Hosseinpour-Niazi Somayeh, Bakhshi Bahar, Mirmiran Parvin, Gaeini Zahra, Hadaegh Farzad, Azizi Fereidoun
Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
School of Nutritional Sciences and Wellness, University of Arizona, Tucson, AZ, USA.
Nutr Metab (Lond). 2023 Sep 12;20(1):39. doi: 10.1186/s12986-023-00761-0.
In this prospective cohort study, we aimed to evaluate the association between dietary carbohydrates, whole grains, refined grains, and simple sugar with the risk of metabolic syndrome (MetS) and assess the effect of weight change on these associations.
This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS). We included 1915 healthy participants with complete demographic, anthropometric and dietary measurements, among whom 591 developed MetS during 8.9 years of follow-up. Intake of dietary carbohydrates, whole grains, refined grains, and simple sugar was assessed with a validated semi-quantitative food frequency questionnaire. Multivariable adjusted Cox regression was used to estimate hazard ratios (HRs) for MetS events across tertiles of dietary variables. Using joint classification, the effect of weight change on the association between dietary variables and risk of MetS was assessed by Cox regression.
Carbohydrate intake was not associated with the risk of MetS in multivariable-adjusted models. Whole grains intake was inversely associated with the risk of MetS (HR: 0.78, CI: 0.63-0.98), while this association disappeared after adjustment for weight change. The risk of MetS increased by 11% (1.11, 1.09-1.14) for each 3% energy increment from simple sugar, and by 5% (1.05, 1.03-1.08) for each 1 serving/day increment in refined grains. Consumption of refined grains increased the risk of MetS; an effect modification of this association was found by weight change. Among subjects with weight loss, intake of refined grains < median intake decreased the risk of MetS (0.59, 0.41-0.87). However, consumption of refined grains ≥ median intake increased the risk of MetS in individuals with weight gain (1.47, 1.08-2.01). Simple sugar was positively associated with an increased risk of MetS, after adjustment for weight change (3.00, 2.37-3.82). In joint classification, intake of simple sugar greater than median intake increased the risk of MetS, independent of weight change.
Our findings suggest an effect modification by weight change on the association between carbohydrates, and refined grains intake and the risk of MetS. Weight loss along with lower consumption of carbohydrates, and refined grains reduced the risk of MetS. However, simple sugar intake, regardless of weight change, was associated with an increased risk of MetS.
在这项前瞻性队列研究中，我们旨在评估膳食碳水化合物、全谷物、精制谷物和单糖与代谢综合征（MetS）风险之间的关联，并评估体重变化对这些关联的影响。
本研究在德黑兰脂质与葡萄糖研究（TLGS）的框架内进行。我们纳入了1915名具有完整人口统计学、人体测量学和膳食测量数据的健康参与者，其中591人在8.9年的随访期间发生了MetS。使用经过验证的半定量食物频率问卷评估膳食碳水化合物、全谷物、精制谷物和单糖的摄入量。多变量调整后的Cox回归用于估计膳食变量三分位数中MetS事件的风险比（HRs）。通过联合分类，采用Cox回归评估体重变化对膳食变量与MetS风险之间关联的影响。
在多变量调整模型中，碳水化合物摄入量与MetS风险无关。全谷物摄入量与MetS风险呈负相关（HR：0.78，CI：0.63 - 0.98），但在调整体重变化后这种关联消失。单糖每增加3%的能量摄入，MetS风险增加11%（1.11，1.09 - 1.14），精制谷物每增加1份/天的摄入量，MetS风险增加5%（1.05，1.03 - 1.08）。食用精制谷物会增加MetS风险；发现体重变化对这种关联有效应修正作用。在体重减轻的受试者中，精制谷物摄入量低于中位数的人群MetS风险降低（0.59，0.41 - 0.87）。然而，在体重增加的个体中，精制谷物摄入量≥中位数会增加MetS风险（1.47，1.08 - 2.01）。在调整体重变化后，单糖与MetS风险增加呈正相关（3.00，2.37 - 3.82）。在联合分类中，单糖摄入量大于中位数会增加MetS风险，与体重变化无关。
我们的研究结果表明体重变化对碳水化合物、精制谷物摄入量与MetS风险之间的关联有效应修正作用。体重减轻以及减少碳水化合物和精制谷物的摄入量可降低MetS风险。然而，无论体重如何变化，单糖摄入都与MetS风险增加有关。
