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Carbohydrates, glycemic index and diabetes mellitus

Carbohydrate substitution for fat or protein and risk of type 2 diabetes in male smokers

European Journal of Clinical Nutrition volume 66, pages 716–721 (2012)Cite this article

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Abstract

BACKGROUND/OBJECTIVES:

We examined the associations between carbohydrate substitutions (total; low-, medium-, high-glycemic index (GI) carbohydrates) for fat or protein and risk of type 2 diabetes.

SUBJECTS/METHODS:

The cohort comprised 25 943 male smokers among whom 1098 diabetes cases were identified from a national register during a 12-year follow-up. Diet was assessed by a validated food frequency questionnaire. The relative risks (RR) and confidence intervals (CI) for diabetes were analyzed using Cox proportional hazard modeling, and multivariate nutrient density models were applied to examine the associations between substitutions of macronutrients and diabetes risk.

RESULTS:

The risk of diabetes was lower when fat or protein was replaced with an isoenergetic amount (2% of energy intake) of carbohydrates, the multivariate RRs were 0.96 (95% CI: 0.94, 0.99) and 0.85 (95% CI: 0.80, 0.90), respectively. The lower risks were due to replacing saturated plus trans fatty acids, and meat, milk or plant protein with carbohydrates, respectively. Low-, medium- or high-GI carbohydrates did not associate with lower diabetes risk when replacing fat or fatty acids, except when total fat was replaced with medium-GI carbohydrates. Low-, medium- and high-GI carbohydrates had similar inverse associations with diabetes risk when they replaced total, meat or milk protein.

CONCLUSION:

Higher carbohydrate intake at the expense of fat, attributable to trans and saturated fatty acids, or protein was associated with decreased diabetes risk. Replacing fat or protein with lower-GI carbohydrates was not more beneficial than replacing it with higher-GI carbohydrates.

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Acknowledgements

The ATBC Study was supported by the US Public Health Service contracts (N01-CN-45165, N01-RC-45035, and N01-RC-37004) from the National Cancer Institute. This work was supported by the Academy of Finland (Grants no. 111420, 141005), Doctoral Programs in Public Health, the Finnish Cultural Foundation, the Kyllikki and Uolevi Lehikoinen Foundation, and the Juho Vainio Foundation.

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Authors and Affiliations

  1. The Division of Welfare and Health Promotion, National Institute for Health and Welfare, Helsinki, Finland

    M E Similä, J P Kontto, L M Valsta, S Männistö & J Virtamo

  2. The Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

    D Albanes

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  1. M E Similä
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  2. J P Kontto
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Correspondence to M E Similä.

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Similä, M., Kontto, J., Valsta, L. et al. Carbohydrate substitution for fat or protein and risk of type 2 diabetes in male smokers. Eur J Clin Nutr 66, 716–721 (2012). https://doi.org/10.1038/ejcn.2012.24

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