Cesar I Fernandez-Lazaro1, Itziar Zazpe2, Susana Santiago3, Estefanía Toledo4, María Barbería-Latasa5, Miguel Ángel Martínez-González6. 1. University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain. 2. University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain; University of Navarra, Department of Nutrition and Food Sciences and Physiology, School of Pharmacy and Nutrition, 31008, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029, Madrid, Spain. 3. IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain; University of Navarra, Department of Nutrition and Food Sciences and Physiology, School of Pharmacy and Nutrition, 31008, Pamplona, Spain. 4. University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029, Madrid, Spain. 5. University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain. 6. University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029, Madrid, Spain; Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. Electronic address: mamartinez@unav.es.
Abstract
BACKGROUND & AIMS: Emerging evidence supports shifting the focus from carbohydrate quantity to carbohydrate quality to obtain greater health benefits. We investigated the association of carbohydrate quality with all-cause mortality using a single, multidimensional carbohydrate quality index (CQI) designed to account for multiple characteristics of carbohydrate quality. METHODS: A prospective study was conducted among 19,083 participants in the Seguimiento Universidad de Navarra (SUN) Project, a Mediterranean cohort of middle-aged university graduates. The CQI was based on four dimensions: high total dietary fiber intake, low glycemic index, high whole-grain carbohydrate: total grain carbohydrate ratio, and high solid carbohydrate: total carbohydrate ratio. RESULTS: During 12.2 years of median follow-up, 440 deaths were identified. We found an inverse association between the CQI and all-cause mortality. The multivariable-adjusted hazard ratio (HR) for the highest vs. the lowest tertile of the CQI was 0.70 (95% CI, 0.53-0.93; Ptrend = 0.018). However, each individual dimension of the CQI was not independently associated with lower mortality risk, with HR (95% CI) between extreme tertiles as follows: 0.77 (0.52-1.14; Ptrend = 0.192) for high fiber intake; 0.81 (0.59-1.12; Ptrend = 0.211) for low glycemic index; 0.87 (0.69-1.11; Ptrend = 0.272) for high whole-grain carbohydrate: total-grain carbohydrate ratio; and 0.81 (0.61-1.07; Ptrend = 0.139) for high solid carbohydrate: total carbohydrate ratio. Our analyses remained similar after using repeated measurements of diet with updated nutritional exposures after a ten-year follow-up. CONCLUSIONS: The CQI as a whole, but none of its individual dimensions, was associated with lower mortality. The CQI seems to comprehensively capture the combined effects of quality domains.
BACKGROUND & AIMS: Emerging evidence supports shifting the focus from carbohydrate quantity to carbohydrate quality to obtain greater health benefits. We investigated the association of carbohydrate quality with all-cause mortality using a single, multidimensional carbohydrate quality index (CQI) designed to account for multiple characteristics of carbohydrate quality. METHODS: A prospective study was conducted among 19,083 participants in the Seguimiento Universidad de Navarra (SUN) Project, a Mediterranean cohort of middle-aged university graduates. The CQI was based on four dimensions: high total dietary fiber intake, low glycemic index, high whole-grain carbohydrate: total grain carbohydrate ratio, and high solid carbohydrate: total carbohydrate ratio. RESULTS: During 12.2 years of median follow-up, 440 deaths were identified. We found an inverse association between the CQI and all-cause mortality. The multivariable-adjusted hazard ratio (HR) for the highest vs. the lowest tertile of the CQI was 0.70 (95% CI, 0.53-0.93; Ptrend = 0.018). However, each individual dimension of the CQI was not independently associated with lower mortality risk, with HR (95% CI) between extreme tertiles as follows: 0.77 (0.52-1.14; Ptrend = 0.192) for high fiber intake; 0.81 (0.59-1.12; Ptrend = 0.211) for low glycemic index; 0.87 (0.69-1.11; Ptrend = 0.272) for high whole-grain carbohydrate: total-grain carbohydrate ratio; and 0.81 (0.61-1.07; Ptrend = 0.139) for high solid carbohydrate: total carbohydrate ratio. Our analyses remained similar after using repeated measurements of diet with updated nutritional exposures after a ten-year follow-up. CONCLUSIONS: The CQI as a whole, but none of its individual dimensions, was associated with lower mortality. The CQI seems to comprehensively capture the combined effects of quality domains.
Authors: Rocío Zamanillo-Campos; Alice Chaplin; Dora Romaguera; Itziar Abete; Jordi Salas-Salvadó; Vicente Martín; Ramón Estruch; Josep Vidal; Miguel Ruiz-Canela; Nancy Babio; Francisca Fiol; José Antonio de Paz; Rosa Casas; Romina Olbeyra; Miguel A Martínez-González; Jesús F García-Gavilán; Albert Goday; Cesar I Fernandez-Lazaro; J Alfredo Martínez; Frank B Hu; Jadwiga Konieczna Journal: Clin Nutr Date: 2022-08-20 Impact factor: 7.643
Authors: Susana Santiago; Itziar Zazpe; Cesar I Fernandez-Lazaro; Víctor de la O; Maira Bes-Rastrollo; Miguel Ángel Martínez-González Journal: Nutrients Date: 2021-03-17 Impact factor: 5.717