Glycemic index, glycemic load, and cereal fiber intake and risk of type 2 diabetes in US black women.
BACKGROUND
Previous studies of carbohydrate quality and risk of type 2 diabetes mellitus have yielded inconsistent findings. Because diet is in part culturally determined, a study of dietary factors in US black women is of interest.


METHODS
We used data from the Black Women's Health Study, a prospective cohort study of 59,000 US black women, to examine the association of glycemic load, glycemic index, and cereal fiber with risk of type 2 diabetes. Diet was assessed at baseline in 1995 with a modified version of the National Cancer Institute-Block food frequency questionnaire.


RESULTS
During 8 years of follow-up, there were 1,938 incident cases of diabetes. Cox proportional hazards models were used to estimate incidence rate ratios (IRRs) for quintiles of dietary factors, while controlling for lifestyle and dietary factors. Glycemic index was positively associated with the risk of diabetes: the IRR for the highest quintile relative to the lowest was 1.23 (95% confidence interval [CI], 1.05-1.44). Cereal fiber intake was inversely associated with risk of diabetes, with an IRR of 0.82 (95% CI, 0.70-0.96) for the highest vs lowest quintiles of intake. Stronger associations were seen among women with a body mass index (calculated as weight in kilograms divided by height in meters squared) lower than 25: IRRs for the highest vs lowest quintile were 1.91 (95% CI, 1.16-3.16) for glycemic index (P value for interaction, .12) and 0.41 (95% CI, 0.24-0.72) for cereal fiber intake (P value for interaction, .05).


CONCLUSIONS
Increasing cereal fiber in the diet may be an effective means of reducing the risk of type 2 diabetes, a disease that has reached epidemic proportions in black women.
Slone Epidemiology Center, Boston, MA 02215, USA. skrishnan@slone.bu.edu
Supriya
S
Krishnan
Lynn
L
Rosenberg
Martha
M
Singer
Frank B
FB
Hu
Luc
L
Djoussé
L Adrienne
LA
Cupples
Julie R
JR
Palmer
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000208:ethnology* / Q000517:prevention & control; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004043:Dietary Fiber / Q000008:administration & dosage*; D002523:Edible Grain / Q000737:chemistry; D005260:Female; D005500:Follow-Up Studies; D038321:Glycemic Index; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004043:Dietary Fiber