Abstract
Background: The relation between carbohydrate intake and risk of ischemic heart disease (IHD) has not been fully explored in Asian populations known to have high-carbohydrate diets. Objective: We assessed whether intakes of total carbohydrates, different types of carbohydrates, and their food sources were associated with IHD mortality in a Chinese population. Design: We prospectively examined the association of carbohydrate intake and IHD mortality in 53,469 participants in the Singapore Chinese Health Study with an average follow-up of 15 y. Diet was assessed by using a semiquantitative food-frequency questionnaire. HRs and 95% CIs were calculated by using a Cox proportional hazards analysis. Results: We documented 1660 IHD deaths during 804,433 personyears of follow-up. Total carbohydrate intake was not associated with IHD mortality risk [men: HR per 5% of energy, 0.97 (95% CI: 0.92, 1.03); women: 1.06 (95% CI: 0.99, 1.14)]. When types of carbohydrates were analyzed individually, starch intake was associated with higher risk [men: 1.03 (95% CI: 0.99, 1.08); women: 1.08, (95% CI: 1.02, 1.14)] and fiber intake with lower risk of IHD mortality [men: 0.94 (95% CI: 0.82, 1.08); women: 0.71 (95% CI: 0.60, 0.84)], with stronger associations in women than men (both P-interaction < 0.01). In substitution analyses, the replacement of one daily serving of rice with one daily serving of noodles was associated with higher risk (difference in HR: 26.11%; 95% CI: 10.98%, 43.30%). In contrast, replacing one daily serving of rice with one of vegetables (223.81%; 95% CI: 233.12%, 213.20%), fruit (211.94%; 95% CI: 217.49%, 26.00%), or whole-wheat bread (219.46%; 95% CI: 234.28%, 21.29%) was associated with lower risk of IHD death. Conclusions: In this Asian population with high carbohydrate intake, the total amount of carbohydrates consumed was not substantially associated with IHD mortality. In contrast, the shifting of food sources of carbohydrates toward a higher consumption of fruit, vegetables, and whole grains was associated with lower risk of IHD death.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 53-64 |
| Number of pages | 12 |
| Journal | American Journal of Clinical Nutrition |
| Volume | 100 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 1 2014 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Medicine (miscellaneous)
- Nutrition and Dietetics
Cite this
Amount, type, and sources of carbohydrates in relation to ischemic heart disease mortality in a Chinese population : A prospective cohort study. / Rebello, Salome A.; Koh, Hiromi; Chen, Cynthia; Naidoo, Nasheen; Odegaard, Andrew O.; Koh, Woon Puay; Butler, Lesley M.; Yuan, Jian Min; Van Dam, Rob M.
In: American Journal of Clinical Nutrition, Vol. 100, No. 1, 01.07.2014, p. 53-64.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Amount, type, and sources of carbohydrates in relation to ischemic heart disease mortality in a Chinese population
T2 - A prospective cohort study
AU - Rebello, Salome A.
AU - Koh, Hiromi
AU - Chen, Cynthia
AU - Naidoo, Nasheen
AU - Odegaard, Andrew O.
AU - Koh, Woon Puay
AU - Butler, Lesley M.
AU - Yuan, Jian Min
AU - Van Dam, Rob M.
PY - 2014/7/1
Y1 - 2014/7/1
N2 - Background: The relation between carbohydrate intake and risk of ischemic heart disease (IHD) has not been fully explored in Asian populations known to have high-carbohydrate diets. Objective: We assessed whether intakes of total carbohydrates, different types of carbohydrates, and their food sources were associated with IHD mortality in a Chinese population. Design: We prospectively examined the association of carbohydrate intake and IHD mortality in 53,469 participants in the Singapore Chinese Health Study with an average follow-up of 15 y. Diet was assessed by using a semiquantitative food-frequency questionnaire. HRs and 95% CIs were calculated by using a Cox proportional hazards analysis. Results: We documented 1660 IHD deaths during 804,433 personyears of follow-up. Total carbohydrate intake was not associated with IHD mortality risk [men: HR per 5% of energy, 0.97 (95% CI: 0.92, 1.03); women: 1.06 (95% CI: 0.99, 1.14)]. When types of carbohydrates were analyzed individually, starch intake was associated with higher risk [men: 1.03 (95% CI: 0.99, 1.08); women: 1.08, (95% CI: 1.02, 1.14)] and fiber intake with lower risk of IHD mortality [men: 0.94 (95% CI: 0.82, 1.08); women: 0.71 (95% CI: 0.60, 0.84)], with stronger associations in women than men (both P-interaction < 0.01). In substitution analyses, the replacement of one daily serving of rice with one daily serving of noodles was associated with higher risk (difference in HR: 26.11%; 95% CI: 10.98%, 43.30%). In contrast, replacing one daily serving of rice with one of vegetables (223.81%; 95% CI: 233.12%, 213.20%), fruit (211.94%; 95% CI: 217.49%, 26.00%), or whole-wheat bread (219.46%; 95% CI: 234.28%, 21.29%) was associated with lower risk of IHD death. Conclusions: In this Asian population with high carbohydrate intake, the total amount of carbohydrates consumed was not substantially associated with IHD mortality. In contrast, the shifting of food sources of carbohydrates toward a higher consumption of fruit, vegetables, and whole grains was associated with lower risk of IHD death.
AB - Background: The relation between carbohydrate intake and risk of ischemic heart disease (IHD) has not been fully explored in Asian populations known to have high-carbohydrate diets. Objective: We assessed whether intakes of total carbohydrates, different types of carbohydrates, and their food sources were associated with IHD mortality in a Chinese population. Design: We prospectively examined the association of carbohydrate intake and IHD mortality in 53,469 participants in the Singapore Chinese Health Study with an average follow-up of 15 y. Diet was assessed by using a semiquantitative food-frequency questionnaire. HRs and 95% CIs were calculated by using a Cox proportional hazards analysis. Results: We documented 1660 IHD deaths during 804,433 personyears of follow-up. Total carbohydrate intake was not associated with IHD mortality risk [men: HR per 5% of energy, 0.97 (95% CI: 0.92, 1.03); women: 1.06 (95% CI: 0.99, 1.14)]. When types of carbohydrates were analyzed individually, starch intake was associated with higher risk [men: 1.03 (95% CI: 0.99, 1.08); women: 1.08, (95% CI: 1.02, 1.14)] and fiber intake with lower risk of IHD mortality [men: 0.94 (95% CI: 0.82, 1.08); women: 0.71 (95% CI: 0.60, 0.84)], with stronger associations in women than men (both P-interaction < 0.01). In substitution analyses, the replacement of one daily serving of rice with one daily serving of noodles was associated with higher risk (difference in HR: 26.11%; 95% CI: 10.98%, 43.30%). In contrast, replacing one daily serving of rice with one of vegetables (223.81%; 95% CI: 233.12%, 213.20%), fruit (211.94%; 95% CI: 217.49%, 26.00%), or whole-wheat bread (219.46%; 95% CI: 234.28%, 21.29%) was associated with lower risk of IHD death. Conclusions: In this Asian population with high carbohydrate intake, the total amount of carbohydrates consumed was not substantially associated with IHD mortality. In contrast, the shifting of food sources of carbohydrates toward a higher consumption of fruit, vegetables, and whole grains was associated with lower risk of IHD death.
UR - http://www.scopus.com/inward/record.url?scp=84903521228&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84903521228&partnerID=8YFLogxK
U2 - 10.3945/ajcn.113.076273
DO - 10.3945/ajcn.113.076273
M3 - Article
C2 - 24787492
AN - SCOPUS:84903521228
VL - 100
SP - 53
EP - 64
JO - American Journal of Clinical Nutrition
JF - American Journal of Clinical Nutrition
SN - 0002-9165
IS - 1
ER -