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 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.
Clin Nutr. 2021 Apr;40(4):2364-2372. doi: 10.1016/j.clnu.2020.10.029. Epub 2020 Oct 29.
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.
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; P = 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; P = 0.192) for high fiber intake; 0.81 (0.59-1.12; P = 0.211) for low glycemic index; 0.87 (0.69-1.11; P = 0.272) for high whole-grain carbohydrate: total-grain carbohydrate ratio; and 0.81 (0.61-1.07; P = 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.
越来越多的证据表明，关注碳水化合物的质量而非数量可以带来更大的健康益处。我们使用单一的多维碳水化合物质量指数（CQI）来研究碳水化合物质量与全因死亡率之间的关系，该指数旨在考虑碳水化合物质量的多个特征。
在纳瓦拉大学随访研究（SUN）项目中对 19083 名中年大学毕业生的地中海队列进行了一项前瞻性研究。CQI 基于四个维度：高总膳食纤维摄入量、低血糖指数、高全谷物碳水化合物：总谷物碳水化合物比和高固体碳水化合物：总碳水化合物比。
在中位随访 12.2 年期间，确定了 440 例死亡。我们发现 CQI 与全因死亡率之间呈负相关。CQI 最高与最低三分位组的多变量调整后的危险比（HR）为 0.70（95%CI，0.53-0.93；P=0.018）。然而，CQI 的每个单独维度与较低的死亡率风险无关，极端三分位组之间的 HR（95%CI）如下：高纤维摄入量为 0.77（0.52-1.14；P=0.192）；低血糖指数为 0.81（0.59-1.12；P=0.211）；高全谷物碳水化合物：总谷物碳水化合物比为 0.87（0.69-1.11；P=0.272）；高固体碳水化合物：总碳水化合物比为 0.81（0.61-1.07；P=0.139）。在经过 10 年随访后更新营养暴露的饮食重复测量后，我们的分析仍然相似。
整体 CQI，但没有任何单一维度，与较低的死亡率相关。CQI 似乎全面捕捉了质量领域的综合效应。
