ABSTRACT
BACKGROUND AND AIMS: Beyond the quantity of carbohydrate intake, further research is needed to know the relevance of carbohydrate quality following operational indices. No previous longitudinal study has assessed the association between an index for quality of dietary carbohydrate intake and the risk of cardiovascular disease (CVD). Here, we examined the association between a carbohydrate quality index (CQI) and the risk of CVD. METHODS AND RESULTS: We used a validated semi-quantitative 136-item food-frequency questionnaire (FFQ) in a prospective follow-up study of 17,424 middle-aged adults from Spain. The CQI was defined by four criteria: dietary fiber intake, glycemic index, whole-grain/total-grain carbohydrate ratio, and solid/total carbohydrate ratio. We observed 129 incident cases of CVD during 10.1 y of median follow-up. An inverse association for CQI was found (hazard ratio = 0.44, 95% confidence interval (CI): 0.25-0.78 for the highest versus the lowest tertile, p for trend = 0.008). Participants in the highest tertile of the whole-grain/total-grain carbohydrate ratio had 47% lower risk of CVD (95% CI: 0.33-0.85, p for trend = 0.008). Participants with higher baseline CQI and higher baseline energy from carbohydrates had the lowest risk of CVD. CONCLUSION: In this Mediterranean cohort, a better quality of dietary carbohydrates measured by the CQI, showed a significant inverse association with the incidence of CVD. Specially, a higher proportion of carbohydrates from whole grains was strongly inversely associated with CVD. "Heart-healthy" diets should be focused not only on carbohydrate quantity but also on a multidimensional assessment of the type and quality of carbohydrates.
Subject(s)
Cardiovascular Diseases/epidemiology , Dietary Carbohydrates/metabolism , Glycemic Index , Whole Grains/metabolism , Adult , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/prevention & control , Diet, Healthy , Dietary Carbohydrates/adverse effects , Dietary Carbohydrates/classification , Dietary Fiber/metabolism , Energy Intake , Feeding Behavior , Female , Follow-Up Studies , Humans , Incidence , Longitudinal Studies , Male , Middle Aged , Prospective Studies , Protective Factors , Recommended Dietary Allowances , Risk Assessment , Risk Factors , Spain/epidemiology , Surveys and Questionnaires , Whole Grains/classificationABSTRACT
Mineral availability from sorghum grain in some varieties may be low because of the presence of phytates and tannins. However, heat processing of sorghum may lower tannin and phytate levels and thus improve mineral availability. Sorghum has potential in the manufacture of gluten free breakfast cereals, therefore flaked breakfast cereals were manufactured from whole grains of three contrasting sorghum varieties and compared to that manufactured from whole grain wheat. The content of tannin, phytate, minerals (Ca, Fe and Zn), in vitro mineral availability and phytate: mineral molar ratios were determined in the raw whole grain flours and the cooked flaked breakfast cereal. For all grain varieties, the in vitro mineral availability of flaked breakfast cereal was higher than the raw flours, an effect most probably related to the concomitant reduction in tannins and phytate levels after processing. The in vitro mineral availability of the flaked wheat breakfast cereal was significantly higher than that of all sorghum breakfast cereals, with that manufactured from the brown sorghum IS8237C having the lowest value (p≤0.05). Given that the sorghum varieties in this study gave lower mineral availability than wheat, other sorghum varieties now require evaluation to identify those with improved mineral availability.
Subject(s)
Breakfast , Food Handling/methods , Minerals/analysis , Nutritive Value , Phytic Acid/analysis , Sorghum/chemistry , Tannins/analysis , Whole Grains/chemistry , Calcium/analysis , Digestion , Flour/analysis , Gastric Juice/chemistry , Intestinal Secretions/chemistry , Iron/analysis , Sorghum/classification , Whole Grains/classification , Zinc/analysisABSTRACT
The aim of this paper is to analyze the a priori dietary indexes used in the studies that have evaluated the role of the Mediterranean Diet in influencing the risk of developing cardiovascular disease. All the studies show that this dietary pattern protects against cardiovascular disease, but studies show quite different effects on specific conditions such as coronary heart disease or cerebrovascular disease. A priori dietary indexes used to measure dietary exposure imply quantitative and/or qualitative divergences from the traditional Mediterranean Diet of the early 1960s, and, therefore, it is very difficult to compare the results of different studies. Based on real cultural heritage and traditions, we believe that the a priori indexes used to evaluate adherence to the Mediterranean Diet should consider classifying whole grains and refined grains, olive oil and monounsaturated fats, and wine and alcohol differently.