Amount, type, and sources of carbohydrates in relation to ischemic heart disease mortality in a Chinese population: A prospective cohort study

Salome A. Rebello, Hiromi Koh, Cynthia Chen, Nasheen Naidoo, Andrew O. Odegaard, Woon Puay Koh, Lesley M. Butler, Jian Min Yuan, Rob M. Van Dam

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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 languageEnglish (US)
Pages (from-to)53-64
Number of pages12
JournalAmerican Journal of Clinical Nutrition
Volume100
Issue number1
DOIs
StatePublished - Jul 1 2014
Externally publishedYes

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Myocardial Ischemia
Cohort Studies
Carbohydrates
Prospective Studies
Mortality
Population
Food
Vegetables
Fruit
Diet
Bread
Singapore
Starch
Triticum
Health

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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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 journalArticle

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. / Amount, type, and sources of carbohydrates in relation to ischemic heart disease mortality in a Chinese population : A prospective cohort study. In: American Journal of Clinical Nutrition. 2014 ; Vol. 100, No. 1. pp. 53-64.
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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.",
author = "Rebello, {Salome A.} and Hiromi Koh and Cynthia Chen and Nasheen Naidoo and Odegaard, {Andrew O.} and Koh, {Woon Puay} and Butler, {Lesley M.} and Yuan, {Jian Min} and {Van Dam}, {Rob M.}",
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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.

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