Research Group on Preventive Activities and Promotion Illes Balears (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Primary Care Research Unit of Mallorca (IB-Salut), Palma de Mallorca, Spain.
Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), Palma de Mallorca, Spain; Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
Clin Nutr. 2022 Oct;41(10):2264-2274. doi: 10.1016/j.clnu.2022.08.008. Epub 2022 Aug 20.
BACKGROUND & AIMS: The quality of dietary carbohydrates rather than total carbohydrate intake may determine the accumulation of visceral fat; however, to date, few studies have examined the impact of diet on adiposity using specific imaging techniques. Thus, the aim of this prospective study was to investigate the association between concurrent changes in carbohydrate quality index (CQI) and objectively-quantified adiposity distribution over a year.
We analyzed a cohort of 1476 participants aged 55-75 years with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus randomized controlled trial. Dietary intake information was obtained at baseline, 6- and 12-months from a validated 143-item semi-quantitative food-frequency questionnaire, and CQI (range: 4 to 20) was calculated based on four dietary criteria: total dietary fibre, glycemic index, wholegrain/total grain carbohydrate ratio, and solid/total carbohydrate ratio. Overall and regional adiposity (total body fat, visceral fat and android-to-gynoid fat ratio) was quantified using dual-energy X-ray absorptiometry at all three time points. Multiple adjusted linear mixed-effects models were used to assess associations between concurrent changes in repeatedly measured CQI and adiposity over time.
After controlling for potential confounding factors, a 3-point increment in CQI over 12-month follow-up was associated with a decrease in visceral fat (β -0.067 z-score, 95% CI -0.088; -0.046, p < 0.001), android-to-gynoid fat ratio (-0.038, -0.059; -0.017, p < 0.001), and total fat (-0.064, -0.080; -0.047, p < 0.001). Fibre intake and the ratio of wholegrain/total grain showed the strongest inverse associations with all adiposity indicators.
In this prospective cohort of older adults with overweight/obesity and MetS, we found that improvements in dietary carbohydrate quality over a year were associated with concurrent favorable changes in visceral and overall fat deposition. These associations were mostly driven by dietary fibre and the wholegrain/total grain ratio.
The trial was registered at the International Standard Randomized. CONTROLLED TRIAL: (ISRCTN: http://www.isrctn.com/ISRCTN89898870) with number 89898870 and registration date of 24 July 2014, retrospectively registered.
饮食中碳水化合物的质量而非总碳水化合物的摄入量可能决定内脏脂肪的堆积；然而，迄今为止，很少有研究使用特定的成像技术来检查饮食对肥胖的影响。因此，本前瞻性研究的目的是在一年的时间内，研究碳水化合物质量指数（CQI）的同时变化与客观量化的脂肪分布之间的关联。
我们分析了超重/肥胖和代谢综合征（MetS）的 1476 名年龄在 55-75 岁的 PREDIMED-Plus 随机对照试验参与者队列的资料。基线、6 个月和 12 个月时，通过验证的 143 项半定量食物频率问卷获得饮食摄入信息，根据四个饮食标准计算 CQI（范围：4-20）：总膳食纤维、血糖指数、全谷物/总谷物碳水化合物比和固体/总碳水化合物比。使用双能 X 射线吸收法在所有三个时间点均测量总身体脂肪、内脏脂肪和安卓到女性脂肪比来量化整体和区域肥胖。使用多因素线性混合效应模型评估 12 个月随访期间反复测量 CQI 的同时变化与随时间变化的肥胖之间的关联。
在控制潜在混杂因素后，12 个月随访期间 CQI 增加 3 分与内脏脂肪减少（β-0.067z 分数，95%CI-0.088；-0.046，p<0.001）、安卓到女性脂肪比降低（β-0.038，-0.059；-0.017，p<0.001）和总脂肪降低（β-0.064，-0.080；-0.047，p<0.001）相关。纤维摄入量和全谷物/总谷物的比例与所有肥胖指标的负相关最强。
在这项针对超重/肥胖和 MetS 的老年成年人的前瞻性队列研究中，我们发现，一年来饮食中碳水化合物质量的改善与内脏和整体脂肪沉积的同时改善相关。这些关联主要由膳食纤维和全谷物/总谷物的比例驱动。
