A Low-Fat Dietary Pattern and Diabetes: A Secondary Analysis From the Women’s Health Initiative Dietary Modification Trial

Howard, Barbara V.; Aragaki, Aaron K.; Tinker, Lesley F.; Allison, Matthew; Hingle, Melanie; Johnson, Karen C.; Manson, Jo Ann E.; Shadyab, Aladdin H.; Shikany, James M.; Snetselaar, Linda; Thomson, Cynthia A.; Zaslavsky, Oleg; Prentice, Ross L.

doi:10.2337/dc17-0534

Cited by 32 publications

(21 citation statements)

References 23 publications

(16 reference statements)

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“…Notably, participants in this trial increased carbohydrate intake by ~ 8% of energy, with a corresponding reciprocal decrease in fat intake of ~ 8%. This also supports the assertion that greater carbohydrate intake, particularly from grains and fruits, could delay progression to T2DM [4].…”

Section: Discussionsupporting

confidence: 85%

“…It is clear that body fat accumulation is the dominant factor behind development of type 2 diabetes mellitus (T2DM), and consistent evidence shows that reversing that process by weight loss is the key mechanism for prevention, as well as for remission of established T2DM [2]. Several large diabetes prevention trials have shown modest weight loss to be effective, principally by lowering fat intake (< 30%E) along with lifestyle modification [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Lower carbohydrate and higher fat intakes are associated with higher hemoglobin A1c: findings from the UK National Diet and Nutrition Survey 2008–2016

2019

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Purpose Evidence of low-carbohydrate, high-fat diets (LCHF) for type 2 diabetes (T2DM) prevention is scarce. We investigated how carbohydrate intake relates to HbA1c and T2DM prevalence in a nationally representative survey dataset. Methods We analyzed dietary information (4-day food diaries) from 3234 individuals aged ≥ 16 years, in eight waves of the UK National Diet and Nutrition Survey (2008-2016). We calculated LCHF scores (0-20, higher score indicating lower %food energy from carbohydrate, with reciprocal higher contribution from fat) and UK Dietary Reference Value (DRV) scores (0-16, based on UK dietary recommendations). Associations between macronutrients and diet scores and diabetes prevalence were analyzed (in the whole sample) using multivariate logistic regression. Among those without diabetes, analyses between exposures and %HbA1c (continuous) were analyzed using multivariate linear regression. All analyses were adjusted for age, sex, body mass index, ethnicity, smoking status, total energy intake, socioeconomic status and survey years. Results In the overall study sample, 194 (6.0%) had diabetes. Mean intake was 48.0%E for carbohydrates, and 34.9%E for total fat. Every 5%E decrease in carbohydrate, and every 5%E increase in fat, was associated with 12% (95% CI 0.78-0.99; P = 0.03) and 17% (95% CI 1.02-1.33; P = 0.02) higher odds of diabetes, respectively. Each two-point increase in LCHF score is related to 8% (95% CI 1.02-1.14; P = 0.006) higher odds of diabetes, while there was no evidence for association between DRV score and diabetes. Among the participants without diagnosed diabetes (n = 3130), every 5%E decrease in carbohydrate was associated with higher %HbA1c by + 0.016% (95% CI 0.004-0.029; P = 0.012), whereas every 5%E increase in fat was associated with higher %HbA1c by + 0.029% (95% CI 0.015-0.043; P < 0.001). Each two-point increase in LCHF score is related to higher %HbA1c by + 0.010% (0.1 mmol/mol), while each two-point increase in the DRV score is related to lower %HbA1c by − 0.023% (0.23 mmol/mol). Conclusions Lower carbohydrate and higher fat intakes were associated with higher HbA1c and greater odds of having diabetes. These data do not support low(er) carbohydrate diets for diabetes prevention. Keywords Reduced carbohydrate diet • Carbohydrate-restricted diet • High-fat diet • Dietary recommendation • Glycated hemoglobin • Type 2 diabetes Abbreviations T2DM Type 2 diabetes LCHF Low-carbohydrate, high-fat diet NDNS National diet and nutrition survey DRV Dietary reference value NMES Non-milk extrinsic sugar NSP Non-starch polysaccharide BMI Body mass index NS-SEC National statistics socioeconomic classification Electronic supplementary material The online version of this article (

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Lower carbohydrate and higher fat intakes are associated with higher hemoglobin A1c: findings from the UK National Diet and Nutrition Survey 2008–2016

2019

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“…In people who are predisposed (for genetic and other reasons), fat accumulates in ectopic sites including liver and pancreas, which damages organ functions (12) , (Figure 1). Reversing that process by weight loss of at least 3-7% is a key mechanism to prevent or delay onset of T2D (13)(14)(15)(16) , and remission of established T2D can be achieved by greater loss, >15% for greatest success, with an intensive weight management program (17) .…”

Section: Type 2 Diabetes: a Disease Process Of Obesitymentioning

confidence: 99%

“…Several large 'diabetes prevention' trials have shown a clear benefit on T2D risk reduction principally by modest weight loss mainly by lowering fat intake (<30%E). Other lifestyle modifications have more modest value (13)(14)(15)(16) . While weight loss by LFD has been largely incorporated in 'diabetes prevention' trials, the randomised controlled trials (RCT) of LCDs for weight loss do not have long enough follow-up to evaluate incident T2D and were not designed to study incident T2D as a primary outcome.…”

Section: Opportunities For the Use Of Low-carbohydrate Diets For Diabmentioning

confidence: 99%

Low and reduced carbohydrate diets: challenges and opportunities for type 2 diabetes management and prevention

2020

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Low-carbohydrate diets (LCD) have been promoted for weight control and type 2 diabetes (T2D) management, based on an emerging body of evidence, including meta-analyses with an indication of publication bias. Proposed definitions vary between 50 and 130 g/d, or <10 and <40 % of energy from carbohydrate, with no consensus on LCD compositional criteria. LCD are usually followed with limited consideration for other macronutrients in the overall diet composition, introducing variance in the constituent foods and in metabolic responses. For weight management, extensive evidence supports LCD as a valid weight loss treatment, up to 1–2 years. Solely lowering carbohydrate intake does not, in the medium/long term, reduce HbA1c for T2D prevention or treatment, as many mechanisms interplay. Under controlled feeding conditions, LCD are not physiologically or clinically superior to diets with higher carbohydrates for weight-loss, fat loss, energy expenditure or glycaemic outcomes; indeed, all metabolic improvements require weight loss. Long-term evidence also links the LCD pattern to increased CVD risks and mortality. LCD can lead to micronutrient deficiencies and increased LDL-cholesterol, depending on food selection to replace carbohydrates. Evidence is limited but promising regarding food choices/sources to replace high-carbohydrate foods that may alleviate the negative effects of LCD, demanding further insight into the dietary practice of medium to long term LCD followers. Long-term, high-quality studies of LCD with different food sources (animal and/or plant origins) are needed, aiming for clinical endpoints (T2D incidence and remission, cardiovascular events, mortality). Ensuring micronutrient adequacy by food selection or supplementation should be considered for people who wish to pursue long-term LCD.

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“…High fruit and vegetable intake has been suggested to have an important role in prevention of this disorder 2. Evidence from prospective studies linking fruit and vegetable intake with type 2 diabetes is inconsistent and weak,345, and evidence from randomised controlled trials is sparse 6. Previous research studies have typically used dietary food frequency questionnaires to assess fruit and vegetable intake, which are subject to measurement error and recall bias 7.…”

Section: Introductionmentioning

confidence: 99%

Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries

Zheng

Sharp

Imamura

et al. 2020

BMJ

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Abstract Objective To investigate the association of plasma vitamin C and carotenoids, as indicators of fruit and vegetable intake, with the risk of type 2 diabetes. Design Prospective case-cohort study. Setting Populations from eight European countries. Participants 9754 participants with incident type 2 diabetes, and a subcohort of 13 662 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort of 340 234 participants: EPIC-InterAct case-cohort study. Main outcome measure Incident type 2 diabetes. Results In a multivariable adjusted model, higher plasma vitamin C was associated with a lower risk of developing type 2 diabetes (hazard ratio per standard deviation 0.82, 95% confidence interval 0.76 to 0.89). A similar inverse association was shown for total carotenoids (hazard ratio per standard deviation 0.75, 0.68 to 0.82). A composite biomarker score (split into five equal groups), comprising vitamin C and individual carotenoids, was inversely associated with type 2 diabetes with hazard ratios 0.77, 0.66, 0.59, and 0.50 for groups 2-5 compared with group 1 (the lowest group). Self-reported median fruit and vegetable intake was 274 g/day, 396 g/day, and 508 g/day for participants in categories defined by groups 1, 3, and 5 of the composite biomarker score, respectively. One standard deviation difference in the composite biomarker score, equivalent to a 66 (95% confidence interval 61 to 71) g/day difference in total fruit and vegetable intake, was associated with a hazard ratio of 0.75 (0.67 to 0.83). This would be equivalent to an absolute risk reduction of 0.95 per 1000 person years of follow up if achieved across an entire population with the characteristics of the eight European countries included in this analysis. Conclusions These findings indicate an inverse association between plasma vitamin C, carotenoids, and their composite biomarker score, and incident type 2 diabetes in different European countries. These biomarkers are objective indicators of fruit and vegetable consumption, and suggest that diets rich in even modestly higher fruit and vegetable consumption could help to prevent development of type 2 diabetes.

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A Low-Fat Dietary Pattern and Diabetes: A Secondary Analysis From the Women’s Health Initiative Dietary Modification Trial

Abstract: In this secondary analysis, a dietary intervention in postmenopausal women aimed at reducing fat and increasing intake of vegetables, fruits, and grains did not increase risk of diabetes and may have slowed progression.

Cited by 32 publications

References 23 publications

Lower carbohydrate and higher fat intakes are associated with higher hemoglobin A1c: findings from the UK National Diet and Nutrition Survey 2008–2016

Lower carbohydrate and higher fat intakes are associated with higher hemoglobin A1c: findings from the UK National Diet and Nutrition Survey 2008–2016

Low and reduced carbohydrate diets: challenges and opportunities for type 2 diabetes management and prevention

Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries

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