

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Carbohydrate quality is an aetiological factor of diet-related disease. Indices of carbohydrate quality featuring various ratios of carbohydrates-to-dietary fibre-to-sugar have been associated with improved product and/or diet quality in westernised countries. Carbohydrate intake is especially high in Asia Pacific. Thus, this study evaluated the ability of such carbohydrate metrics to discriminate the nutritional quality of carbohydrate-rich packaged foods and beverages in Australia, Malaysia, Singapore, Thailand and the Philippines, with an additional focus on beverages. This evaluation was conducted by comparing product nutritional composition and assessing products against three national nutrient profiling models. Results showed that Australia had the highest proportion of products meeting all metrics, compared to the Southeast Asian countries. Beverages had a low adherence to all metrics compared to solid foods. Across the five countries, both processed food and beverages meeting the metrics generally contained higher dietary fibre, protein, and certain vitamins and minerals whilst having lower energy, total sugars, free sugars, trans fat and cholesterol content compared to products not meeting the metrics. The metrics were also aligned with national nutrient profiling models to identify nutritious products. In conclusion, these metrics allowed us to discriminate product nutritional quality in the countries assessed and are applicable to beverages.

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Carbohydrate quality and quantity and risk of coronary heart disease among US women and men

Cited by 55 publications

References 40 publications

Association of Dietary Patterns with Type 2 Diabetes Mellitus among Middle-Aged Adults in Uygur Population of Xinjiang Region

Association of Dietary Patterns with Type 2 Diabetes Mellitus among Middle-Aged Adults in Uygur Population of Xinjiang Region

Prominent positioning and food swaps are effective interventions to reduce the saturated fat content of the shopping basket in an experimental online supermarket: a randomized controlled trial

An Assessment of Three Carbohydrate Metrics of Nutritional Quality for Packaged Foods and Beverages in Australia and Southeast Asia

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