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

Background: The carbohydrate-to-fiber ratio is a recommended measure of carbohydrate quality; however, its relation to incident coronary heart disease (CHD) is not currently known. Objective: We aimed to assess the relation between various measures of carbohydrate quality and incident CHD. Design: D... Full description

Journal Title: The American Journal of Clinical Nutrition 2018, Vol. 107(2), pp.257-267
Main Author: Alessa, Hala B
Other Authors: Cohen, Randy , Malik, Vasanti S , Adebamowo, Sally N , Rimm, Eric B , Manson, Joann E , Willett, Walter C , Hu, Frank B
Format: Electronic Article Electronic Article
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ID: ISSN: 0002-9165 ; E-ISSN: 1938-3207 ; DOI: 10.1093/ajcn/nqx060
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recordid: oxford10.1093/ajcn/nqx060
title: Carbohydrate quality and quantity and risk of coronary heart disease among US women and men
format: Article
creator:
  • Alessa, Hala B
  • Cohen, Randy
  • Malik, Vasanti S
  • Adebamowo, Sally N
  • Rimm, Eric B
  • Manson, Joann E
  • Willett, Walter C
  • Hu, Frank B
subjects:
  • Carbohydrates
  • Carbohydrate Quality
  • Diet Quality
  • Whole Grains
  • Type 2 Diabetes
  • Starch
  • Fiber
ispartof: The American Journal of Clinical Nutrition, 2018, Vol. 107(2), pp.257-267
description: Background: The carbohydrate-to-fiber ratio is a recommended measure of carbohydrate quality; however, its relation to incident coronary heart disease (CHD) is not currently known. Objective: We aimed to assess the relation between various measures of carbohydrate quality and incident CHD. Design: Data on diet and lifestyle behaviors were prospectively collected on 75,020 women and 42,865 men participating in the Nurses' Health Study (NHS) and the Health Professionals FollowUp Study (HPFS) starting in 1984 and 1986, respectively, and every 2-4 y thereafter until 2012. All participants were free of known diabetes mellitus, cancer, or cardiovascular disease at baseline. Cox proportional hazards regression models were used to assess the relation between dietary measures of carbohydrate quality and incident CHD. Results: After 1,905,047 (NHS) and 921,975 (HPFS) person-years of follow-up, we identified 7,320 cases of incident CHD. In models adjusted for age, lifestyle behaviors, and dietary variables, the highest quintile of carbohydrate intake was not associated with incident CHD (pooled-RR = 1.04; 95% CI: 0.96, 1.14; P-trend = 0.31). Total fiber intake was not associated with risk of CHD (pooled-RR = 0.94; 95% CI: 0.85, 1.03; P-trend = 0.72), while cereal fiber was associated with a lower risk for incident CHD (pooled-RR = 0.80; 95% CI: 0.74, 0.87; P-trend < 0.0001). In fully adjusted models, the carbohydrate-to-total fiber ratio was not associated with incident CHD (pooled-RR = 1.04; 95% CI: 0.96. 1.13; P-trend = 0.46). However, the carbohydrate-to-cereal fiber ratio and the starch-to--cereal fiber ratio were associated with an increased risk for incident CHD (pooled-RR = 1.20; 95% CI: 1.11, 1.29; P-trend < 0.0001, and pooled-RR = 1.17; 95%CI: 1.09, 1.27; P-trend < 0.0001, respectively). Conclusion: 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-tofiber 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. Am J Clin Nutr 2018;107:257-267. Keywords: carbohydrates, carbohydrate quality, diet quality, whole grains, type 2 diabetes, starch, fiber doi: https://doi.org/10.1093/ajcn/nqx060
language:
source:
identifier: ISSN: 0002-9165 ; E-ISSN: 1938-3207 ; DOI: 10.1093/ajcn/nqx060
fulltext: fulltext
issn:
  • 0002-9165
  • 00029165
  • 1938-3207
  • 19383207
url: Link


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titleCarbohydrate quality and quantity and risk of coronary heart disease among US women and men
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descriptionBackground: The carbohydrate-to-fiber ratio is a recommended measure of carbohydrate quality; however, its relation to incident coronary heart disease (CHD) is not currently known. Objective: We aimed to assess the relation between various measures of carbohydrate quality and incident CHD. Design: Data on diet and lifestyle behaviors were prospectively collected on 75,020 women and 42,865 men participating in the Nurses' Health Study (NHS) and the Health Professionals FollowUp Study (HPFS) starting in 1984 and 1986, respectively, and every 2-4 y thereafter until 2012. All participants were free of known diabetes mellitus, cancer, or cardiovascular disease at baseline. Cox proportional hazards regression models were used to assess the relation between dietary measures of carbohydrate quality and incident CHD. Results: After 1,905,047 (NHS) and 921,975 (HPFS) person-years of follow-up, we identified 7,320 cases of incident CHD. In models adjusted for age, lifestyle behaviors, and dietary variables, the highest quintile of carbohydrate intake was not associated with incident CHD (pooled-RR = 1.04; 95% CI: 0.96, 1.14; P-trend = 0.31). Total fiber intake was not associated with risk of CHD (pooled-RR = 0.94; 95% CI: 0.85, 1.03; P-trend = 0.72), while cereal fiber was associated with a lower risk for incident CHD (pooled-RR = 0.80; 95% CI: 0.74, 0.87; P-trend < 0.0001). In fully adjusted models, the carbohydrate-to-total fiber ratio was not associated with incident CHD (pooled-RR = 1.04; 95% CI: 0.96. 1.13; P-trend = 0.46). However, the carbohydrate-to-cereal fiber ratio and the starch-to--cereal fiber ratio were associated with an increased risk for incident CHD (pooled-RR = 1.20; 95% CI: 1.11, 1.29; P-trend < 0.0001, and pooled-RR = 1.17; 95%CI: 1.09, 1.27; P-trend < 0.0001, respectively). Conclusion: 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-tofiber 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. Am J Clin Nutr 2018;107:257-267. Keywords: carbohydrates, carbohydrate quality, diet quality, whole grains, type 2 diabetes, starch, fiber doi: https://doi.org/10.1093/ajcn/nqx060
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