Randomized Controlled Trial

. 2020 Feb 1;111(2):291-306.

doi: 10.1093/ajcn/nqz298.

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

Miguel A Martínez-González^{1

2

3}, Cesar I Fernandez-Lazaro², Estefanía Toledo^{1

2}, Andrés Díaz-López^{1

4

5}, Dolores Corella^{1

6}, Albert Goday^{1

7}, Dora Romaguera^{1

8}, Jesús Vioque^{9

10}, Ángel M Alonso-Gómez^{1

11}, Julia Wärnberg^{1

12}, J Alfredo Martínez^{1

13

14}, Luís Serra-Majem^{1

15}, Ramon Estruch^{1

16}, Francisco J Tinahones^{1

17}, José Lapetra^{1

18}, Xavier Pintó^{1

19}, Josep A Tur^{1

8

20}, José López-Miranda^{1

21}, Naomi Cano-Ibáñez^{9

22}, Miguel Delgado-Rodríguez^{9

23}, Pilar Matía-Martín²⁴, Lidia Daimiel¹⁴, Vicente Martín Sánchez^{7

25}, Josep Vidal^{26

27}, Clotilde Vázquez^{1

28}, Emilio Ros^{1

29}, Pilar Buil-Cosiales^{1

2

30}, Olga Portoles^{1

6}, María Soria-Florido^{7

31}, Jadwiga Konieczna^{1

8}, Eva M Navarrete-Muñoz^{9

10}, Lucas Tojal-Sierra^{1

11}, José C Fernández-García^{1

17}, Itziar Abete^{1

13}, Patricia Henríquez-Sánchez^{1

15}, Araceli Muñoz-Garach^{1

17}, José M Santos-Lozano^{1

18}, Emili Corbella^{1

19}, Maria Del Mar Bibiloni^{1

8

20}, Nerea Becerra-Tomás^{1

4

5}, Rocío Barragán^{1

6}, Olga Castañer^{1

7}, Miquel Fiol^{1

8}, Manoli García de la Hera^{9

10}, María C Belló-Mora^{1

11}, Alfredo Gea², Nancy Babio^{1

4

5}, Montse Fitó^{1

7}, Miguel Ruiz-Canela^{1

2}, Itziar Zazpe^{1

2

32}, Jordi Salas-Salvadó^{1

4

5

33}

Affiliations

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.

PMID: 31868210
DOI: 10.1093/ajcn/nqz298

Free article

Randomized Controlled Trial

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

Miguel A Martínez-González et al. Am J Clin Nutr. 2020.

Free article

. 2020 Feb 1;111(2):291-306.

doi: 10.1093/ajcn/nqz298.

Authors

Affiliations

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.

PMID: 31868210
DOI: 10.1093/ajcn/nqz298

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.

Keywords: PREDIMED-Plus; carbohydrate; carbohydrate quality index; cardiovascular disease; fiber; glycemic index; obesity; randomized controlled trials.

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Comment in

Dietary carbohydrate and cardiometabolic risk: quality over quantity.
Pereira MA. Pereira MA. Am J Clin Nutr. 2020 Feb 1;111(2):246-247. doi: 10.1093/ajcn/nqz336. Am J Clin Nutr. 2020. PMID: 31927575 No abstract available.

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

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

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