Highlights
- •CQI sums fiber, GI, whole-grain: total carbohydrates and solid: total carbohydrates.
- •There is not specific and disambiguous measure of carbohydrate quality.
- •Better CQI showed a significant inverse association with CVD incidence.
- •More than 50% of energy from carbohydrates and highest CQI showed a lower risk of CVD.
- •“Heart-healthy” diet should be focused on type and quality of carbohydrates.
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.
Keywords
Abbreviations:
BMI (body mass index), CI (confidence interval), CQI (carbohydrate quality index), CVD (cardiovascular disease), FFQ (food frequency questionnaire), HR (hazard ratio), MET (metabolic equivalent score), MUFA (monounsaturated fatty acids), PUFA (polyunsaturated fatty acids), Q_O (baseline assessment), SD (standard deviation), SFA (saturated fatty acids), SUN (Seguimiento Universidad de Navarra. Follow-up University of Navarra), TFA (trans fatty acids)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 11, 2016
Accepted:
July 5,
2016
Received in revised form:
June 20,
2016
Received:
April 22,
2016
Identification
Copyright
© 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
