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

AlEssa, Hala B; Bhupathiraju, Shilpa N; Malik, Vasanti; Wedick, Nicole M.; Campos, Hannia; Rosner, Bernard; Willett, Walter C.; Hu, Frank B.

doi:10.3945/ajcn.115.116558

Cited by 89 publications

(76 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is critical to note that individuals should choose foods that are high in WG ingredients (at least 16 grams WG ingredients in dry weight per serving) to achieve approximately 48 grams/day of WG intake, while maintaining a low consumption of refined carbohydrates, which have established adverse effects. 38,39 In this regard, low-carbohydrate diets that ignore the health benefits of WG foods should be adopted with caution, as they have been linked to higher CVD risk and mortality. 40–42 Instead, diets that emphasize the quality of carbohydrates, fats, and proteins, such as the Mediterranean diet, Dietary Approaches to Stop Hypertension diet, and Alternate Healthy Eating Index 2010, should be recommended to facilitate disease prevention.…”

Section: Discussionmentioning

confidence: 99%

Whole Grain Intake and Mortality From All Causes, Cardiovascular Disease, and Cancer

2016

View full text Add to dashboard Cite

Background Current findings on associations between whole grain (WG) intake and mortality are inconsistent and have not been summarized by meta-analysis. Methods and Results We searched for prospective cohort studies reporting associations between WG and mortality from all causes, CVD, and cancer through February 2016 in Medline, Embase, and clinicaltrials.gov, and further included unpublished results from National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999–2004. Fourteen studies were eligible for analysis, which included 786,076 participants, 97,867 total deaths, 23,957 CVD deaths, and 37,492 cancer deaths. Pooled relative risks (RR, 95% confidence intervals [95%CIs]) comparing extreme WG categories (high vs. low) were 0.84 (0.80, 0.88; P<0.001, I2=74%, Pheterogeneity<0.001) for total mortality, 0.82 (0.79, 0.85; P<0.001, I2=0%, Pheterogeneity=0.53) for CVD mortality, and 0.88 (0.83, 0.94; P<0.001, I2=54%, Pheterogeneity=0.02) for cancer mortality. Intakes of WG ingredients in dry weight were estimated among studies reporting RRs for ≥3 quantitative WG categories, which were <50 grams/day among most study populations. The two-stage dose-response random-effects meta-analysis showed monotonic associations between WG intake and mortality (Pnonlinearity>0.05). For each 16 grams/day increase in WG (approximately 1 serving/day), RRs (95%CIs) of total, CVD, and cancer mortality were 0.93 (0.92, 0.94, P<0.001), 0.91 (0.90, 0.93, P<0.001), and 0.95 (0.94, 0.96, P<0.001), respectively. Conclusions Our meta-analysis demonstrated inverse associations of WG intake with total and cause-specific mortality, and findings were particularly strong and robust for CVD mortality. These findings further support current Dietary Guidelines for Americans, which recommends at least 3 servings/day of WG intake.

show abstract

Section: Discussionmentioning

confidence: 99%

Whole Grain Intake and Mortality From All Causes, Cardiovascular Disease, and Cancer

2016

View full text Add to dashboard Cite

show abstract

“…We derived race, age at menarche, parity and age at first birth (AFB) and family history of cancer from the most recent main NHS or NHS II cohort questionnaires. We estimated caffeine and total fiber intakes using the 133-item semi-quantitative food frequency questionnaire at baseline using methods described previously (2). We chose to adjust for these two dietary factors specifically because they have been consistently associated with type 2 diabetes, cardiovascular disease, and cardiometabolic health in general (11, 12, 30, 40, 43).…”

Section: Methodsmentioning

confidence: 99%

Objective Measures of Physical Activity and Cardiometabolic and Endocrine Biomarkers

AlEssa

Chomistek

Hankinson

et al. 2017

Medicine &Amp; Science in Sports &Amp; Exercise

View full text Add to dashboard Cite

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.

show abstract

“…A more recent analysis from US health professionals pointed that 4-year weight change was positively and strongly associated with increased daily servings of potato chips, potatoes, sugar sweetened beverages (SSBs), unprocessed red meats, and processed meats and inversely associated with intake of vegetables, whole grains, fruits, nuts, and yogurt 48, 59 . In addition, to specific foods, poor carbohydrate quality also appears to influence subsequent weight gain 59 and T2D risk 60 . A considerable amount of attention has focused on added sugar intake primarily because of their caloric contributions to the diet.…”

Section: Major Drivers Of the Obesity And Diabetes Epidemicsmentioning

confidence: 99%

Epidemiology of Obesity and Diabetes and Their Cardiovascular Complications

Bhupathiraju

2016

Circulation Research

719

442

View full text Add to dashboard Cite

Obesity and diabetes have reached epidemic proportions in the past few years. In 2011–2012, more than a third of the US population was obese. Although recent trend data indicate that the epidemic has “leveled off”, prevalence of abdominal obesity continues to rise, especially among adults. As seen for obesity, the past few decades have seen a doubling of the diabetes incidence with an increasing number of type 2 diabetes cases being diagnosed in children. Significant racial and ethnic disparities exist in the prevalence and trends of obesity and diabetes. In general, in both adults and children, non-Hispanic blacks and Mexican Americans appear to be at a high risk than their non-Hispanic white counterparts. Secular changes in agricultural policies, diet, food environment, physical activity, and sleep have all contributed to the upward trends in the “diabesity” epidemic. Despite marginal improvements in physical activity and the US diet, the food environment has changed drastically to an “obesogenic” one with increased portion sizes and limited access to healthy food choices especially for disadvantaged populations. Interventions that improve the food environment are critical as both obesity and diabetes raise the risk of cardiovascular disease by nearly two-fold. Among those with type 2 diabetes, significant sex differences occur in the risk of cardiovascular disease such that diabetes completely eliminates or attenuates the advantages of being female. Given the substantial burden of obesity and diabetes, future research efforts should adopt a translational approach to find sustainable and holistic solutions in preventing these costly diseases.

show abstract

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

Abstract: 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.

Cited by 89 publications

References 39 publications

Whole Grain Intake and Mortality From All Causes, Cardiovascular Disease, and Cancer

Whole Grain Intake and Mortality From All Causes, Cardiovascular Disease, and Cancer

Objective Measures of Physical Activity and Cardiometabolic and Endocrine Biomarkers

Epidemiology of Obesity and Diabetes and Their Cardiovascular Complications

Contact Info

Product

Resources

About