Search

It is unknown if fibre intake differs across diabetes status in USA adults and is associated with glycaemic outcomes. This cross-sectional analysis utilised National Health and Nutrition Examination Survey cycles 2013–2018 data to estimate usual total dietary fibre intake in USA adults and across diabetes status (no diabetes, prediabetes and type II diabetes (T2D)). Associations among dietary fibre intake and glycaemic outcomes were also reported across groups. Adults (≥ 19 years) with at least one dietary recall were included. Diabetes status was determined from self-report data and measured HbA1c. Independent samples t tests were used to compare mean (se) intake across sub-populations. 14 640 adults (51·3 % female) with 26·4 % and 17·4 % classified as having prediabetes and T2D, respectively. Adults with T2D reported greater mean (se) dietary fibre intake compared with no T2D for females (9·5 (0·13) v. 8·7 (0·11) g/1000 kcal/d and males (8·5 (0·12) v. 7·7 (0·11) g/1000 kcal/d; P < 0·01)). However, only 4·2 (0·50)% and 8·1 (0·90)% of males and females with T2D, respectively, met the adequate intake for fibre. Fibre intake was associated with lower insulin (β = −0·80, P < 0·01), serum glucose (β = −1·35, P < 0·01) and Homeostatic Model Assessment for Insulin Resistance (β = −0·22, P < 0·01) in adults without diabetes, and no relationships in adults with prediabetes or T2D were found. Although dietary fibre intake was highest among adults with T2D, intake was suboptimal across all groups. In adults without diabetes, dietary fibre intake was associated with improved glycaemic outcomes and insulin resistance; however, these associations were attenuated by anthropometric and lifestyle covariates. [ABSTRACT FROM AUTHOR]

Background: The quality of carbohydrate intake, as measured by the glycemic index (GI), has not been evaluated nationally over the past 2 decades in the United States., Objectives: We aimed to develop a comprehensive and nationally representative dietary GI and glycemic load (GL) database from 1999 to 2018 National Health and Nutrition Examination Survey (NHANES) and to examine GI and GL time trends and subpopulation differences., Methods: We used an artificial intelligence (AI)-enabled model to match GI values from 2 GI databases to food codes from United States Department of Agriculture, which were manually validated. We examined nationally representative distributions of dietary GI and GL from 1999 to 2018 using the multistage, clustered sampling design of NHANES., Results: Assigned GI values covered 99.9% of total carbohydrate intake. The initial AI accuracy was 75.0%, with 31.3% retained after manual curation guided by substantive domain expertise. A total of 7976 unique food codes were matched to GI values, of which soft drinks and white bread were top contributors to dietary GI and GL. Of the 49,205 NHANES adult participants, the mean dietary GI was 55.7 (95% confidence interval [CI]: 55.5, 55.8) and energy-adjusted dietary GL was 133.0 (95% CI: 132.3, 133.8). From 1999 to 2018, dietary GI and GL decreased by 4.6% and 13.8%, respectively. Dietary GL was higher among females (134.6; 95% CI: 133.8, 135.5) than among males (131.3; 95% CI: 130.3, 132.3), those with ≤high school degree (137.7; 95% CI: 136.8, 138.7) than among those with ≥college degree (126.5; 95% CI: 125.3, 127.7), and those living under the poverty level (140.9; 95% CI: 139.6, 142.1) than among those above the poverty level. Differences in race were observed (Black adults, 139.4; 95% CI: 138.2, 140.7; White adults, 131.6; 95% CI: 130.5, 132.6)., Conclusions: The national GI and GL database facilitates large-scale and high-quality surveillance or cohort studies of diet and health outcomes in the United States., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

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 Follow- Up 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. [ABSTRACT FROM AUTHOR]

Carbohydrate foods (≥40% energy from carbohydrates) are the main source of energy in the US diet. In contrast to national-level dietary guidance, many regularly consumed carbohydrate foods are low in fiber and whole grains but high in added sugar, sodium, and/or saturated fat. Given the important contribution of higher-quality carbohydrate foods to affordable healthy diets, new metrics are needed to convey the concept of carbohydrate quality to policymakers, food industry stakeholders, health professionals, and consumers. The recently developed Carbohydrate Food Quality Scoring System is well aligned with multiple key healthy messages on nutrients of public health concern from the 2020-2025 Dietary Guidelines for Americans. Two models are described in a previously published paper: one for all non-grain carbohydrate-rich foods (e.g., fruits, vegetables, legumes) known as the Carbohydrate Food Quality Score-4 (CFQS-4), and one for grain foods only known as the Carbohydrate Food Quality Score-5 (CFQS-5). These CFQS models provide a new tool that can guide policy, programs, and people towards improved carbohydrate food choices. Specifically, the CFQS models represent a way to unify and reconcile diverse ways to describe different types of carbohydrate-rich foods (e.g., refined vs. whole, starchy vs. non-starchy, dark green vs. red/orange) and make for more useful and informative messaging that better aligns with a food's nutritional and/or health contributions. The present paper's aims are to show that the CFQS models can inform future dietary guidelines and help support carbohydrate food recommendations with other health messages aimed at promoting foods that are nutrient-dense, fiber-rich, and low in added sugar.

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. [ABSTRACT FROM AUTHOR]