title: Carbohydrate quantity and quality and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) study.
abstract: BACKGROUND
  Carbohydrate quantity and quality may play an important role in the development of type 2 diabetes.
  
  
  OBJECTIVE
  We investigated the associations of dietary glycemic load (GL), glycemic index (GI), carbohydrate, and fiber intake with the incidence of type 2 diabetes.
  
  
  METHODS
  A prospective cohort study was conducted in 37,846 participants of the EPIC-NL (European Prospective Investigation into Cancer and Nutrition-Netherlands) study, aged 21-70 y at baseline and free of diabetes. Dietary intake was assessed with the use of a validated food-frequency questionnaire. Incident diabetes cases were mainly self-reported and verified against general practitioner records.
  
  
  RESULTS
  During a mean follow-up of 10 y, 915 incident diabetes cases were documented. Dietary GL was associated with an increased diabetes risk after adjustment for age, sex, established diabetes risk factors, and dietary factors [hazard ratio (HR) per SD increase: 1.27; 95% CI: 1.11, 1.44; P < 0.001] [corrected]. GI tended to increase diabetes risk (HR: 1.08; 95% CI: 1.00, 1.17; P = 0.05). Dietary fiber was inversely associated with diabetes risk (HR: 0.92; 95% CI: 0.85, 0.99; P < 0.05), whereas carbohydrate intake was associated with increased diabetes risk (HR: 1.15; 95% CI: 1.01, 1.32; P < 0.05). Of the carbohydrate subtypes, only starch was related to increased diabetes risk [HR: 1.25 (1.07, 1.46), P < 0.05]. All associations became slightly stronger after exclusion of energy misreporters.
  
  
  CONCLUSIONS
  Diets high in GL, GI, and starch and low in fiber were associated with an increased diabetes risk. Both carbohydrate quantity and quality seem to be important factors in diabetes prevention. Energy misreporting contributed to a slight attenuation of associations.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands. i.sluijs-2@umcutrecht.nl
authors.forename: Ivonne
authors.initials: I
authors.lastname: Sluijs
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.forename: Daphne L
authors.initials: DL
authors.lastname: van der A
authors.forename: Annemieke M
authors.initials: AM
authors.lastname: Spijkerman
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Joline W
authors.initials: JW
authors.lastname: Beulens
mesh_terms: D000328:Adult; D000368:Aged; D001481:Basal Metabolism; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004040:Dietary Carbohydrates / Q000009:adverse effects* / Q000592:standards; D002149:Energy Intake; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D038321:Glycemic Index; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013213:Starch; D013395:Sucrose; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D004040:Dietary Carbohydrates; D013395:Sucrose; D013213:Starch