Carbohydrate quantity and quality and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) study.

Description

This prospective study sought to investigate the associations of dietary glycemic load (GL), glycemic index (GI), carbohydrate, and fibre intake with the incidence of type 2 diabetes. The study cohort included 37,846 participants of the EPIC-NL (European Prospective Investigation into Cancer and Nutrition-Netherlands) study, aged 21-70 years at baseline and without preexisting diabetes. A total of 915 incident diabetes cases were recorded during a mean follow-up of 10 years. Results showed that dietary GL was associated with an increased diabetes risk after adjustment for confounding variables, but only a trend was observed for GI. Higher dietary fibre was associated with a decreased diabetes risk whereas carbohydrate intake was associated with increased diabetes risk. Moreover, no evidence for different effects of simple and complex carbohydrate subtypes on diabetes risk was observed. These findings were not modified by the degree of adiposity and exclusion of energy misreporters accentuated all associations, even after adjusting for total energy intake. These results suggest that both carbohydrate quantity and quality seem to be important factors in diabetes prevention. In their editorial comment, Liu S and Chou EL highlighted the better understanding of the association between carbohydrates and diabetes risk which was added by including GI values of foods into dietary assessment of GL. Moreover, they also emphasized the importance of appropriate statistical models to analyze highly correlated variables and proper interpretation.