Dietary Carbohydrate Quality Research Articles

Association between a dietary carbohydrate index and cardiovascular disease in the SUN (Seguimiento Universidad de Navarra) Project

Background and aimsBeyond 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 resultsWe 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. ConclusionIn 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.

Dietary Approaches to Prevent Age Related Macular Degeneration:A Review

Age Related Macular Degeneration (ARMD) is the leading cause of irreversible blindness in older adults which has no cure and limited therapeutic options. ARMD may become an increasing concern in the developing countries like India as a result of socio-economic and dietary changes that accompany the economic development1. Diet is potentially one of the most cost effective strategies to prevent the development of end stage condition of ARMD. This review describes the current literature on the role of quality of diet and nutritional supplementation in prevention of advanced ARMD. Various researchers have explored the association between diet, nutrient intake and advanced ARMD. In the Age Related Eye Disease Study (AREDS), use of a daily antioxidant supplementation reduced the rate of progression from intermediate to advanced ARMD by 25% over a period of 5 years and resulted in a 19% reduction in the risk of moderate visual loss<sup>2</sup>. A high dietary fat intake was reported to be associated with a higher incidence of late ARMD whereas higher intakes of fish or n-3 fatty acids were associated with lower incidence of ARMD<sup>3</sup>. Chiu et al. reported that quality of dietary carbohydrates influences the risk of ARMD<sup>4</sup>. But at present, research shows insufficient evidence to recommend dietary modifications and nutritional supplementation in ARMD. Therefore to summarize, the temporal relationship of the diet to advanced ARMD, is a function of the quality of diet. Observational studies suggest that increased dietary intake of omega-3 fatty acids, macular carotenoids, antioxidants and oriental dietary pattern reduces the risk of ARMD whereas, poor dietary carbohydrates quality (as defined by dietary glycemic index) and western dietary pattern may increase the risk of ARMD.

Abstract P317: Dietary Carbohydrate Quantity and Quality Measures and Risk of Stroke

Background: Dietary carbohydrates with high glycemic index and low in cereal fiber have been associated with increased risk of diabetes, a risk factor for stroke. Few prospective studies have examined the relation between measures of carbohydrate quality and risk of incident stroke. The relation between carbohydrate to fiber ratio and stroke risk remains unknown. Methods: We prospectively examined the associations of dietary carbohydrate quantity and quality measures (total carbohydrate, fiber [total, cereal, fruit and vegetable], glycemic index and load, and carbohydrate/fiber ratio) and risk of incident stroke among 40,689 men in the Health Professionals Follow-up Study, aged 40 to 75 years and free of diagnosed cardiovascular disease and cancer at baseline in 1986. Diet was collected using a validated questionnaire every 4 years. We calculated the hazard ratio of total, ischemic, and hemorrhagic strokes by quintiles of energy-adjusted intake of dietary variables using multivariate Cox proportional hazard models. Multivariate models were adjusted for age, lifestyle (BMI, smoking, alcohol, physical activity, multivitamins and aspirin use), history of diseases (family history of CHD, baseline history of hypertension, diabetes and hypercholesterolemia) and diet (total energy, red meat, magnesium, polyunsaturated fat to saturated fat ratio and trans fat). Results: During 24 years of follow-up, 1,530 total stroke events (including 847 ischemic, 178 hemorrhagic and 505 unspecified types) were documented. In multivariate analyses adjusted for age, lifestyle risk factors, history of diseases and total energy intake, carbohydrate (RR=0.74, 95% CI: 0.61 - 0.91, Ptrend 0.008), cereal fiber (RR=0.77, 95% CI: 0.64 - 0.93, Ptrend 0.003) and glycemic load (RR=0.78, 95% CI: 0.64 - 0.95, Ptrend 0.03) were associated with reduced risk of total stroke, comparing the extreme quintiles. With further adjustment for dietary variables, these associations were attenuated to non-significant levels, carbohydrate (RR=0.84, 95% CI: 0.67 - 1.05, Ptrend 0.20), cereal fiber (RR=0.91, 95% CI: 0.73 - 1.14, Ptrend 0.40) and glycemic load (RR=0.84, 95% CI: 0.68 - 1.05, Ptrend 0.26). Vegetable, fruit and total fiber, glycemic index and carbohydrate to fiber ratio were also not significantly associated with incident stroke risk. The results for total stroke were relatively similar to those for ischemic and hemorrhagic stroke types. Conclusions: Consumption of high quality carbohydrate foods did not appear to confer protection against incident stroke risk among this population of US men.

Dietary carbohydrate quantity and quality in relation to obesity: A pooled analysis of three Finnish population-based studies.

The relationship between carbohydrate intake, dietary glycaemic index (GI) and load (GL), and obesity remains unsolved. Sugar intake and obesity represent a timely topic, but studies on sugar subcategories are scarce. We aimed to study whether total carbohydrate, sucrose, lactose, fibre, dietary GI, and GL are associated with obesity in 25-79-year-old Finns. Our pooled analysis included three cross-sectional population-based studies: the DILGOM Study (n = 4842), the Helsinki Birth Cohort Study (n =1979), and the Health 2000 Survey (n = 5521). Diet was assessed by a validated food-frequency questionnaire, and anthropometric measurements were collected by standardised protocols. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression analysis. In the model, which included sex, age, education, smoking, physical activity, and energy intake, the likelihood of being obese (body mass index ⩾ 30 kg/m(2)) appeared lower in the highest quartiles of total carbohydrate (OR 0.65; 95% CI 0.57-0.74; P for trend < 0.0001), sucrose (OR 0.53; 95% CI 0.47-0.61; P < 0.0001), and dietary GL (OR 0.64; 95% CI 0.56-0.73; P < 0.0001) compared to the lowest quartiles. In contrast, dietary GI did not associate with obesity. Fibre intake associated inversely with abdominal obesity (OR 0.80; 95% CI 0.71-0.90; P < 0.001). The inverse sucrose-obesity relationship appeared stronger in high fruit consumers compared to low fruit consumers (P for interaction 0.02). CONCLUSIONS ALTHOUGH MOST OF THE STUDIED CARBOHYDRATE EXPOSURES WERE ASSOCIATED WITH A DIMINISHED LIKELIHOOD OF BEING OBESE, PROSPECTIVE STUDIES ARE NEEDED TO ASSESS TEMPORAL RELATIONS TO SUPPORT CAUSAL INFERENCE.

Adolescent and Early Adulthood Dietary Carbohydrate Quantity and Quality in Relation to Breast Cancer Risk.

We investigated quantity and quality of dietary carbohydrate as well as insulin load and insulin index during adolescence and also early adulthood in relation to risk of breast cancer in the Nurses' Health Study II. During 20 years of follow-up of 90,534 premenopausal women who completed a diet questionnaire in 1991, 2,833 invasive breast cancer cases were documented. In 1998, 44,263 of these women also completed a questionnaire about their diet during high school; among these women, we documented 1,118 cases of breast cancer. Multivariable-adjusted Cox proportional hazards regression was used to model relative risks (RR) and 95% confidence intervals (95% CI) for breast cancer across categories of dietary carbohydrate, glycemic index (GI), glycemic load (GL), as well as insulin load and insulin index scores. Adolescent or early adult intakes of GI or GL were not associated with risk of breast cancer. Comparing women in the highest versus lowest quintile, the multivariable-adjusted RRs were 1.14 (0.95-1.38) for adolescent GI scores and 1.03 (0.91-1.16) for early adulthood GI scores. We also did not observe associations with insulin index and insulin load scores in adolescence or early adulthood and breast cancer risk. We found that diets high in GI, GL, insulin index, and insulin load during adolescence or early adulthood were not associated with an increased risk of breast cancer in this cohort study. Diets with a high glucose or insulin response in adolescence or early adulthood were not significant predictors of breast cancer incidence.

Dietary Carbohydrate Intake Does Not Impact Insulin Resistance or Androgens in Healthy, Eumenorrheic Women.

Diet is proposed to contribute to androgen-related reproductive dysfunction. This study evaluated the association between dietary macronutrient intake, carbohydrate fraction intake, and overall diet quality on androgens and related hormones, including anti-Müllerian hormone (AMH) and insulin, in healthy, regularly menstruating women. This was a prospective cohort study from 2005 and 2007. The study was conducted at the University at Buffalo, western New York State, USA. Participants were 259 eumenorrheic women without a self-reported history of infertility, polycystic ovary syndrome (PCOS), or other endocrine disorder. A 24-hour dietary recall was administered 4 times per menstrual cycle, and hormones were measured 5 to 8 times per cycle for 1 (n = 9) or 2 (n = 250) cycles per woman (n = 509 cycles). Associations between the dietary intake of carbohydrates (starch, sugar, sucrose, and fiber), macronutrients, overall diet quality and hormones (insulin, AMH, and total and free testosterone), as well as the relationship of dietary intake with occurrences of high total testosterone combined with high AMH (fourth quartile of each), ie, the "PCOS-like phenotype," were assessed. No significant relationships were identified between dietary intake of carbohydrates, percent calories from any macronutrient or overall diet quality (ie, Mediterranean diet score) and relevant hormones (insulin, AMH, and total and free testosterone). Likewise, no significant relationships were identified between dietary factors and the occurrence of a subclinical PCOS-like phenotype. Despite evidence of a subclinical continuum of a PCOS-related phenotype of elevated androgens and AMH related to sporadic anovulation identified in previous studies, dietary carbohydrate and diet quality do not appear to relate to these subclinical endocrine characteristics in women without overt PCOS.

Associations of Dietary Carbohydrate Quality (CQ) with Daily Interstitial Glucose Patterns in Community‐Dwelling Individuals: a Pilot Study

BackgroundIn controlled feeding studies, daily glucose patterns assessed by continuous glucose monitoring (CGM) reflect overall dietary carbohydrate quality (CQ) and the pattern of carbohydrate intake. However, few studies in non‐diabetic, community‐dwelling individuals exist. The purpose of this study was to determine associations of dietary variables reflecting CQ with interstitial glucose patterns in community‐dwelling, non‐diabetic individuals consuming self‐selected diets. The study is ongoing and results from the first 5 participants who completed measurements at Purdue University are reported here.MethodsHealthy, non‐smoking adults (1 M/ 4 F; aged 33.2±10.9 y; BMI 25.6±4 kg/m2 (mean±SD)) wore a CGM (iPro2, Medtronic) for 24h and performed a multiple pass 24h dietary recall for the same day. Glucose peak (PK) and total area under the curve (AUC) were determined, and macronutrients, fiber (total, soluble and insoluble), glycemic index (GI) and glycemic load (GL) were calculated with Nutrition Data System for Research software version 2011.ResultsSoluble fiber (but not total or insoluble fiber) was inversely associated with glucose AUC (r= ‐0.82; p=0.086) and PK (r= ‐0.97; p=0.005), while GI and GL were positively associated with glucose AUC (r=0.80‐0.82; p=0.098‐0.086) and PK (r=.87‐88; p=0.057‐0.048). GL was not associated with glucose PK after controlling for energy intake (r=0.84; p=0.157), but soluble fiber remained associated with glucose PK after controlling for GI (r=‐0.95; p=0.048).ConclusionInterstitial glucose patterns assessed by CGM may reflect self‐selected dietary CQ.

Diet, the Gut Microbiome and Cardio‐Metabolic Risk

The gut microbiome has been implicated as a potential mediator of diet‐related effects on cardio‐metabolic risk. There is evidence to suggest that diet can alter human physiology and disease risk by influencing the composition and activity of the gut microbiota, via mechanisms that may include the production of short chain fatty acids, bile acid deconjugation and polyphenol metabolism. There is substantial variation in the microbiota, with greater variation in fecal bacterial composition between individuals than within an individual, a finding that might underlie variance in the expression of risk factors for chronic diseases.This presentation will examine evidence that dietary modification of cardio‐metabolic risk is mediated, in part, through the gut microbiome. It will address the impact of dietary fatty acids, carbohydrates, prebiotics in novel functional foods, and increased consumption of fruits and vegetables on the gut microbiome and metabolic risk in randomized controlled trials (RCT).The ‘RISCK’ study was a multi‐centred RCT which was designed to evaluated the impact of the amount and quality of dietary fat and carbohydrate on cardio‐metabolic risk in a population at risk of metabolic syndrome. Low fat, high carbohydrate diets increased fecal Bifidobacterium, and reduce fasting glucose and cholesterol. Diets containing high glycaemic index carbohydrates also increased fecal Bacteroides, while high carbohydrate low glycaemic index diets increased Faecalibacterium prausnitzii. In other studies, a high intake of fermentable fibre and plant polyphenols were shown to regulate microbial activities within the gut. In conclusion, these findings provide further evidence for the impact of diet on the gut microbiome, the significance of these effects on cardio‐metabolic risk remain to be confirmed.

Frequency of eating away-from-home and quality of dietary carbohydrate and fat intake in the SUN Project

To investigate the association between eating- away-from-home (EAFH) and a) the quality of dietary carbohydrate intake and b) the quality of fat intake. We assessed 19,371 participants in the SUN cohort who completed a validated baseline food frequency questionnaire. Quality indices of carbohydrate (CQI) and fat (FQI) were used. Multiple regression models were fitted to determine the association between the frequency of EAFH (4 categories) and both indices. Logistic regression analysis was used to assess the association between the frequency of EAFH and low CQI or FQI ((<25th percentile). Participants showed an average CQI and FQI of 11,3 (SD 3,2) and 1,7 (SD 0,5), respectively. A higher frequency of EAFH (≥ 2 times/week) was associated with a poorer CQI and a poorer FQI. For CQI, the adjusted mean difference was -0,29, 95%CI: -0,41, -0,17 (p for trend <0,001), and for FQI it was -0,02, 95%CI: -0,03, -0,001 (p for trend 0,03). Participants with a highest frequency (≥ 2 times/week) of EAFH had higher adjusted risk of a poorer CQI, (adjusted OR 1,31, 95%CI 1,17, 1,46, p for trend <0,001), but this habit (EAFH) was unrelated to FQI (adjusted OR 0,93, 95%CI: 0,83, 1,03, p for trend 0,194). A higher frequency of EAFH was associated with a poorer quality of dietary fat, and particularly, dietary carbohohydrate. These findings highlight the importance of nutritional education addressed to consumers who frequently do out-of-home meals.

Diet, lifestyle, and genetic risk factors for type 2 diabetes: a review from the Nurses' Health Study, Nurses' Health Study 2, and Health Professionals' Follow-up Study.

The epidemiological evidence collected from three large US cohorts (Nurses' Health Study, Nurses' Health Study 2, and Health Professionals' Follow-up Study) has yielded important information regarding the roles of overall diet, individual foods and nutrients, physical activity and other lifestyle factors in the development of type 2 diabetes. Excess adiposity is a major risk factor for diabetes, and thus, maintaining a healthy body weight and avoidance of weight gain during adulthood is the cornerstone of diabetes prevention. Independent of body weight, the quality or type of dietary fat and carbohydrate is more crucial than the quantity in determining diabetes risk. Higher consumption of coffee, whole grains, fruits, and nuts is associated with lower risk of diabetes, whereas regular consumption of refined grains, red and processed meats, and sugar-sweetened beverages including fruits juices is associated with increased risk. Dietary patterns rich in fruits and vegetables, whole grains, and nuts and legumes but lower in red and processed meats, refined grains, and sugar-sweetened beverages are consistently associated with diabetes risk, even after adjustment for body mass index. The genome-wide association studies conducted in these cohorts have contributed substantially to the discoveries of novel genetic loci for type 2 diabetes and other metabolic traits, although the identified common variants explain only a small proportion of overall diabetes predisposition. Taken together, these ongoing large cohort studies have provided convincing epidemiologic evidence that a healthy diet, together with regular physical activity, maintenance of a healthy weight, moderate alcohol consumption, and avoidance of sedentary behaviors and smoking would prevent the majority of type 2 diabetes cases.

Differences among pulse grains and cereal grains in dietary fiber (259.5)

Pulses, i.e., dry beans, dry peas, chickpeas, and lentils, are grain legumes that serve as staple food crops for populations around the world. Since ancient times, pulses have been combined with cereal grains, primarily wheat, rice, or corn, or tubers such as potato or cassava to provide a balanced source of protein and carbohydrate and a nutritionally adequate diet when combined with seed oils, fruit and vegetables. In this setting, the established ratio of cereal grains to pulses to meet nutritional requirements is 2:1; however, over the last 60 years both production and consumption patterns, globally, have changed to 8:1. One consequence of these changes has been on a marked but largely unappreciated shift in dietary carbohydrate quality. This presentation focuses on differences among pulse crops in their amount and type of dietary fiber and how this relates to the amounts and types of dietary fiber provided by various cereal grains. Data will be reported using the AOAC 2011.25 Integrated Total Dietary Fiber Assay to quantify dietary fiber and oligosaccharide content. These data will be considered in the context of the pandemic of overweight and obesity that has swept the globe over the last 60 years since there has been virtually no scrutiny of the potential association between the decline in pulse consumption and the global rise in obesity and its associated metabolic disorders.Grant Funding Source: PHS R01‐ CA172375 and American Pulse Association

Trends in dietary carbohydrate consumption from 1991–2008 in the Framingham Heart Study offspring cohort

Longitudinal studies evaluating trends in dietary carbohydrate consumption among U.S. adults are limited. More recent studies reflective of the changes in food supply are needed to evaluate long‐term intakes and to compare them to dietary recommendations. We examined trends in dietary carbohydrate intake in the Framingham Heart Study (FHS) Offspring Cohort over a 17‐year period. The FHS offspring generation was recruited in 1971–75. Follow‐up exams were conducted every 4 years. Dietary data collection began at Exam 5 in 1991 using a semi‐quantitative food frequency questionnaire. This analysis included 3265 adults ages ≥25y with complete dietary data in at least three exams from 1991–2008. Mixed effects linear regression was used to examine trends in macronutrient and food intake using SASv9.3. Over 17 years of follow‐up, % energy from total carbohydrates (50.95% to 46.84%; p‐trend&lt;0.0005) and from total sugars (18.19 % to 16.62%; p‐trend&lt;0.0005) decreased. There was a decrease in % energy from fructose (5.41 to 4.76 %; p‐trend &lt;0.0005) and % energy from sugar in beverages (1.43% to 0.9%, p‐trend&lt;0.0005). Dietary fiber intake increased (18.01 to 19.21g, p‐trend&lt;0.0005). Similar trends were observed when the analyses were stratified by sex. These results suggest some improvement in dietary carbohydrate quality over time in this cohort.Grant Funding Source: American Cancer Society Research Scholar Grant (#RSG‐12–005–01‐CNE)

Calorie intake and blood lipidomics

Weight loss is inherently linked to the utilization of stored fats and should be detectable as changes in the blood lipidome. Such lipid changes may serve as biomarkers and may reveal protective responses, eg, in markers associated with insulin resistance or risk of type II diabetes. Conversely, fat utilization may be biased, at least initially, towards the metabolism of unsaturated fats vs saturated fats, which could have important public health consequences, as acute weight‐loss might be a period of exposure conditions that favor atherosclerosis development.Testing these issues in FBNF1 rat models of both stable and acute weight loss/caloric restriction (CR) enabled control of diet quantity/quality and minimized confounds. Rats were fed ad libitum, different periods of 40% CR (1, 2, 4, 8, or 18 weeks), or 10–40% CR for 8 weeks. Sera lipids were assessed using a high resolution mass spectrometry‐based analysis that detected &gt;;500 intact lipids (&gt;;300 structurally identified), spanning 6 LIPIDMAPS categories. Data supporting both issues above were observed. Data are also compared with metabolomics biomarkers for: (i) CR defined in rats that cross‐species to reflect caloric intake and future disease risk in humans, and; (ii) relative intakes and quality of dietary protein, carbohydrate, and fat. Complementary analyses are in progress in the NIA CALERIE trial of CR in humans. NIH support

Testing the boundaries of recommended carbohydrate intakes: Macronutrient exchanges, carbohydrate quality and nutritional adequacy

AbstractAim: The aim of this study was to explore the relationships between dietary carbohydrate, other macronutrients, carbohydrate quality and nutritional adequacy in the diets of free‐living Australian teenagers, and to consider the implications for total carbohydrate recommendations.Methods: Using the Children's Nutrition and Physical Activity Survey (2007) database, the nutrient intakes of boys and girls aged 14–16 years were assessed by quintile of carbohydrate intake.Results: Carbohydrate intake was inversely associated with intakes of saturated fat, polyunsaturated fat, long‐chain omega 3, monounsaturated fat and protein (for each association, P for trend &lt;0.001). Carbohydrate intake was associated with increased intake of fibre in boys (P for trend &lt;0.05) but not girls, the association being nonlinear. As carbohydrate intake increased, the densities of fibre, vitamin C, folate, thiamin and β‐carotene declined and the density of sugar increased, implying a decline in carbohydrate quality. Nutritional adequacy was generally compatible with a wide range of carbohydrate intakes.Conclusions: In combination, the exchanges of carbohydrate for polyunsaturated fat, long‐chain omega 3, monounsaturated fat and protein would be expected to increase coronary disease risk via several mechanisms. This implies that there may be a progressive increase in coronary risk as carbohydrate intakes increase across the Acceptable Macronutrient Distribution Range (AMDR), as the exchange of carbohydrate for saturated fat is now considered to be neutral for coronary risk. There is a case for lowering the upper and lower boundaries of the AMDR for carbohydrate intake as a strategy for chronic disease prevention. Lower boundaries would be unlikely to increase the risk for obesity or nutrient inadequacy.

Advances in functional fibres and carbohydrates

Our food landscape has evolved to the stage where carbohydrate foods dominate our diets — in accordance with dietary guidelines worldwide. The implications of this, and the role of functional carbohydrates and fibre, which further improve dietary carbohydrate quality, were addressed at the 2nd European BENEO Scientific Symposium in Heidelberg, Germany, in March 2012. This article will summarise the 15 presentations given by independent scientists and leading experts in their fields, as well as BENEO Institute experts, at that meeting.

Metabolic Impact of the Amount and Type of Dietary Carbohydrates on the Risk of Obesity and Diabetes

The relationship between dietary carbohydrates and the current obesity and diabetes epidemic is the subject of intense renewed interest. Since glucose is an essential source of energy, with limited body stores, maintenance of blood levels and changes in its metabolism are strongly determined by the intake of carbohydrates in the diet. Depending on the individual genetic susceptibility and the impact of other risk factors, these metabolic changes can potentially deteriorate into manifest abnormalities with an important disease risk. In this review we focus on the impact of changing the quantity and quality of dietary carbohydrates on the biochemistry of fat synthesis and storage and on the metabolic abnormalities that can lead to overweight and obesity and to complications such as the metabolic syndrome and type 2 diabetes mellitus. Using simple illustrations of the metabolic pathways involved, we summarize current research on the following issues: ∞ Does an increase in dietary carbohydrates induce changes in blood lipids and an increase in body fat? ∞ Does a diet with a high glycemic index lead to higher energy intakes, obesity and a higher risk of developing type 2 diabetes mellitus? ∞ Is sucrose more obesigenic than starch? ∞ Does excessive consumption of food and drinks sweetened with fructose explain the current epidemic of obesity and diabetes? Despite convincing experimental data explaining the metabolic outcomes of excess consumption of these carbohydrate types, the evidence from dietary intervention studies has been undermined by methodological issues. Clear nomenclature and classification are still needed before this information can be applied to explain metabolic risks in each individual as well as to set up guidelines for the public health authorities and the food industry.

Abstract MP064: Dietary Contributors to Glycemic load in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Glycemic load (GL) is a measure that incorporates both the quality (i.e., glycemic index) and quantity of dietary carbohydrate and is a measure of the overall glycemic impact of the diet. In observational studies, high-GL diets have been associated with a greater prevalence of multiple coronary heart disease risk factors, including type 2 diabetes, overweight/obesity, dyslipidemia, inflammation, and abnormal blood clotting. To begin to develop interventions to reduce dietary GL, it is necessary to identify the major contributors to GL at the population level. We studied contributors to GL in 21,636 participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study (7074 white men, 2472 black men, 7287 white women, and 4803 black women) whose mean (SD) age was 64.9 (9.3) years at baseline (2003-2007). Mean daily GL, as well as individual carbohydrate food and food group contributors to GL, were determined for each participant using intake data from the Block 1998 semi-quantitative food frequency questionnaire administered at baseline. Mean (SD) daily GL was 107.1 (44.1), 115.0 (53.8), 89.9 (40.6), and 100.0 (49.6) g/d in white men, black men, white women, and black women, respectively. Sugar-sweetened beverages was the main carbohydrate food group contributing to GL in both black men and women and were important contributors to GL in white men and women (Figure). Regular soft drinks in particular were the leading individual carbohydrate contributor to GL in black men (4.0 median % of daily GL). The main carbohydrate food group contributing to GL in both white men and women was breads. Dark breads were the leading individual carbohydrate contributors to GL in white men, white women, and black women (2.7, 3.2, and 2.4 median % of daily GL, respectively). Sugar-sweetened beverages were a major contributor to dietary GL in this sample of US adults, especially in blacks. Decreasing the consumption of these beverages should be considered in future interventions to reduce dietary GL.

Influence of two breakfast meals differing in glycemic load on satiety, hunger, and energy intake in preschool children

BackgroundGlycemic load (GL) is the product of glycemic index of a food and amount of available carbohydrate in that food divided by 100. GL represents quality and quantity of dietary carbohydrate. Little is known about the role of GL in hunger, satiety, and food intake in preschool children. The aim of this study was to investigate the effect of two breakfast meals differing in GL on hunger, satiety, and subsequent food intake at lunch in preschool children aged 4-6 y.MethodsTwenty three subjects consumed low-GL (LGL) and high-GL (HGL) breakfast meals according to a randomized crossover design followed by an ad libitum lunch 4 h after consumption of breakfast. Children were asked to consume meals until they are full. Each treatment was repeated twice in non-consecutive days and data were averaged.ResultsChildren in LGL group consumed significantly lower amounts of GL, total carbohydrate, energy, energy density, and dietary fiber and higher amounts of protein and fat at the breakfast compared to those in HGL group. Prior to lunch, children were hungrier in the HGL intervention group compared to the LGL intervention group (P < 0.03). However, no significant difference was observed between LGL and HGL intervention groups in the amount of food and energy consumed during lunch.ConclusionsDecreased hunger in children prior to lunch in LGL group is likely due to higher protein and fat content of LGL breakfast. Diets that are low in GL can be recommended as part of healthy diet for preschool children.

Trends in dietary carbohydrate quality during puberty from 1988 to 2007: a cause for concern?

The extent to which the quality of dietary carbohydrates (CHO) changes throughout puberty is not known. We analysed trends in the quantity and quality of CHO intake among German adolescents by separately examining trends during puberty (pubertal trends) and trends in CHO intake from 1988 to 2007 (secular trends). Linear mixed-effects regression analyses were performed in 216 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study who had provided weighed 3d dietary records at the onset of the pubertal growth spurt (defined by age at take-off) and over the subsequent 4 years. Over the course of puberty, CHO quality changed little: added sugar intake from beverages increased in girls (0·25 (se 0·12)% energy (% E)/year, P=0·04) and added sugar intake from sweets decreased in both sexes (boys: -0·22 (se 0·11)% E/year, P=0·049; girls: -0·20 (se 0·10)% E/year, P=0·04). For both sexes, significant upward secular trends were observed for CHO (% E), glycaemic load (g/MJ) and added sugar intakes from sources other than sweets and soft drinks (% E), while absolute fibre intake (g/d) decreased (P≤0·04). Concomitant increases in total added sugar intake (% E) and decreases in fibre and whole-grain densities (g/MJ) (P=0·001-0·02) were confined to boys only. The quality of dietary CHO consumed by healthy German adolescents shows notable secular declines, but does not change markedly during puberty. Public health initiatives should be tailored to improve the overall quality of CHO nutrition.

Abstract 2823: Dietary glycemic index, glycemic load and insulin index, in relation to risk of prostate cancer

Abstract Background: The insulin and insulin-like growth factor (IGF) axis has been shown to play a role in prostate cancer tumorigenesis. Circulating IGF-1 and fasting insulin as well as insulin resistance have been associated with increased risk of total or advanced prostate cancer in some epidemiological studies. Through alterations by diet the insulin and IGF axis may be potentially modifiable. The dietary insulin response depends largely but not entirely on the quality and quantity of dietary carbohydrates. The glycemic index (GI) is a measure of the propensity of carbohydrate containing foods to raise blood glucose levels postprandially. The more recently developed food insulin index is a comparable measure which is based on the diet's effect on insulin secretion, also taking into account foods with low or no carbohydrate content. We hypothesized that high dietary glycemic index, glycemic load (GL) and insulin index (II) are associated with increased risk of prostate cancer. Material and Methods: We followed 47,779 Health Professionals Follow-up Study participants between 1986 and 2006 for prostate cancer incidence. Dietary intake was assessed by food frequency questionnaire (FFQ) in 1986 and updated every 4 years. Dietary GL was calculated by multiplying GI by the carbohydrate content and consumption frequency of each FFQ item and then summing over all the items. Values for the food insulin index of the FFQ items were provided by the University of Sydney, Australia. The dietary II was calculated as a function of food insulin index, energy content and consumption frequency of all FFQ items. Multivariate adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression. Results: Between 1986 and 2006, we confirmed 5,112 prostate cancer cases, including 860 advanced/fatal (regionally invasive or metastatic disease at diagnosis, or metastases or death from prostate cancer during follow-up) cases. Dietary GI, GL and II were not associated with risk of total or advanced prostate cancer. For total prostate cancer, the multivariate adjusted HRs comparing the highest versus lowest quintile were 1.01 (CI 0.92-1.12, p-trend=0.26) for GI, 1.07 (CI 0.97-1.19, p-trend=0.19) for GL and 1.05 (CI 0.94-1.17, p-trend=0.15) for II. For advanced prostate cancer, the HRs were 1.05 (CI 0.75-1.47, p-trend=0.76) for GI, 0.99 (CI 0.70-1.40, p-trend=0.64) for GL, and 0.99 (CI 0.68-1.44, p-trend=0.92) for II. Results did not change substantially when the cohort was restricted to men with PSA screening. Stratification by BMI, diabetes and age at diagnosis, or by tumor grade, did not suggest any heterogeneity (all p-values for interaction were &amp;gt;0.11). Conclusion: These results suggest that long-term exposure to a diet with a high insulin response as reflected by high dietary glycemic index, glycemic load and insulin index does not affect prostate cancer incidence or progression. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2823.