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Moslehi N, Kamali Z, Mirmiran P, Barzin M, Khalaj A. Association of postoperative dietary macronutrient content and quality with total weight loss and fat-free mass loss at midterm after sleeve gastrectomy. Nutrition 2024; 120:112331. [PMID: 38295491 DOI: 10.1016/j.nut.2023.112331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVES This study aimed to investigate the associations of macronutrient quantities and qualities with percentage total weight loss and percentage of fat-free mass loss relative to total weight loss in adults undergoing sleeve gastrectomy. METHODS This cross-sectional study included 146 patients on postoperative time since sleeve gastrectomy of 2 to 4 y. Diet was assessed using a food frequency questionnaire. Macronutrient quality index, carbohydrate quality index, fat quality index, and healthy plate protein quality index were calculated. The associations of dietary variables with percentage total weight loss and percentage of fat-free mass loss relative to total weight loss were determined using linear regression. Logistic regression was used to estimate the odds of non-response (percentage total weight loss < 25%) and excessive fat-free mass loss (percentage of fat-free mass loss relative to total weight loss > 28%) based on dietary intakes. RESULTS Forty-six (31.5%) were non-responders, and 49 (33.6%) experienced excessive fat-free mass loss. The fully adjusted model showed a 0.75 decrease in percentage total weight loss per 5% carbohydrate increase (95% CI, -1.45 to -0.05). The odds of non-response were 53% lower per 5% increase in protein (95% CI, 0.23-0.94). Each 5-g higher intake of fat was associated with 0.29 higher percentage of fat-free mass loss relative to total weight loss (95% CI, 0.03-0.55). The odds of excessive fat-free mass loss were reduced by 5% per gram of fiber intake (95% CI, 0.90-0.99). Each 5% increment in energy intake from protein that was isocalorically substituted for either carbohydrate or fat was associated with lower odds of nonresponse. Macronutrient quality indices had no significant associations. CONCLUSIONS Adherence to a high-protein, high-fiber diet after sleeve gastrectomy may enhance surgical success by improving total weight loss and preventing excessive fat-free mass loss.
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Affiliation(s)
- Nazanin Moslehi
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Kamali
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
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Xiao Y, Xiang L, Jiang Y, Tang Y, Gu H, Wang Y, Peng L. Carbohydrate quality, not quantity, linked to reduced colorectal cancer incidence and mortality in US populations: evidence from a prospective study. BMC Med 2024; 22:97. [PMID: 38443943 PMCID: PMC10916156 DOI: 10.1186/s12916-024-03325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Carbohydrates have been implicated in colorectal cancer (CRC) risk, but the specific impact of carbohydrate quality and quantity on CRC susceptibility in US populations remains unclear. METHODS We followed 101,694 participants from Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. The carbohydrate quality index (CQI) and low-carbohydrate diet score (LCDs) were used to evaluate the daily carbohydrate quality and quantity separately, where higher scores indicated greater adherence. Cox proportional hazards regression was used to compute HRs and 95% CIs for incident CRC and related death. Subgroup analyses were conducted to identify potential effect modifiers. RESULTS During follow-up, we documented 1085 incident cases of CRC, of whom 311 died from CRC. Individuals in the highest compared with the lowest quartiles of CQI had a lower CRC incidence (Q4 vs Q1: HR 0.80, 95% CI 0.67-0.96, Ptrend = 0.012) and mortality (Q4 vs Q1: HR 0.61, 95% CI 0.44-0.86, Ptrend = 0.004). The inverse association between CQI and CRC risk was observed for distal colon and rectum but not for proximal colon cancer. Regarding mortality, this association was only significant for rectum cancer. Subgroup analyses indicated this inverse association of CQI with CRC risk was only observed in participants with lower LCDs. No significant associations were found between LCDs and CRC incidence or mortality. CONCLUSIONS Our findings suggest focusing on higher quality, rather than restricting the quantity, of carbohydrate consumption may be an effective approach to reduce the risk of CRC in the US population, particularly for distal colon and rectal cancers.
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Affiliation(s)
- Yi Xiao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.288 Tianwen Avenue, Chongqing, 400010, Nan'an District, China
| | - Ling Xiang
- Department of Clinical Nutrition, The Second Affiliated Hospital of Chongqing Medical University, No.288 Tianwen Avenue, Chongqing, 400010, Nan'an District, China.
| | - Yahui Jiang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.288 Tianwen Avenue, Chongqing, 400010, Nan'an District, China
| | - Yunhao Tang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.288 Tianwen Avenue, Chongqing, 400010, Nan'an District, China
| | - Haitao Gu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.288 Tianwen Avenue, Chongqing, 400010, Nan'an District, China
| | - Yaxu Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.288 Tianwen Avenue, Chongqing, 400010, Nan'an District, China.
| | - Linglong Peng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.288 Tianwen Avenue, Chongqing, 400010, Nan'an District, China.
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Vilela DLS, da Silva A, Pinto SL, Bressan J. Preoperative Carbohydrate Quality Index Is Related to Markers of Glucose Metabolism 12 Months After Roux-en-Y Gastric Bypass. Obes Surg 2023; 33:3155-3162. [PMID: 37606805 DOI: 10.1007/s11695-023-06771-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE The role of carbohydrates in weight loss in patients undergoing bariatric surgery (BS) remains poorly understood. Therefore, this study aimed to verify the relationship of the carbohydrate quality index (CQI) with weight loss and cardiometabolic risk markers up to 1 year after BS. MATERIAL AND METHODS This study included 50 patients with obesity undergoing Roux-en-Y gastric bypass. Data collection was performed preoperatively and 3 and 12 months after surgery. The foods consumed were documented using a 24-h food recall in 3 days. The CQI was calculated considering the following parameters: dietary fiber intake, sugar level; whole grains: proportion of total grains; solid carbohydrate: total carbohydrate ratio. RESULTS From the total study sample, 58 participants were followed up for 3 months, and eight participants dropped out of the study. The remaining 50 patients were followed up for 12 months. Subjects were classified into tertiles according to the index score. A 1-unit increase in CQI was associated with a -1.02 decrease in insulin concentrations at 12 months and a -1.04 decrease in HOMA-IR. Concerning the total sample, the median of the CQI was 8 points and did not change at 3 and 12 months after surgery, but there was an improvement in some components of the index. CONCLUSION The data suggest that the quality of carbohydrates can interfere with markers of insulin resistance after BS and the quality of carbohydrates is a point to be guided in patients undergoing BS.
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Affiliation(s)
- Darlene L S Vilela
- Laboratory of Energy Metabolism and Body Composition (LAMECC), Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, 36570-900, Brazil.
| | - Alessandra da Silva
- Laboratory of Energy Metabolism and Body Composition (LAMECC), Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, 36570-900, Brazil
| | - Sônia L Pinto
- Laboratory of Energy Metabolism and Body Composition (LAMECC), Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, 36570-900, Brazil
- Department of Nutrition, Universidade Federal de Tocantins, Palmas, Tocantins, 77001-090, Brazil
| | - Josefina Bressan
- Laboratory of Energy Metabolism and Body Composition (LAMECC), Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, 36570-900, Brazil
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Moslehi N, Golzarand M, Mirmiran P, Hosseinpanah F, Azizi F. Macronutrient quality and the incidence of metabolically unhealthy phenotypes in adults with normal weight and overweight/obesity. Obes Res Clin Pract 2023; 17:369-377. [PMID: 37696712 DOI: 10.1016/j.orcp.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/15/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE We aimed to investigate the associations of macronutrient quality indices with the incident metabolically unhealthy normal weight (MUNW) and metabolically unhealthy overweight/obesity (MUO) phenotypes. METHODS This prospective study included 512 metabolically healthy normal weight and 787 metabolically healthy overweight/obese adults from the third study examination of the Tehran Lipid and Glucose Study. The participants were followed through the sixth study examination. Diet was measured with a food frequency questionnaire. The macronutrient quality index (MQI), carbohydrate quality index (CQI), fat quality index (FQI), and healthy plate quality index (HPPQI) were calculated. Hazard ratio (HR) and 95 % confidence interval (95 % CI) were estimated for incident unhealthy phenotypes using Cox regression. RESULTS After controlling all possible confounding factors, a one-point higher HPPQI was linked to a 28 % lower risk of MUNW (HR = 0.72; 95 % CI = 0.59, 0.87). Compared to the lowest quartile, the incident MUNW was also lower in the two last quartiles of the HPPQI. A one-unit increase in MQI was associated with a 5 % lower incident MUO (HR = 0.95; 95 % CI = 0.92, 0.99). The incident MUO was also higher for the highest compared to the lowest MQI quartile. In quartiles 2-4 of the HPPQI, incident MUO was lower with respective HRs (95 % CI) of 0.71 (0.54, 0.93), 0.60 (0.45, 0.80), and 0.66 (0.50, 0.86) in the fully-adjusted model. CONCLUSIONS A higher overall macronutrient quality was independently associated with a lower incident MUO. A higher dietary protein quality was related to a lower risk for MUNW and MUO.
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Affiliation(s)
- Nazanin Moslehi
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahdieh Golzarand
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nikrad N, Hosseini B, Pakmehr A, Tousi AZ, Ardekani AM, Farhangi MA, Akhavan-Sigari R. Dietary carbohydrate quality index (CQI), cardio-metabolic risk factors and insulin resistance among adults with obesity. BMC Endocr Disord 2023; 23:171. [PMID: 37568117 PMCID: PMC10416415 DOI: 10.1186/s12902-023-01420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS), as a cluster of cardiometabolic risk factors, is a global public health concern due to its increasing prevalence. Considering the previous evidence of the association between carbohydrate quality and cardiometabolic risk factors, our study was aimed to evaluate any possible association between carbohydrate quality index (CQI) and cardiometabolic risk factors among obese adults. METHODS In this cross-sectional study, 336 apparently healthy individuals with obesity were participated. Dietary intake was assessed by a semi-quantitative Food Frequency Questionnaire (FFQ), including 168 food items validated for the Iranian population. CQI was calculated with three components of solid carbohydrates to total carbohydrates ratio, dietary fiber intake, and dietary glycemic index (GI). Body composition was determined by bioelectrical impedance analysis (BIA). Blood pressure was measured by sphygmomanometer and enzymatic methods were used to evaluate serum lipid, glucose, and insulin concentrations. RESULTS Subjects in the third quartile of CQI had significantly lower systolic blood pressure (SBP) (P = 0.03) and diastolic blood pressure (DBP) (P = 0.01). Participants in the higher quartiles of CQI had more intake of energy, carbohydrates, fat, saturated fatty acid (SFA), and mono-saturated fatty acid (MUFA) (P < 0.05). Moreover, the homeostasis model assessment of insulin resistance (HOMA-IR) was decreased in the second quartile of CQI [odds ratio (OR) = 0.146, P = 0.01) after adjustment for age, body mass index (BMI), sex, physical activity, socioeconomic status (SES) and energy intake. CONCLUSION According to our findings, a higher quality of dietary carbohydrates, determined by CQI, could be associated with a lower risk of hypertension.
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Affiliation(s)
- Negin Nikrad
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Hosseini
- Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azin Pakmehr
- Tehran University of Medical Sciences, Tehran, Iran
| | - Ayda Zahiri Tousi
- Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran
| | - Abnoos Mokhtari Ardekani
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Science, & Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | | | - Reza Akhavan-Sigari
- Department of Neurosurgery, University Medical Center Tuebingen, Tuebingen, Germany
- Department of Health Care Management and Clinical Research, Collegium Humanum Warsaw Management University, Warsaw, Poland
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Kahrizsangi MA, Ebrahimi Z, Shateri Z, Mansouri F, Zangene A, Rajabzadeh-Dehkordi M, Nouri M, Rashidkhani B. Carbohydrate quality indices and colorectal cancer risk: a case-control study. BMC Cancer 2023; 23:347. [PMID: 37069525 PMCID: PMC10108463 DOI: 10.1186/s12885-023-10786-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the fourth and third most common cancer in Iran and the world, respectively. Carbohydrates can lead to the proliferation of cancer cells, including CRC. The current study aimed to investigate the association between glycemic load (GL), insulin load (IL), glycemic index (GI), insulin index (II), low-carbohydrate diet score (LCDS), and carbohydrate quality index (CQI) with CRC odds. METHODS The present case-control study was performed on 71 CRC cases and 142 controls in the Hospital Cancer Organization and three general hospitals in Tehran, Iran. We calculated the dietary GI, GL, IL, II, CQI, and LCDS by a validated food frequency questionnaire. RESULTS The results indicated that people who were in the highest tertile of the GI had higher odds of CRC compared to the lower tertile (in the adjusted model: odds ratio (OR) = 3.89; 95% confidence interval (CI): 1.71-8.84). On the contrary, people who were in the highest tertile of the CQI and LCDS had significantly lower odds of CRC compared to the lower tertile (in the adjusted model: tertile (T) 2-OR = 0.24; 95% CI: 0.11-0.53 and T3-OR = 0.15; 95% CI: 0.06-0.39 for CQI and T2-OR = 0.33; 95% CI: 0.13-0.79 and T3-OR = 0.28; 95% CI: 0.10-0.82 for LCDS). Also, IL was positively associated with the odds of CRC after adjusting for confounding factors (T2-OR = 2.46; CI: 1.08-5.61 and T3- OR = 2.80; 95% CI: 1.07-7.31). Regarding the GL, only individuals who were in the second tertile had significantly higher odds of CRC compared to the first tertile (OR = 2.42; CI: 1.07-5.47). CONCLUSION According to the findings, it is recommended to use a diet with high-quality carbohydrates and low GI and GL to minimize the odds of developing CRC. People should also be encouraged to have a balanced carbohydrate intake.
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Affiliation(s)
- Masoud Amini Kahrizsangi
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zohreh Ebrahimi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Zainab Shateri
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Mansouri
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Zangene
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Milad Rajabzadeh-Dehkordi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Nouri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Bahram Rashidkhani
- Department of Community Nutrition, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Nouri M, Mahmoodi M, Shateri Z, Ghadiri M, Rajabzadeh-Dehkordi M, Vali M, Gargari BP. How do carbohydrate quality indices influence on bone mass density in postmenopausal women? A case-control study. BMC Womens Health 2023; 23:42. [PMID: 36721166 PMCID: PMC9887922 DOI: 10.1186/s12905-023-02188-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Carbohydrates are the primary energy source in Asian countries, including Iran. An emerging method can be used to measure the quality of carbohydrates, including the carbohydrate quality index (CQI), which includes a variety of components. Low-carbohydrate diet score (LCDS) has been proposed as a new method of scoring micronutrient intake that could provide a reasonable explanation for the link between diet and the risk of chronic diseases. OBJECTIVE This study aimed to investigate the relationship between CQI, LCDS, glycemic index (GI), glycemic load (GL), insulin load (IL), and insulin index (II) with bone mass density (BMD) in postmenopausal women. METHOD In this case-control study, 131 postmenopausal women with osteoporosis/osteopenia and 131 healthy postmenopausal women aged 45-65 participated. The dual-energy X-ray absorptiometry (DEXA) method measured the BMD of the lumbar vertebrae and femoral neck. A validated semi-quantitative food frequency questionnaire was used to assess dietary intake. Logistic regression were used to evaluate the relation between GI, GL, II, IL, CQI, and LCDS with BMD. RESULTS Diets with higher GI increased the risk of osteopenia and osteoporosis, but LCDS and CQI decreased the risk of osteopenia and osteoporosis. CONCLUSION These findings suggest that a higher intake of fruits and vegetables and receiving various dietary vitamins, minerals, and antioxidant compounds may be a useful way to prevent osteopenia in Iranian women.
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Affiliation(s)
- Mehran Nouri
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Mahmoodi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zainab Shateri
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Marzieh Ghadiri
- Student Research Committee, Department of Biochemistry and Diet Therapy, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Milad Rajabzadeh-Dehkordi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohebat Vali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahram Pourghassem Gargari
- Nutrition Research Center, Department of Biochemistry and Diet Therapy, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Zamanillo-Campos R, Chaplin A, Romaguera D, Abete I, Salas-Salvadó J, Martín V, Estruch R, Vidal J, Ruiz-Canela M, Babio N, Fiol F, de Paz JA, Casas R, Olbeyra R, Martínez-González MA, García-Gavilán JF, Goday A, Fernandez-Lazaro CI, Martínez JA, Hu FB, Konieczna J. Longitudinal association of dietary carbohydrate quality with visceral fat deposition and other adiposity indicators. Clin Nutr 2022; 41:2264-2274. [PMID: 36084360 PMCID: PMC9529821 DOI: 10.1016/j.clnu.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND & AIMS The quality of dietary carbohydrates rather than total carbohydrate intake may determine the accumulation of visceral fat; however, to date, few studies have examined the impact of diet on adiposity using specific imaging techniques. Thus, the aim of this prospective study was to investigate the association between concurrent changes in carbohydrate quality index (CQI) and objectively-quantified adiposity distribution over a year. METHODS We analyzed a cohort of 1476 participants aged 55-75 years with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus randomized controlled trial. Dietary intake information was obtained at baseline, 6- and 12-months from a validated 143-item semi-quantitative food-frequency questionnaire, and CQI (range: 4 to 20) was calculated based on four dietary criteria: total dietary fibre, glycemic index, wholegrain/total grain carbohydrate ratio, and solid/total carbohydrate ratio. Overall and regional adiposity (total body fat, visceral fat and android-to-gynoid fat ratio) was quantified using dual-energy X-ray absorptiometry at all three time points. Multiple adjusted linear mixed-effects models were used to assess associations between concurrent changes in repeatedly measured CQI and adiposity over time. RESULTS After controlling for potential confounding factors, a 3-point increment in CQI over 12-month follow-up was associated with a decrease in visceral fat (β -0.067 z-score, 95% CI -0.088; -0.046, p < 0.001), android-to-gynoid fat ratio (-0.038, -0.059; -0.017, p < 0.001), and total fat (-0.064, -0.080; -0.047, p < 0.001). Fibre intake and the ratio of wholegrain/total grain showed the strongest inverse associations with all adiposity indicators. CONCLUSIONS In this prospective cohort of older adults with overweight/obesity and MetS, we found that improvements in dietary carbohydrate quality over a year were associated with concurrent favorable changes in visceral and overall fat deposition. These associations were mostly driven by dietary fibre and the wholegrain/total grain ratio. TRIAL REGISTRATION The trial was registered at the International Standard Randomized. CONTROLLED TRIAL: (ISRCTN: http://www.isrctn.com/ISRCTN89898870) with number 89898870 and registration date of 24 July 2014, retrospectively registered.
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Affiliation(s)
- Rocío Zamanillo-Campos
- Research Group on Preventive Activities and Promotion Illes Balears (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Primary Care Research Unit of Mallorca (IB-Salut), Palma de Mallorca, Spain
| | - Alice Chaplin
- Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), Palma de Mallorca, Spain; Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Dora Romaguera
- Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), Palma de Mallorca, Spain; Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Itziar Abete
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, Pamplona, University of Navarra, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Jordi Salas-Salvadó
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain; Institut d'Investigació Pere Virgili (IISPV), Reus, Spain
| | - Vicente Martín
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institute of Biomedicine (IBIOMED), University of León, León, Spain
| | - Ramón Estruch
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Josep Vidal
- CIBER Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; Department of Endocrinology, Institut d'Investigacions Biomédiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Miguel Ruiz-Canela
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain
| | - Nancy Babio
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain; Institut d'Investigació Pere Virgili (IISPV), Reus, Spain
| | - Francisca Fiol
- Atención Primaria Mallorca, Centro de Salud Son Serra de la Vileta, Palma de Mallorca, Spain
| | | | - Rosa Casas
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Romina Olbeyra
- Institut d'Investigacions Biomédiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Miguel A Martínez-González
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain
| | - Jesús F García-Gavilán
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain; Institut d'Investigació Pere Virgili (IISPV), Reus, Spain
| | - Albert Goday
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM), Department of Medicine, University of Barcelona, Barcelona, Spain; Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Cesar I Fernandez-Lazaro
- Department of Preventive Medicine and Public Health, IdiSNA, University of Navarra, Pamplona, Spain
| | - J Alfredo Martínez
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, Pamplona, University of Navarra, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Precision Nutrition and Cardiometabolic Health Program, IMDEA Food, CEI UAM + CSIC, Madrid, Spain
| | - Frank B Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jadwiga Konieczna
- Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), Palma de Mallorca, Spain; Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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9
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Jebraeili H, Shabbidar S, Sajjadpour Z, Aghdam SD, Qorbani M, Rajab A, Sotoudeh G. The association between carbohydrate quality index and anthropometry, blood glucose, lipid profile and blood pressure in people with type 1 diabetes mellitus: a cross-sectional study in Iran. J Diabetes Metab Disord 2021; 20:1349-1358. [PMID: 34900786 PMCID: PMC8630175 DOI: 10.1007/s40200-021-00864-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/20/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIM Both types and amounts of dietary carbohydrates have always been issues of discussion in diabetes mellitus. Therefore, this study aimed to investigate the association between carbohydrate quality index (CQI) and anthropometry, fasting blood glucose (FBG), lipid profile, systolic (SBP), and diastolic (DBP) blood pressure in adults with type 1 diabetes mellitus (T1DM). MATERIALS & METHODS This was a cross-sectional study conducted on 261 adults with T1DM aged 17-36 years who referred to the Iranian Diabetes Association or Diabetes Clinic of Tehran University of Medical Sciences. Dietary data were collected using a 147-item food frequency questionnaire (FFQ). The CQI was calculated from the three indices including dietary fiber, glycemic index (GI), and solid carbohydrates/total carbohydrates ratio. The weight, height, waist circumference, physical activity, HcA1c, SBP, DBP of all participants were measured. Biochemical assessment including serum lipids and FBG levels were analyzed on 81 individuals. RESULTS Participants with a higher CQI had a lower body weight, GI, glycemic load, energy, and macronutrient intake (p < 0.05). In addition, after adjustment for age, sex, duration of diabetes, body mass index, physical activity, and energy intake, the lowest level of glycated hemoglobin A1c (HbA1c) was observed in the third tertile of CQI (β = -0.2; SE = 0.1; p-trend = 0.04). No significant association was observed with respect to CQI with FBG, lipid profile, and blood pressure. CONCLUSION It was concluded that there was an inverse association between CQI and HbA1c. No significant association was found with respect to CQI with FBG, lipid profile and blood pressure.
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Affiliation(s)
- Haniyeh Jebraeili
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, No. 44, Hojjatdoost Alley, Naderi St. Keshavarz Blvd, P.O. Box: 1417653761, Tehran, Iran
| | - Sakineh Shabbidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, No. 44, Hojjatdoost Alley, Naderi St. Keshavarz Blvd, P.O. Box: 1417653761, Tehran, Iran
| | - Zahra Sajjadpour
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, No. 44, Hojjatdoost Alley, Naderi St. Keshavarz Blvd, P.O. Box: 1417653761, Tehran, Iran
| | - Saeideh Delshad Aghdam
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, No. 44, Hojjatdoost Alley, Naderi St. Keshavarz Blvd, P.O. Box: 1417653761, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Gity Sotoudeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, No. 44, Hojjatdoost Alley, Naderi St. Keshavarz Blvd, P.O. Box: 1417653761, Tehran, Iran
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10
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Muñoz-Cabrejas A, Laclaustra M, Guallar-Castillón P, Casasnovas JA, Jarauta E, Sandoval-Insausti H, Donat-Vargas C, Moreno-Franco B. High-quality intake of carbohydrates is associated with lower prevalence of subclinical atherosclerosis in femoral arteries: The AWHS study. Clin Nutr 2021; 40:3883-3889. [PMID: 34134004 DOI: 10.1016/j.clnu.2021.04.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/16/2021] [Accepted: 04/30/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS High-quality of the carbohydrates consumed, apart from their total amount, appear to protect from cardiovascular disease (CVD). However, the relationship between the quality of carbohydrates and the early appearance of atherosclerosis has not yet been described. Our objective was to estimate the association between the quality of dietary carbohydrates and subclinical atherosclerosis in femoral and carotid arteries. METHODS Cross-sectional study of femoral and carotid atherosclerosis assessed using ultrasounds of 2074 middle-aged males, 50.9 (SD 3.9) years old, with no previous CVD, and pertaining to the Aragon Workers' Health Study (AWHS) cohort. Food frequency questionnaires were used to calculate a carbohydrate quality index (CQI) defined as: consumption of dietary fiber, a lower glycemic index, the ratio of whole grains/total grains, and the ratio of solid carbohydrates/total carbohydrates. The presence of plaques across four CQI intervals was studied using adjusted logistic regression models. RESULTS The CQI showed a direct inverse association with subclinical atherosclerosis in femoral territories. Participants with a higher consumption of high-quality carbohydrates (13-15 points) were less likely to have femoral plaques when compared with participants in the lowest index interval (4-6 points) (OR = 0.59; 95% CI = 0.39, 0.89; p = 0.005). No association was found between the CQI and the presence of subclinical atherosclerosis in carotid territories. A lower consumption of high-quality carbohydrates tended to be associated with a greater atherosclerosis extension, considered as the odds for having more affected territories (p = 0.011). CONCLUSIONS Among middle-aged males, a high-quality intake of carbohydrates is associated with a lower prevalence of femoral artery subclinical atherosclerosis when compared with a lower consumption. Thus, indicating an early relationship between the quality of carbohydrates and the development of CVD.
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Affiliation(s)
| | - M Laclaustra
- Agencia Aragonesa para La Investigación y El Desarrollo, ARAID, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain; CIBERCV Instituto de Salud Carlos III. Madrid, Spain.
| | - P Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain; CIBERESP Instituto de Salud Carlos III, Madrid, Spain; IMDEA-Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - J A Casasnovas
- Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - E Jarauta
- Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - H Sandoval-Insausti
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - C Donat-Vargas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain; CIBERESP Instituto de Salud Carlos III, Madrid, Spain; Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - B Moreno-Franco
- Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain.
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11
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Suara SB, Siassi F, Saaka M, Rahimiforoushani A, Sotoudeh G. Relationship between dietary carbohydrate quality index and metabolic syndrome among type 2 diabetes mellitus subjects: a case-control study from Ghana. BMC Public Health 2021; 21:526. [PMID: 33731080 PMCID: PMC7968214 DOI: 10.1186/s12889-021-10593-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/08/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Dietary carbohydrate quality may play an important role in disease development. We evaluated the association between carbohydrate quality index (CQI) and the odds of metabolic syndrome (MetS) in type 2 diabetes mellitus (T2DM) subjects in Ghana. METHODS In this case-control study, we analyzed data using 124 T2DM subjects. We obtained dietary information using 2-day 24-h dietary recalls. We calculated CQI from dietary fiber, glycemic index, whole grains/total grains ratio, and solid carbohydrates/total carbohydrates ratio. Serum lipid profiles were measured after an overnight fast of 8-12 h. RESULTS Upon adjustments for the effects of covariates, the CQI showed a positive association with high-density lipoprotein cholesterol concentration (beta coefficient (β) = 0.24; standard error (SE) = 0.20; P for trend = 0.01), and an inverse relationship with waist circumference (β = - 17.29; SE = 4.00; P for trend < 0.001), systolic blood pressure (β = - 15.74; SE = 4.69; P for trend < 0.001), diastolic blood pressure (β = - 7.23; SE = 2.97; P for trend = 0.02), and triglyceride concentrations (β = - 0.43; SE = 0.11; P for trend < 0.001). Overall, the CQI had an inverse relationship with the odds of MetS (Odds ratio tertile 3 vs.1 0.05; 95% Confidence interval: 0.01-0.23; p-trend < 0.001). Also, a positive correlation was found between the CQI and fiber, but the CQI showed a negative relationship with dietary glycemic index. CONCLUSIONS The present results suggest an inverse association between the CQI of a diet and the odds of MetS. The CQI approach of dietary recommendation may be a useful strategy for dietary carbohydrate selection for the prevention of MetS.
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Affiliation(s)
- Sufyan Bakuri Suara
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, International Campus, Tehran University of Medical Sciences, Number 21 Dameshgh St. Vali-e Asr Ave., Tehran, 1416753955, Iran
| | - Fereydoun Siassi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Hojatdost street, Naderi street, Keshavarz Blv, Tehran, Iran.
| | - Mahama Saaka
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Post Office Box 1350, Tamale, Ghana
| | - Abbas Rahimiforoushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Gity Sotoudeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Hojatdost street, Naderi street, Keshavarz Blv, Tehran, Iran.
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12
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Fernandez-Lazaro CI, Zazpe I, Santiago S, Toledo E, Barbería-Latasa M, Martínez-González MÁ. Association of carbohydrate quality and all-cause mortality in the SUN Project: A prospective cohort study. Clin Nutr 2020; 40:2364-2372. [PMID: 33190989 DOI: 10.1016/j.clnu.2020.10.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/23/2020] [Accepted: 10/17/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND & AIMS Emerging evidence supports shifting the focus from carbohydrate quantity to carbohydrate quality to obtain greater health benefits. We investigated the association of carbohydrate quality with all-cause mortality using a single, multidimensional carbohydrate quality index (CQI) designed to account for multiple characteristics of carbohydrate quality. METHODS A prospective study was conducted among 19,083 participants in the Seguimiento Universidad de Navarra (SUN) Project, a Mediterranean cohort of middle-aged university graduates. The CQI was based on four dimensions: high total dietary fiber intake, low glycemic index, high whole-grain carbohydrate: total grain carbohydrate ratio, and high solid carbohydrate: total carbohydrate ratio. RESULTS During 12.2 years of median follow-up, 440 deaths were identified. We found an inverse association between the CQI and all-cause mortality. The multivariable-adjusted hazard ratio (HR) for the highest vs. the lowest tertile of the CQI was 0.70 (95% CI, 0.53-0.93; Ptrend = 0.018). However, each individual dimension of the CQI was not independently associated with lower mortality risk, with HR (95% CI) between extreme tertiles as follows: 0.77 (0.52-1.14; Ptrend = 0.192) for high fiber intake; 0.81 (0.59-1.12; Ptrend = 0.211) for low glycemic index; 0.87 (0.69-1.11; Ptrend = 0.272) for high whole-grain carbohydrate: total-grain carbohydrate ratio; and 0.81 (0.61-1.07; Ptrend = 0.139) for high solid carbohydrate: total carbohydrate ratio. Our analyses remained similar after using repeated measurements of diet with updated nutritional exposures after a ten-year follow-up. CONCLUSIONS The CQI as a whole, but none of its individual dimensions, was associated with lower mortality. The CQI seems to comprehensively capture the combined effects of quality domains.
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Affiliation(s)
- Cesar I Fernandez-Lazaro
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain
| | - Itziar Zazpe
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain; University of Navarra, Department of Nutrition and Food Sciences and Physiology, School of Pharmacy and Nutrition, 31008, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029, Madrid, Spain
| | - Susana Santiago
- IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain; University of Navarra, Department of Nutrition and Food Sciences and Physiology, School of Pharmacy and Nutrition, 31008, Pamplona, Spain
| | - Estefanía Toledo
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029, Madrid, Spain
| | - María Barbería-Latasa
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain
| | - Miguel Ángel Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029, Madrid, Spain; Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
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13
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Zazpe I, Santiago S, Gea A, Ruiz-Canela M, Carlos S, Bes-Rastrollo M, Martínez-González MA. Association between a dietary carbohydrate index and cardiovascular disease in the SUN (Seguimiento Universidad de Navarra) Project. Nutr Metab Cardiovasc Dis 2016; 26:1048-1056. [PMID: 27524801 DOI: 10.1016/j.numecd.2016.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/20/2016] [Accepted: 07/05/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Beyond the quantity of carbohydrate intake, further research is needed to know the relevance of carbohydrate quality following operational indices. No previous longitudinal study has assessed the association between an index for quality of dietary carbohydrate intake and the risk of cardiovascular disease (CVD). Here, we examined the association between a carbohydrate quality index (CQI) and the risk of CVD. METHODS AND RESULTS We used a validated semi-quantitative 136-item food-frequency questionnaire (FFQ) in a prospective follow-up study of 17,424 middle-aged adults from Spain. The CQI was defined by four criteria: dietary fiber intake, glycemic index, whole-grain/total-grain carbohydrate ratio, and solid/total carbohydrate ratio. We observed 129 incident cases of CVD during 10.1 y of median follow-up. An inverse association for CQI was found (hazard ratio = 0.44, 95% confidence interval (CI): 0.25-0.78 for the highest versus the lowest tertile, p for trend = 0.008). Participants in the highest tertile of the whole-grain/total-grain carbohydrate ratio had 47% lower risk of CVD (95% CI: 0.33-0.85, p for trend = 0.008). Participants with higher baseline CQI and higher baseline energy from carbohydrates had the lowest risk of CVD. CONCLUSION In this Mediterranean cohort, a better quality of dietary carbohydrates measured by the CQI, showed a significant inverse association with the incidence of CVD. Specially, a higher proportion of carbohydrates from whole grains was strongly inversely associated with CVD. "Heart-healthy" diets should be focused not only on carbohydrate quantity but also on a multidimensional assessment of the type and quality of carbohydrates.
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Affiliation(s)
- I Zazpe
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain; Department of Nutrition and Food Sciences and Physiology, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - S Santiago
- Department of Nutrition and Food Sciences and Physiology, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - A Gea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - M Ruiz-Canela
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - S Carlos
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - M Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - M A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
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