Carbohydrate quality and quantity and risk of type 2 diabetes in US women
Carbohydrate quality and quantity and risk of type 2 diabetes in US women
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DOI：
10.3945/ajcn.115.116558
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发表时间：
2015-12-01
影响因子：
7.1
通讯作者：
Hu, Frank B.
中科院分区：
文献类型：
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作者：
AlEssa, Hala B.;Bhupathiraju, Shilpa N.;Hu, Frank B.
背景：碳水化合物质量可能是2型糖尿病（T2D）的重要决定因素；然而，各种碳水化合物质量指标与T2D风险之间的关系尚未系统研究。目的：本研究的目的是前瞻性地研究碳水化合物、淀粉、纤维以及这些营养素的不同组合与女性患T2D风险之间的关系。设计：我们前瞻性地跟踪了护士健康研究（1984-2008）中70,025名无心血管疾病、癌症和糖尿病的女性。每隔4年使用一份经过验证的问卷收集饮食信息。使用Cox回归来评估与T2D事件的关联。结果：在1484213人年的随访中，我们确定了6934例T2D病例。在多变量分析中，当比较极端五分位数时，较高的碳水化合物摄入量与T2D无关（RR = 0.98; 95% CI: 0.89, 1.08； p趋势= 0.84），而淀粉与较高的风险相关（RR = 1.23; 95% CI: 1.12, 1.35； p趋势，0.0001）。总纤维（RR = 0.80; 95% CI: 0.72, 0.89; P-trend, 0.0001）、谷物纤维（RR = 0.71, 95% CI: 0.65, 0.78; P-trend, 0.0001）和水果纤维（RR = 0.79; 95% CI: 0.72, 0.85; P-trend, 0.0001）与较低的T2D风险相关。碳水化合物与总纤维摄入量的比例与T2D的高风险有轻微相关（RR = 1.09; 95% CI: 1.00, 1.20； p趋势= 0.04）。另一方面，我们发现碳水化合物与谷物纤维的比值（RR = 1.28, 95% CI: 1.17, 1.39， p趋势值为0.0001）、淀粉与总纤维的比值（RR = 1.12, 95% CI: 1.02, 1.23， p趋势值为0.03）、淀粉与谷物纤维的比值（RR = 1.39, 95% CI: 1.27, 1.53， p趋势值为0.0001）与T2D呈正相关。结论：高淀粉、低纤维和高淀粉/谷物纤维比例的饮食与T2D的高风险相关。膳食中淀粉与谷物纤维的比例可能是评估与T2D相关的碳水化合物质量的新指标。
Background: Carbohydrate quality may be an important determinant of type 2 diabetes (T2D); however, relations between various carbohydrate quality metrics and T2D risk have not been systematically investigated.Objective: The purpose of this study was to prospectively examine the association between carbohydrates, starch, fibers, and different combinations of these nutrients and risk of T2D in women.Design: We prospectively followed 70,025 women free of cardiovascular disease, cancer, and diabetes at baseline from the Nurses' Health Study (1984-2008). Diet information was collected with the use of a validated questionnaire every 4 y. Cox regression was used to evaluate associations with incident T2D.Results: During 1,484,213 person-years of follow-up, we ascertained 6934 incident T2D cases. In multivariable analyses, when extreme quintiles were compared, higher carbohydrate intake was not associated with T2D (RR = 0.98; 95% CI: 0.89, 1.08; P-trend = 0.84), whereas starch was associated with a higher risk (RR = 1.23; 95% CI: 1.12, 1.35; P-trend,0.0001). Total fiber (RR = 0.80; 95% CI: 0.72, 0.89; P-trend, 0.0001), cereal fiber (RR = 0.71, 95% CI: 0.65, 0.78; P-trend, 0.0001), and fruit fiber (RR = 0.79; 95% CI: 0.72, 0.85; P-trend, 0.0001) were associated with a lower T2D risk. The ratio of carbohydrate to total fiber intake was marginally associated with a higher risk of T2D (RR = 1.09; 95% CI: 1.00, 1.20; P-trend = 0.04). On the other hand, we found positive associations between the ratios of carbohydrate to cereal fiber (RR = 1.28; 95% CI: 1.17, 1.39; P-trend, 0.0001), starch to total fiber (RR = 1.12; 95% CI: 1.02, 1.23; P-trend = 0.03), and starch to cereal fiber (RR = 1.39; 95% CI: 1.27, 1.53; P-trend, 0.0001) and T2D.Conclusions: 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.