title: High Fiber and Low Starch Intakes Are Associated with Circulating Intermediate Biomarkers of Type 2 Diabetes among Women.
abstract: BACKGROUND
  Carbohydrate quality has been consistently related to the risk of type 2 diabetes (T2D). However, limited information is available about the effect of carbohydrate quality on biomarkers related to T2D.
  
  
  OBJECTIVE
  We examined the associations of carbohydrate quality measures (CQMs) including carbohydrate intake; starch intake; glycemic index; glycemic load; total, cereal, fruit, and vegetable fiber intakes; and different combinations of these nutrients with plasma concentrations of adiponectin, C-reactive protein (CRP), and glycated hemoglobin (HbA1c).
  
  
  METHODS
  This is a cross-sectional analysis of 2458 diabetes-free women, ages 43-70 y, in the Nurses Health Study. CQMs were estimated from food-frequency questionnaires, and averages from 1984, 1986, and 1990 were used. Plasma biomarkers were collected in 1990. Multiple linear regression models were used to assess the associations between CQMs and biomarkers.
  
  
  RESULTS
  After age, body mass index, lifestyle, and dietary variables were adjusted, 1) total fiber intake was positively associated with adiponectin (P-trend = 0.004); 2) cereal fiber intake was positively associated with adiponectin and inversely associated with CRP, and fruit fiber intake was negatively associated with HbA1c concentrations (all P-trend < 0.03); 3) starch intake was inversely associated with adiponectin (P-trend = 0.02); 4) a higher glycemic index was associated with lower adiponectin and higher HbA1c (both P-trend < 0.05); 5) a higher carbohydrate-to-total fiber intake ratio was associated with lower adiponectin (P-trend = 0.005); 6) a higher starch-to-total fiber intake ratio was associated with lower adiponectin and higher HbA1c (both P-trend < 0.05); and 7) a higher starch-to-cereal fiber intake ratio was associated with lower adiponectin (P-trend = 0.002).
  
  
  CONCLUSIONS
  A greater fiber intake and a lower starch-to-fiber intake ratio are favorably associated with adiponectin and HbA1c, but only cereal fiber intake was associated with CRP in women. Further research is warranted to understand the potential mechanism of these associations in early progression of T2D.
authors.affiliation: Departments of Nutrition.
authors.forename: Hala B
authors.identifier: http://orcid.org/0000-0002-6871-3379
authors.initials: HB
authors.lastname: AlEssa
authors.affiliation: Departments of Nutrition.
authors.forename: Sylvia H
authors.initials: SH
authors.lastname: Ley
authors.affiliation: Biostatistics, and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Bernard
authors.identifier: http://orcid.org/0000-0001-6907-0056
authors.initials: B
authors.lastname: Rosner
authors.affiliation: Departments of Nutrition.
authors.forename: Vasanti S
authors.initials: VS
authors.lastname: Malik
authors.affiliation: Departments of Nutrition, Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Walter C
authors.identifier: http://orcid.org/0000-0003-1458-7597
authors.initials: WC
authors.lastname: Willett
authors.affiliation: Departments of Nutrition.
authors.forename: Hannia
authors.initials: H
authors.lastname: Campos
authors.affiliation: Departments of Nutrition, Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA Frank.hu@channing.harvard.edu.
authors.forename: Frank B
authors.identifier: http://orcid.org/0000-0002-8412-2261
authors.initials: FB
authors.lastname: Hu
mesh_terms: D052242:Adiponectin / Q000097:blood*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000209:etiology; D004032:Diet; D004034:Diet Surveys; D004040:Dietary Carbohydrates / Q000494:pharmacology*; D004043:Dietary Fiber / Q000494:pharmacology* / Q000627:therapeutic use; D002523:Edible Grain / Q000737:chemistry; D005247:Feeding Behavior; D005260:Female; D005638:Fruit / Q000737:chemistry; D006442:Glycated Hemoglobin / Q000378:metabolism*; D038321:Glycemic Index; D006801:Humans; D008875:Middle Aged; D013213:Starch / Q000494:pharmacology*; D011795:Surveys and Questionnaires
chemical_list: D052242:Adiponectin; D015415:Biomarkers; D001786:Blood Glucose; D002097:C-Reactive Protein; D004040:Dietary Carbohydrates; D004043:Dietary Fiber; D006442:Glycated Hemoglobin; D013213:Starch; C499918:ADIPOQ protein, human
keywords: C-reactive protein; HbA1c; adiponectin; biological markers/blood; carbohydrate quality; carbohydrate-to-fiber ratio; diabetes mellitus; dietary fiber; starch; type 2