Abstract
The long-term impact of carbohydrate quality on abdominal weight gain is not fully understood. We aimed to examine the prospective relation of a carbohydrate quality index (CQI; defined by four criteria: dietary fiber, glycemic index, whole grain-to-total grain ratio, and solid-to-total carbohydrate ratio), total, cereal grain, vegetable, and fruit fiber, carbohydrate-to-total fiber ratio, and carbohydrate-to-cereal fiber ratio with changes in waist circumference (WC). Subjects were middle-aged to older, mostly white, participants in the Framingham Offspring cohort (n = 3101 subjects), with mean baseline age 54.9 ± 0.2 years (mean ± SE) and body mass index (BMI) 27.2 ± 0.1 kg/m2. Food frequency questionnaire (FFQ), health, and lifestyle data were collected approximately every four years over a median total follow-up of 18 years. Repeated measure mixed models were used to estimate adjusted mean change in WC per four-year interval across quartiles of carbohydrate variables. In the most adjusted model, a higher CQI was marginally associated with a smaller increase in WC (2.0 ± 0.1 vs. 2.4 ± 0.1 cm in highest vs. lowest quartile, p-trend = 0.04). Higher ratios of carbohydrate-to-fiber and carbohydrate-to-cereal fiber were associated with greater increases in WC per four-year interval (2.6 ± 0.1 vs. 2.0 ± 0.1 cm, p-trend < 0.001, and 2.5 ± 0.1 vs. 2.1 ± 0.1 cm in highest versus lowest categories, p-trend = 0.007, respectively); whereas higher intake of total fiber (1.8 ± 0.1 vs. 2.7 ± 0.1 cm, p-trend < 0.001), cereal fiber (2.0 ± 0.1 vs. 2.5 ± 0.1 cm, p-trend = 0.001), and fruit fiber (2.0 ± 0.1 vs. 2.7 ± 0.1 cm, p-trend < 0.001) were associated with smaller increases in WC compared to lower intakes. There was a significant interaction between total fiber and total carbohydrate (as % of total energy intake). After stratification, the association between fiber intake and change in WC was not maintained in the context of a high carbohydrate diet. Better carbohydrate quality, primarily higher fiber intake and lower carbohydrate-to-fiber ratios, may help attenuate increases in abdominal adiposity over time.
Highlights
Over the past few decades, the prevalence of abdominal obesity, primarily measured by waist circumference (WC), has increased in adults [1,2]
Dietary fiber intake at baseline was 18.2 ± 8.0 g/day, of which cereal fiber was the top contributor (29.1% of total fiber), followed by vegetable fiber (24.2%) and fruit fiber (18.6%). Those in the highest quartile of carbohydrate quality index (CQI) were less likely to be smokers, tended to have the highest total energy, total fiber, whole grain and vegetable intakes, and lowest refined grain and sugar-sweetened beverages (SSBs) intakes
The average four-year change in WC was an increase of 2.7 ± 6.3 cm but ranged from a decrease of 24.3 cm to an increase of 29.6 cm
Summary
Over the past few decades, the prevalence of abdominal obesity, primarily measured by waist circumference (WC), has increased in adults [1,2]. Abdominal obesity is expected to continue increasing at a rate greater than overall obesity (measured by BMI) alone [3,4]. The relation between abdominal obesity and these diseases may be mediated through increased inflammation, dyslipidemia, and insulin resistance [5,13,14,15]. Lifestyle behaviors, such as poor diet and physical inactivity, are major modifiable factors contributing to excess body weight gain [16]. To be resolved is the contribution of dietary carbohydrate quality to the development of adiposity, abdominal adiposity
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