Association of carbohydrate quality and all-cause mortality in the SUN Project: A prospective cohort study.

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. 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. 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. 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.

Fernandez-Lazaro CI ，Zazpe I ，Santiago S ，Toledo E ，Barbería-Latasa M ，Martínez-González MÁ ... -  《-》

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

Beyond 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. We 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. In 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.

Zazpe I ，Santiago S ，Gea A ，Ruiz-Canela M ，Carlos S ，Bes-Rastrollo M ，Martínez-González MA ... -  《-》

Added sugars and sugar-sweetened beverage consumption, dietary carbohydrate index and depression risk in the Seguimiento Universidad de Navarra (SUN) Project.

Sanchez-Villegas A ，Zazpe I ，Santiago S ，Perez-Cornago A ，Martinez-Gonzalez MA ，Lahortiga-Ramos F ... -  《-》

Dietary carbohydrate quality index and incidence of obesity-related cancers in the "Seguimiento Universidad De Navarra" (SUN) prospective cohort.

Olmedo M ，Santiago S ，Romanos-Nanclares A ，Aramendia-Beitia JM ，Sanchez-Bayona R ，Bes-Rastrollo M ，Martinez-Gonzalez MA ，Toledo E ... -  《-》

Carbohydrate quality index and breast cancer risk in a Mediterranean cohort: The SUN project.

Beyond the quantity of carbohydrate intake, further research is needed on the relevance of carbohydrate quality. Thus, we evaluated the association between an a priori defined carbohydrate quality index (CQI) and the incidence of breast cancer (BC) in a Mediterranean cohort study. We used a validated semi-quantitative 136-item food-frequency questionnaire (FFQ) in a prospective follow-up study of 10,812 middle-aged women. We evaluated at baseline the CQI following 4 criteria: dietary fiber intake, glycemic index, whole-grain:total-grain carbohydrates ratio and the solid carbohydrate:total carbohydrate ratio. Subjects were classified into quartiles according to the final CQI score. During a median follow-up of 11.8 years, we confirmed 101 incident cases of BC. Our study suggests that a higher quality of carbohydrate intake, as measured by the baseline CQI, was associated with a lower risk of BC [HR Q4 vs. Q1 0.39 (95% CI 0.17, 0.87)]. Particularly, a higher whole-grain:total-grain carbohydrates ratio was associated with lower risk of BC [HR T3 vs. T1 0.56 (0.34, 0.90)]. When we stratified by menopausal status, we found an inverse association between CQI and BC in the comparison of extreme quartiles among premenopausal women. In this Mediterranean cohort, a better quality of dietary carbohydrate intake showed a significant inverse association with the incidence of BC, which suggests that strategies for cancer prevention should highlight the quality of this macronutrient.

Romanos-Nanclares A ，Gea A ，Martínez-González MÁ ，Zazpe I ，Gardeazabal I ，Fernandez-Lazaro CI ，Toledo E ... -  《-》