Associations between types and sources of dietary carbohydrates and cardiovascular disease risk: a prospective cohort study of UK Biobank participants

Abstract

Background Recent studies have reported that the associations between dietary carbohydrates and cardiovascular disease (CVD) may depend on the quality, rather than the quantity, of carbohydrates consumed. This study aimed to assess the associations between types and sources of dietary carbohydrates and CVD incidence. A secondary aim was to examine the associations of carbohydrate intakes with triglycerides within lipoprotein subclasses. Methods A total of 110,497 UK Biobank participants with ≥ two (maximum five) 24-h dietary assessments who were free from CVD and diabetes at baseline were included. Multivariable-adjusted Cox regressions were used to estimate risks of incident total CVD (4188 cases), ischaemic heart disease (IHD; 3138) and stroke (1124) by carbohydrate intakes over a median follow-up time of 9.4 years, and the effect of modelled dietary substitutions. The associations of carbohydrate intakes with plasma triglycerides within lipoprotein subclasses as measured by nuclear magnetic resonance (NMR) spectroscopy were examined in 26,095 participants with baseline NMR spectroscopy measurements. Results Total carbohydrate intake was not associated with CVD outcomes. Free sugar intake was positively associated with total CVD (HR; 95% CI per 5% of energy, 1.07;1.03–1.10), IHD (1.06;1.02–1.10), and stroke (1.10;1.04–1.17). Fibre intake was inversely associated with total CVD (HR; 95% CI per 5 g/d, 0.96;0.93–0.99). Modelled isoenergetic substitution of 5% of energy from refined grain starch with wholegrain starch was inversely associated with total CVD (0.94;0.91–0.98) and IHD (0.94;0.90–0.98), and substitution of free sugars with non-free sugars was inversely associated with total CVD (0.95;0.92–0.98) and stroke (0.91;0.86–0.97). Free sugar intake was positively associated with triglycerides within all lipoproteins. Conclusions Higher free sugar intake was associated with higher CVD incidence and higher triglyceride concentrations within all lipoproteins. Higher fibre intake and replacement of refined grain starch and free sugars with wholegrain starch and non-free sugars, respectively, may be protective for incident CVD.

Healthy grocery delivery in the usual care for adults recovering from an acute coronary event: protocol for a three-arm randomised controlled trial

“…We do not yet know if free grocery provision in acute coronary event recovery improves outcomes, or leads to a change in immediate or habitual dietary intakes. The trial is ongoing; therefore, results are not yet known, and no conclusion can be drawn at this time, however, higher dietary fibre and unsaturated fat intakes have been shown effective in the general population17 39 and for those with other NCDs 40 41. Undertaking this trial, however, is an opportunity to answer these research questions, and inform acute CHD management going forward.…”

Dietary patterns, metabolomics and frailty in a large cohort of 120 000 participants

“…, alternate Mediterranean diet [aMED], recommended food score [RFS], dietary approaches to stop hypertension [DASH] and Mediterranean-DASH Intervention for Neurodegenerative Delay [MIND] diet) using the average of at least two repeated 24 h dietary assessments. 24,25 Brief descriptions of the four dietary pattern scores are presented below, and comprehensive information on the compositions and scoring methods is shown in additional file 1: ESI Table 1 †…”

“…To deattenuate the effects of within-person variability and the coefficients for random error, we calculated the dietary pattern scores (i.e., alternate Mediterranean diet [aMED], recommended food score [RFS], dietary approaches to stop hypertension [DASH] and Mediterranean-DASH Intervention for Neurodegenerative Delay [MIND] diet) using the average of at least two repeated 24 h dietary assessments. 24,25 Brief descriptions of the four dietary pattern scores are presented below, and comprehensive information on the compositions and scoring methods is shown in additional file 1: ESI 26 as an adaptation of the Mediterranean diet score (MDS) to the U.S., consists of 9 food components. For alcohol, a value of 1 was given when the intake ranged between 5 g d −1 and 15 g d −1 ; otherwise, the value was 0.…”

Action on the Cerebral Vascular Endothelium in the Prevention of Stroke

“…Different studies demonstrated an association between elevated levels of total cholesterol and LDL-C and increased risk of ischemic stroke [13,14]. A high intake of sugars, including added sugars and those naturally present in honey and fruit juices, is associated with an increased risk of developing cardiovascular diseases and, specifically, stroke [15]. In recent years, several studies have linked stroke with gut dysbiosis (GD) [16].…”