Carbohydrate quality changes and concurrent changes in cardiovascular risk factors: a longitudinal analysis in the PREDIMED-Plus randomized trial-Reference-Cited by-同舟云学术

Carbohydrate quality changes and concurrent changes in cardiovascular risk factors: a longitudinal analysis in the PREDIMED-Plus randomized trial

Published:2019-12-23 Issue:2 Volume:111 Page:291-306
ISSN:0002-9165
Container-title:The American Journal of Clinical Nutrition
language:en
Short-container-title:

Author:

Martínez-González Miguel A¹²³,Fernandez-Lazaro Cesar I²,Toledo Estefanía¹²,Díaz-López Andrés¹⁴⁵,Corella Dolores¹⁶,Goday Albert¹⁷,Romaguera Dora¹⁸,Vioque Jesús⁹¹⁰,Alonso-Gómez Ángel M¹¹¹,Wärnberg Julia¹¹²,Martínez J Alfredo¹¹³¹⁴,Serra-Majem Luís¹¹⁵,Estruch Ramon¹¹⁶,Tinahones Francisco J¹¹⁷,Lapetra José¹¹⁸,Pintó Xavier¹¹⁹,Tur Josep A¹⁸²⁰,López-Miranda José¹²¹,Cano-Ibáñez Naomi⁹²²,Delgado-Rodríguez Miguel⁹²³,Matía-Martín Pilar²⁴,Daimiel Lidia¹⁴,Sánchez Vicente Martín⁷²⁵,Vidal Josep²⁶²⁷,Vázquez Clotilde¹²⁸,Ros Emilio¹²⁹,Buil-Cosiales Pilar¹²³⁰,Portoles Olga¹⁶,Soria-Florido María⁷³¹,Konieczna Jadwiga¹⁸,Navarrete-Muñoz Eva M⁹¹⁰,Tojal-Sierra Lucas¹¹¹,Fernández-García José C¹¹⁷,Abete Itziar¹¹³,Henríquez-Sánchez Patricia¹¹⁵,Muñoz-Garach Araceli¹¹⁷,Santos-Lozano José M¹¹⁸,Corbella Emili¹¹⁹,Bibiloni Maria del Mar¹⁸²⁰,Becerra-Tomás Nerea¹⁴⁵,Barragán Rocío¹⁶,Castañer Olga¹⁷,Fiol Miquel¹⁸,García de la Hera Manoli⁹¹⁰,Belló-Mora María C¹¹¹,Gea Alfredo²,Babio Nancy¹⁴⁵,Fitó Montse¹⁷,Ruiz-Canela Miguel¹²,Zazpe Itziar¹²³²,Salas-Salvadó Jordi¹⁴⁵³³

Affiliation:

1. Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain

2. University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, IdiSNA, Pamplona, Spain

3. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

4. Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain

5. Institut d'Investigació Sanitària Pere Virgili, Reus, Spain

6. Department of Preventive Medicine, University of Valencia, Valencia, Spain

7. Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d'Investigació Médica, Barcelona, Spain

8. Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain

9. CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain

10. Miguel Hernandez University, ISABIAL-FISABIO, Alicante, Spain

11. Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain

12. Department of Nursing, School of Health Sciences, University of Málaga Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain

13. Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, Pamplona, Spain

14. Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, Madrid, Spain

15. Nutrition Research Group, Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain

16. Department of Internal Medicine, Institut d'Investigacions Biomédiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain

17. Virgen de la Victoria Hospital, Department of Endocrinology, IBIMA, University of Málaga, Málaga, Spain

18. Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain

19. Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, Hospitalet de Llobregat, Barcelona Spain

20. Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain

21. Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain

22. Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain

23. Division of Preventive Medicine, University of Jaén, Jaén, Spain

24. Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain

25. Institute of Biomedicine, University of León, León, Spain

26. CIBER Diabetes y Enfermedades Metabólicas, Instituto de Salud Carlos III (ISCIII), Madrid, Spain

27. Department of Endocrinology, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain

28. Department of Endocrinology and Nutrition, Hospital Fundación Jiménez Díaz, Instituto de Investigaciones Biomédicas IISFJD, University Autonoma, Madrid, Spain

29. Lipid Clinic, Department of Endocrinology and Nutrition, IDIBAPS, Hospital Clínic, Barcelona, Spain

30. Atención Primaria, Servicio Navarro de Salud, Pamplona, Navarra, Spain

31. Department of Nutrition, Food Sciences and Gastronomy, University of Barcelona, Barcelona, Spain

32. Department of Nutrition and Food Sciences and Physiology, School of Pharmacy and Nutrition, University of Navarra

33. University Hospital of Sant Joan de Reus, Nutrition Unit, Reus, Spain

Abstract

ABSTRACT Background Overall quality of dietary carbohydrate intake rather than total carbohydrate intake may determine the risk of cardiovascular disease (CVD). Objective We examined 6- and 12-mo changes in carbohydrate quality index (CQI) and concurrent changes in several CVD risk factors in a multicenter, randomized, primary-prevention trial (PREDIMED-Plus) based on an intensive weight-loss lifestyle intervention program. Methods Prospective analysis of 5373 overweight/obese Spanish adults (aged 55–75 y) with metabolic syndrome (MetS). Dietary intake information obtained from a validated 143-item semiquantitative food-frequency questionnaire was used to calculate 6- and 12-mo changes in CQI (categorized in quintiles), based on 4 criteria (total dietary fiber intake, glycemic index, whole grain/total grain ratio, and solid carbohydrate/total carbohydrate ratio). The outcomes were changes in intermediate markers of CVD. Results During the 12-mo follow-up, the majority of participants improved their CQI by increasing their consumption of fruits, vegetables, legumes, fish, and nuts and decreasing their consumption of refined cereals, added sugars, and sugar-sweetened beverages. After 6 mo, body weight, waist circumference (WC), systolic and diastolic blood pressure (BP), fasting blood glucose, glycated hemoglobin (HbA1c), triglyceride levels, triglycerides and glucose (TyG) index, and TyG-WC decreased across successive quintiles of improvement in the CQI. After 12 mo, improvements were additionally observed for HDL cholesterol and for the ratio of total to HDL cholesterol. Favorable improvements (expressed in common units of SD and 95% CI) for quintile 5 compared with quintile 1 of CQI change were observed for most risk factors, including TyG-WC (SD −0.20; 95% CI −0.26, −0.15), HbA1c (SD −0.16; 95% CI −0.23, −0.10), weight (SD −0.12; 95% CI −0.14, −0.09), systolic BP (SD −0.11; 95% CI −0.19, −0.02) and diastolic BP (SD −0.11; 95% CI −0.19, −0.04). Conclusions Improvements in CQI were strongly associated with concurrent favorable CVD risk factor changes maintained over time in overweight/obese adults with MetS. This trial was registered as ISRCTN 89898870.

Funder

European Research Council

CIBER

CIBER de Fisiopatología de la Obesidad y Nutrición

Instituto de Salud Carlos III

Fondo de Investigación en Salud

European Regional Development Fund

Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte

Consejería de Salud de la Junta de Andalucía

Publisher

Oxford University Press (OUP)

Subject