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Carbohydrates, glycemic index and diabetes mellitus

Carbohydrate quality, weight change and incident obesity in a Mediterranean cohort: the SUN Project



To evaluate the association between the carbohydrate quality index (CQI) and weight change or incident overweight/obesity (body mass index 25 kg/m2) in the ‘Seguimiento Universidad de Navarra (SUN)’ cohort.


A total of 8741 participants who were initially free of overweight/obesity were followed up for a median of 7.9 years. We evaluated at baseline the CQI according to four criteria: dietary fiber intake, glycemic index, whole grains/total grains ratio and solid carbohydrates/total carbohydrates ratio. Subjects were classified into quintiles according to CQI. Weight was recorded at baseline and updated every 2 years during follow-up.


Increasing CQI of diet was not significantly associated with lower weight gain, although participants in the highest quintile had the lowest average crude weight gain (+211 g/year). We observed 1862 incident cases of overweight/obesity during follow-up. CQI was significantly associated (P for trend 0.006) with a lower risk of overweight/obesity; adjusted odds ratio for the fourth and fifth quintiles were 0.81 (95% confidence interval (CI): 0.66–0.99) and 0.74 (95% CI: 0.60–0.92), respectively.


In this Mediterranean cohort, CQI showed a significant inverse association with the incidence of overweight/obesity, which highlights that carbohydrate intake guidelines related to obesity prevention should be focused on improving the CQI of the diet.

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The authors thank the enthusiastic collaboration and participation of the SUN cohort participants. We also thank the other members of the SUN study Group: Alonso A, Barrio López MT, Basterra-Gortari FJ, Beunza JJ, Carlos Chillerón S, Carmona L, de Irala J, De la Rosa PA, Delgado-Rodriguez M, Donat Vargas CL, Fernández Montero A, Galbete Ciáurriz C, García López M, Gea Sánchez A, Goñi Ochandorena E, Guillen-Grima F, Hernández A, Lahortiga F, Llorca J, Lopez del Burgo C, Marí Sanchís A, Martí del Moral A, Martín Calvo N, Martínez JA, Nuñez-Cordoba JM, Pimenta A, Ruiz Canela M, Ruiz Zambrana A, Sanchez Adán D, Sanchez-Villegas A, Toledo Atucha E, Toledo Atucha J and Vázquez Ruiz Z. We are also grateful to the members of the Department of Nutrition of Harvard School of Public Health (A Ascherio, W Willett and FB Hu), who helped us design the SUN study. The SUN study has received funding from the Instituto de Salud Carlos III, Official Agency of the Spanish Government for biomedical research (Grants PI1002293, PI1002658, RD06/0045, G03/140 and PI13/00615), the Ministerio de Sanidad, Política Social e Igualdad through the Plan Nacional de Drogas (2010/087), the Navarra Regional Government (45/2011) and the University of Navarra.

Author Contributions

The authors’ responsibilities were as follows: IZ, SS and MAM designed research; IZ, SS and MAM conducted the research; CSO, SB, CFA, MBR and MAM provided essential materials; IZ, SS, CSO, MBR and MAM analyzed data or performed statistical analysis; and SS and IZ had primary responsibility for the final content. All authors revised and approved the final manuscript.

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Correspondence to M Á Martínez-González.

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The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.

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Santiago, S., Zazpe, I., Bes-Rastrollo, M. et al. Carbohydrate quality, weight change and incident obesity in a Mediterranean cohort: the SUN Project. Eur J Clin Nutr 69, 297–302 (2015).

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