Highlights
- •Of 9689 middle-aged Australian women, 10% developed type 2 diabetes over 15 years.
- •Carbohydrate restriction was associated with a 27% higher risk of type 2 diabetes.
- •This association was attenuated after adjustment for BMI.
- •The association was comparable for women with and without prior gestational diabetes.
- •Women should be advised to avoid carbohydrate restricted diets low in fruit and grains.
Abstract
Background and aims
Low-carbohydrate diets (LCDs) are increasingly popular but may be nutritionally inadequate.
We aimed to examine if carbohydrate restriction in midlife is associated with risk
of developing type 2 diabetes (T2DM), and if this association differs by previous
gestational diabetes (GDM) diagnosis.
Methods and results
Dietary intake was assessed for 9689 women from the Australian Longitudinal Study
on Women's Health in 2001 (aged 50–55) and 2013 (aged 62–67) via validated food frequency
questionnaires. Average long-term carbohydrate restriction was assessed using a low-carbohydrate
diet score (highest quartile (Q4) indicating lowest proportion of energy from carbohydrates).
Incidence of T2DM between 2001 and 2016 was self-reported at 3-yearly surveys. Log-binomial
regression was used to estimate relative risks (RR) and 95% CIs. During 15 years of
follow-up, 959 women (9.9%) developed T2DM. Carbohydrate restriction was associated
with T2DM after adjustment for sociodemographic factors, history of GDM diagnosis
and physical activity (Q4 vs Q1: RR 1.27 [95% CI 1.10, 1.48]), and this was attenuated
when additionally adjusted for BMI (1.10 [0.95, 1.27]). Carbohydrate restriction was
associated with lower consumption of fruit, cereals and high-fibre bread, and lower
intakes of these food groups were associated with higher T2DM risk. Associations did
not differ by history of GDM (P for interaction >0.15).
Conclusion
Carbohydrate restriction was associated with higher T2DM incidence in middle-aged
women, regardless of GDM history. Health professionals should advise women to avoid
LCDs that are low in fruit and grains, and to consume a diet in line with current
dietary recommendations.
Keywords
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Article info
Publication history
Published online: November 15, 2019
Accepted:
November 1,
2019
Received in revised form:
October 16,
2019
Received:
July 19,
2019
Handling Editor: A. SianiIdentification
Copyright
© 2019 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.
