Park Young-Hwan, Lee Hye Sun, Yang Juyeon, Lim Li Rang, Kwon Yu-Jin, Lee Ji-Won
Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Clin Nutr. 2024 May;43(5):1117-1124. doi: 10.1016/j.clnu.2024.03.024. Epub 2024 Apr 1.
BACKGROUND & AIMS: The relationship between diet and health, particularly the role of carbohydrates, has been extensively studied. However, carbohydrate intake based on individual health conditions remains unclear. Here, we aimed to investigate whether the association between carbohydrate intake and all-cause mortality varied between individuals with and without diabetes mellitus (DM).
This prospective cohort study used data from the Korean Genome and Epidemiology Study (KoGES). Overall, 143,050 participants were included, with 10.1% having DM. Dietary intake was assessed using a semiquantitative food frequency questionnaire. Cox proportional hazards regression models were used to assess the association between carbohydrate intake and mortality after adjusting for confounders.
The study showed that 5436 deaths occurred during the median follow-up period of 10.1 years. A significant interaction between carbohydrate intake and DM was observed in the study population (interaction p = 0.061). Higher carbohydrate intake proportion was associated with an increased risk of all-cause mortality among individuals with DM (adjusted hazard ratio [HR], p-value = 1.10 [1.01-1.20], p = 0.032). Conversely, no association was observed between the proportion of carbohydrate intake and all-cause mortality in participants without DM. Additionally, both total sugar and added sugar intakes were associated with an increased risk of all-cause mortality in participants with DM (adjusted HR, p-value = 1.02 [1.01-1.04], p < 0.001 and 1.18 [1.13-1.24], p < 0.001).
High carbohydrate (%) and added sugar intake were associated with an increased mortality risk in individuals with DM. Reducing carbohydrate intake and opting for healthy carbohydrates to mitigate mortality risk may be beneficial for individuals with DM, particularly when compared with the general population.
饮食与健康的关系，尤其是碳水化合物的作用，已得到广泛研究。然而，基于个体健康状况的碳水化合物摄入量仍不明确。在此，我们旨在研究碳水化合物摄入量与全因死亡率之间的关联在糖尿病（DM）患者和非糖尿病患者中是否存在差异。
这项前瞻性队列研究使用了韩国基因组与流行病学研究（KoGES）的数据。总共纳入了143,050名参与者，其中10.1%患有DM。使用半定量食物频率问卷评估饮食摄入量。Cox比例风险回归模型用于在调整混杂因素后评估碳水化合物摄入量与死亡率之间的关联。
研究表明，在中位随访期10.1年期间发生了5,436例死亡。在研究人群中观察到碳水化合物摄入量与DM之间存在显著交互作用（交互作用p = 0.061）。较高的碳水化合物摄入比例与DM患者全因死亡率风险增加相关（调整后的风险比[HR]，p值 = 1.10 [1.01 - 1.20]，p = 0.032）。相反，在无DM的参与者中，未观察到碳水化合物摄入比例与全因死亡率之间的关联。此外，总糖和添加糖摄入量均与DM患者全因死亡率风险增加相关（调整后的HR，p值 = 1.02 [1.01 - 1.04]，p < 0.001和1.18 [1.13 - 1.24]，p < 0.001）。
高碳水化合物（%）和添加糖摄入与DM患者的死亡风险增加相关。减少碳水化合物摄入量并选择健康的碳水化合物以降低死亡风险可能对DM患者有益，特别是与一般人群相比。
