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Carbohydrate restriction in midlife is associated with higher risk of type 2 diabetes among Australian women: a cohort study

Carbohydrate restriction in midlife is associated with higher risk of type 2 diabetes among Australian women: a cohort study
Carbohydrate restriction in midlife is associated with higher risk of type 2 diabetes among Australian women: a cohort study

BACKGROUND AND AIMS: Low-carbohydrate diets (LCDs) are increasingly popular but may be nutritionally inadequate. We aimed to examine if carbohydrate restriction in midlife is associated with risk of developing type 2 diabetes (T2DM), and if this association differs by previous gestational diabetes (GDM) diagnosis.

METHODS AND RESULTS: Dietary intake was assessed for 9689 women from the Australian Longitudinal Study on Women's Health in 2001 (aged 50-55) and 2013 (aged 62-67) via validated food frequency questionnaires. Average long-term carbohydrate restriction was assessed using a low-carbohydrate diet score (highest quartile (Q4) indicating lowest proportion of energy from carbohydrates). Incidence of T2DM between 2001 and 2016 was self-reported at 3-yearly surveys. Log-binomial regression was used to estimate relative risks (RR) and 95% CIs. During 15 years of follow-up, 959 women (9.9%) developed T2DM. Carbohydrate restriction was associated with T2DM after adjustment for sociodemographic factors, history of GDM diagnosis and physical activity (Q4 vs Q1: RR 1.27 [95% CI 1.10, 1.48]), and this was attenuated when additionally adjusted for BMI (1.10 [0.95, 1.27]). Carbohydrate restriction was associated with lower consumption of fruit, cereals and high-fibre bread, and lower intakes of these food groups were associated with higher T2DM risk. Associations did not differ by history of GDM (P for interaction >0.15).

CONCLUSION: Carbohydrate restriction was associated with higher T2DM incidence in middle-aged women, regardless of GDM history. Health professionals should advise women to avoid LCDs that are low in fruit and grains, and to consume a diet in line with current dietary recommendations.

Carbohydrates, Cohort study, Gestational diabetes, Nutrition, Type 2 diabetes
0939-4753
400-409
Rayner, Jessica
c3180f1d-9172-4884-826f-761674331097
D'Arcy, Ellie
55b19f4b-c73c-4e0d-9be9-a53c43bbae7a
Ross, Lynda J.
6f5fbe13-0fe8-43ae-9306-868ce2022fc5
Hodge, Allison
94d87cc7-a4a9-47a5-a41d-0e4f13ecb0d1
Schoenaker, Danielle A.J.M.
84b96b87-4070-45a5-9777-5a1e4e45e818
Rayner, Jessica
c3180f1d-9172-4884-826f-761674331097
D'Arcy, Ellie
55b19f4b-c73c-4e0d-9be9-a53c43bbae7a
Ross, Lynda J.
6f5fbe13-0fe8-43ae-9306-868ce2022fc5
Hodge, Allison
94d87cc7-a4a9-47a5-a41d-0e4f13ecb0d1
Schoenaker, Danielle A.J.M.
84b96b87-4070-45a5-9777-5a1e4e45e818

Rayner, Jessica, D'Arcy, Ellie, Ross, Lynda J., Hodge, Allison and Schoenaker, Danielle A.J.M. (2020) Carbohydrate restriction in midlife is associated with higher risk of type 2 diabetes among Australian women: a cohort study. Nutrition, Metabolism & Cardiovascular Diseases, 30 (3), 400-409. (doi:10.1016/j.numecd.2019.11.001).

Record type: Article

Abstract

BACKGROUND AND AIMS: Low-carbohydrate diets (LCDs) are increasingly popular but may be nutritionally inadequate. We aimed to examine if carbohydrate restriction in midlife is associated with risk of developing type 2 diabetes (T2DM), and if this association differs by previous gestational diabetes (GDM) diagnosis.

METHODS AND RESULTS: Dietary intake was assessed for 9689 women from the Australian Longitudinal Study on Women's Health in 2001 (aged 50-55) and 2013 (aged 62-67) via validated food frequency questionnaires. Average long-term carbohydrate restriction was assessed using a low-carbohydrate diet score (highest quartile (Q4) indicating lowest proportion of energy from carbohydrates). Incidence of T2DM between 2001 and 2016 was self-reported at 3-yearly surveys. Log-binomial regression was used to estimate relative risks (RR) and 95% CIs. During 15 years of follow-up, 959 women (9.9%) developed T2DM. Carbohydrate restriction was associated with T2DM after adjustment for sociodemographic factors, history of GDM diagnosis and physical activity (Q4 vs Q1: RR 1.27 [95% CI 1.10, 1.48]), and this was attenuated when additionally adjusted for BMI (1.10 [0.95, 1.27]). Carbohydrate restriction was associated with lower consumption of fruit, cereals and high-fibre bread, and lower intakes of these food groups were associated with higher T2DM risk. Associations did not differ by history of GDM (P for interaction >0.15).

CONCLUSION: Carbohydrate restriction was associated with higher T2DM incidence in middle-aged women, regardless of GDM history. Health professionals should advise women to avoid LCDs that are low in fruit and grains, and to consume a diet in line with current dietary recommendations.

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More information

Accepted/In Press date: 1 November 2019
e-pub ahead of print date: 16 November 2019
Published date: 9 March 2020
Keywords: Carbohydrates, Cohort study, Gestational diabetes, Nutrition, Type 2 diabetes

Identifiers

Local EPrints ID: 441331
URI: http://eprints.soton.ac.uk/id/eprint/441331
ISSN: 0939-4753
PURE UUID: 078a8d52-4acc-4f4a-907f-6e20d9adb105
ORCID for Danielle A.J.M. Schoenaker: ORCID iD orcid.org/0000-0002-7652-990X

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Date deposited: 10 Jun 2020 16:30
Last modified: 09 Jan 2022 04:10

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Contributors

Author: Jessica Rayner
Author: Ellie D'Arcy
Author: Lynda J. Ross
Author: Allison Hodge

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