Dietary Fiber, Glycemic Load, and Risk of NIDDM in Men

Author:

Salmerón Jorge12,Ascherio Alberto13,Rimm Eric B13,Colditz Graham A34,Spiegelman Donna35,Jenkins David J6,Stampfer Meir J134,Wing Alvin L3,Willett Walter C134

Affiliation:

1. Department of Nutrition, St. Michael's Hospital Toronto, Ontario, Canada

2. Brigham and Women's Hospital and Harvard Medical School Boston, Massachusetts; Unidad de Investigación Epidemiológica y en Servicios de Salud St. Michael's Hospital Toronto, Ontario, Canada

3. Department of Epidemiology, St. Michael's Hospital Toronto, Ontario, Canada

4. Harvard School of Public Health Channing Laboratory Department of Medicine, St. Michael's Hospital Toronto, Ontario, Canada

5. Department of Biostatistics, St. Michael's Hospital Toronto, Ontario, Canada

6. Instituto Mexicano del Seguro Social México Clinical Nutrition and Risk Factors Modification Center, St. Michael's Hospital Toronto, Ontario, Canada

Abstract

OBJECTIVE Intake of carbohydrates that provide a large glycemic response has been hypothesized to increase the risk of NIDDM, whereas dietary fiber is suspected to reduce incidence. These hypotheses have not been evaluated prospectively. RESEARCH DESIGN AND METHODS We examined the relationship between diet and risk of NIDDM in a cohort of 42,759 men without NIDDM or cardiovascular disease, who were 40–75 years of age in 1986. Diet was assessed at baseline by a validated semiquantitative food frequency questionnaire. During 6-years of follow-up, 523 incident cases of NIDDM were documented. RESULTS The dietary glycemic index (an indicator of carbohydrate's ability to raise blood glucose levels) was positively associated with risk of NIDDM after adjustment for age, BMI, smoking, physical activity, family history of diabetes, alcohol consumption, cereal fiber, and total energy intake. Comparing the highest and lowest quintiles, the relative risk (RR) of NIDDM was 1.37 (95% CI, 1.02–1.83, P trend = 0.03). Cereal fiber was inversely associated with risk of NIDDM (RR = 0.70; 95% CI, 0.51–0.96, P trend = 0.007; for > 8.1 g/day vs. < 3.2 g/day). The combination of a high glycemic load and a low cereal fiber intake further increased the risk of NIDDM (RR = 2.17, 95% CI, 1.04–4.54) when compared with a low glycemic load and high cereal fiber intake. CONCLUSIONS These findings support the hypothesis that diets with a high glycemic load and a low cereal fiber content increase risk of NIDDM in men. Further, they suggest that grains should be consumed in a minimally refined form to reduce the incidence of NIDDM.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

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