title: Dietary fiber, carbohydrate quality and quantity, and mortality risk of individuals with diabetes mellitus.
abstract: BACKGROUND
  Dietary fiber, carbohydrate quality and quantity are associated with mortality risk in the general population. Whether this is also the case among diabetes patients is unknown.
  
  
  OBJECTIVE
  To assess the associations of dietary fiber, glycemic load, glycemic index, carbohydrate, sugar, and starch intake with mortality risk in individuals with diabetes.
  
  
  METHODS
  This study was a prospective cohort study among 6,192 individuals with confirmed diabetes mellitus (mean age of 57.4 years, and median diabetes duration of 4.4 years at baseline) from the European Prospective Investigation into Cancer and Nutrition (EPIC). Dietary intake was assessed at baseline (1992-2000) with validated dietary questionnaires. Cox proportional hazards analysis was performed to estimate hazard ratios (HRs) for all-cause and cardiovascular mortality, while adjusting for CVD-related, diabetes-related, and nutritional factors.
  
  
  RESULTS
  During a median follow-up of 9.2 y, 791 deaths were recorded, 306 due to CVD. Dietary fiber was inversely associated with all-cause mortality risk (adjusted HR per SD increase, 0.83 [95% CI, 0.75-0.91]) and CVD mortality risk (0.76[0.64-0.89]). No significant associations were observed for glycemic load, glycemic index, carbohydrate, sugar, or starch. Glycemic load (1.42[1.07-1.88]), carbohydrate (1.67[1.18-2.37]) and sugar intake (1.53[1.12-2.09]) were associated with an increased total mortality risk among normal weight individuals (BMI≤25 kg/m(2); 22% of study population) but not among overweight individuals (P interaction≤0.04). These associations became stronger after exclusion of energy misreporters.
  
  
  CONCLUSIONS
  High fiber intake was associated with a decreased mortality risk. High glycemic load, carbohydrate and sugar intake were associated with an increased mortality risk in normal weight individuals with diabetes.
authors.affiliation: University Medical Center, Utrecht, The Netherlands.
authors.forename: Koert N J
authors.initials: KN
authors.lastname: Burger
authors.forename: Joline W J
authors.initials: JW
authors.lastname: Beulens
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.forename: Ivonne
authors.initials: I
authors.lastname: Sluijs
authors.forename: Annemieke M W
authors.initials: AM
authors.lastname: Spijkerman
authors.forename: Diewertje
authors.initials: D
authors.lastname: Sluik
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.forename: Birgit
authors.initials: B
authors.lastname: Teucher
authors.forename: Claus
authors.initials: C
authors.lastname: Dethlefsen
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.forename: Cecilie
authors.initials: C
authors.lastname: Kyrø
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bendinelli
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.forename: Peter M
authors.initials: PM
authors.lastname: Nilsson
authors.forename: Marju
authors.initials: M
authors.lastname: Orho-Melander
authors.forename: Olov
authors.initials: O
authors.lastname: Rolandsson
authors.forename: José María
authors.initials: JM
authors.lastname: Huerta
authors.forename: Francesca
authors.initials: F
authors.lastname: Crowe
authors.forename: Naomi
authors.initials: N
authors.lastname: Allen
authors.forename: Ute
authors.initials: U
authors.lastname: Nöthlings
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D004040:Dietary Carbohydrates / Q000032:analysis* / Q000494:pharmacology*; D004043:Dietary Fiber / Q000032:analysis* / Q000494:pharmacology*; D005260:Female; D038321:Glycemic Index / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D012907:Smoking
chemical_list: D004040:Dietary Carbohydrates; D004043:Dietary Fiber