(03-10-10) Carbohydrate quantity and quality and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition?Ne

Carbohydrate quantity and quality and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition?Netherlands (EPIC-NL) study1,2,3

Ivonne Sluijs, Yvonne T van der Schouw, Daphne L van der A, Annemieke M Spijkerman, Frank B Hu, Diederick E Grobbee and Joline W Beulens
1 From the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands (IS, YTvdS, DEG, and JWB); the Center for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, Netherlands (DLvdA); the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, Netherlands (AMS); and the Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, MA (FBH).
2 Partly supported by the InterAct project, funded by the European Union (Integrated Project LSHM-CT-2006-037197 in the Framework Programme 6 of the European Community). The EPIC-NL study was funded by the European Commission: Public Health and Consumer Protection Directorate 1993?2004; Research Directorate-General 2005; the Dutch Ministry of Public Health, Welfare, and Sports; the Netherlands Cancer Registry; LK Research Funds; Dutch Prevention Funds; Dutch ZON (Zorg Onderzoek Nederland); and the World Cancer Research Fund.
Received April 1, 2010. Accepted for publication July 9, 2010.
3 Address correspondence to I Sluijs, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands. E-mail: [email protected].
Background: Carbohydrate quantity and quality may play an important role in the development of type 2 diabetes.
Objective: We investigated the associations of dietary glycemic load (GL), glycemic index (GI), carbohydrate, and fiber intake with the incidence of type 2 diabetes.
Design: A prospective cohort study was conducted in 37,846 participants of the EPIC-NL (European Prospective Investigation into Cancer and Nutrition?Netherlands) study, aged 21?70 y at baseline and free of diabetes. Dietary intake was assessed with the use of a validated food-frequency questionnaire. Incident diabetes cases were mainly self-reported and verified against general practitioner records.
Results: During a mean follow-up of 10 y, 915 incident diabetes cases were documented. Dietary GL was associated with an increased diabetes risk after adjustment for age, sex, established diabetes risk factors, and dietary factors [hazard ratio (HR) per SD increase: 1.32; 95% CI: 1.14, 1.54; P < 0.001]. GI tended to increase diabetes risk (HR: 1.08; 95% CI: 1.00, 1.17; P = 0.05). Dietary fiber was inversely associated with diabetes risk (HR: 0.92; 95% CI: 0.85, 0.99; P < 0.05), whereas carbohydrate intake was associated with increased diabetes risk (HR: 1.15; 95% CI: 1.01, 1.32; P < 0.05). Of the carbohydrate subtypes, only starch was related to increased diabetes risk [HR: 1.25 (1.07, 1.46), P < 0.05]. All associations became slightly stronger after exclusion of energy misreporters.
Conclusions: Diets high in GL, GI, and starch and low in fiber were associated with an increased diabetes risk. Both carbohydrate quantity and quality seem to be important factors in diabetes prevention. Energy misreporting contributed to a slight attenuation of associations.

Source: Am J Clin Nutr 92: 905-911, 2010.

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