Is the Proportion of Carbohydrate Intake Associated with the Incidence of Diabetes Complications?-An Analysis of the Japan Diabetes Complications Study.
The appropriate proportions of macronutritional intake have been controversial in medical nutritional therapy for diabetes, and evidence of the effects of carbohydrate consumption on diabetes complications in prospective settings is sparse. We investigated the relationships between proportions of carbohydrate intake as the % of total energy and diabetes complications in a nationwide cohort of Japanese patients with type 2 diabetes aged 40-70 years with hemoglobin A1c ≥6.5%. The analysis was of 1516 responders to a baseline dietary survey assessed by the Food Frequency Questionnaire based on food groups. Primary outcomes were times to overt nephropathy, diabetic retinopathy, and cardiovascular disease (CVD) after 8 years. Hazard ratios (HRs) for proportions of carbohydrate intake were estimated by Cox regression adjusted for confounders. High carbohydrate intake was significantly related to higher intakes of grain, fruits, and sweets/snacks and lower intakes of soybean and soy products, vegetables, seaweed, meat and processed meat, fish and processed fish, eggs, milk and dairy products, oil, and alcoholic beverages. During the eight-year follow-up, there were 81, 275, and 129 events of overt nephropathy, diabetic retinopathy, and CVD, respectively. After adjustment for confounders, HRs for complications in patients with carbohydrate intake in the second or third tertiles (51.0%-56.4% and ≥56.5%, respectively) compared with carbohydrate intake in the first tertile (<50.9%, referent) were analyzed. No significant associations were shown in the second and third tertiles relative to first tertile (overt nephropathy: 1.05 (95% Confidence Interval, 0.54-2.06) and 0.98 (0.40-2.44); diabetic retinopathy: 1.30 (0.90-1.88) and 1.30 (0.78-2.15); and CVD: 0.95 (0.55-1.63) and 1.37 (0.69-2.72)). By exploring potentially nonlinear relationships, trends for the incidence of diabetes complications according to proportions of carbohydrate intake were not clearly shown. Findings suggested that proportions of carbohydrate intake were not associated with the incidence of diabetes complications among type 2 diabetes patients in Japan.
Department of Health and Nutrition, University of Niigata Prefecture Faculty of Human Life Studies, Niigata 950-8680, Japan. horikawa@unii.ac.jp.|Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata 951-8510, Japan. horikawa@unii.ac.jp.
Chika
C
Horikawa
Training Department of Administrative Dietitians, Shikoku University, Tokushima, Tokushima 771-1151, Japan. yyoshimura@shikoku-u.ac.jp.
Yukio
Y
Yoshimura
Training Department of Administrative Dietitians, Shikoku University, Tokushima, Tokushima 771-1151, Japan. c-kamada@shikoku-u.ac.jp.
Chiemi
C
Kamada
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto 606-8501, Japan. tanaka.shiro.8n@kyoto-u.ac.jp.
Shiro
S
Tanaka
Department of Public Health, Shiga University of Medical Science, Sihga 520-2192, Japan. sachikot@belle.shiga-med.ac.jp.
Sachiko
S
Tanaka
Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata 951-8510, Japan. smhm@med.niigata-u.ac.jp.
Satoshi
S
Matsunaga
Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata 951-8510, Japan. hanyuo@med.niigata-u.ac.jp.
Osamu
O
Hanyu
Department of Endocrinology and Metabolism, Tokyo Metropolitan Geriatric Hospital, Tokyo 173-0015, Japan. aaraki@tmghig.jp.
Atsushi
A
Araki
Department of Endocrinology and Metabolism, Tokyo Metropolitan Geriatric Hospital, Tokyo 173-0015, Japan. hideki_ito@tmghig.jp.
Hideki
H
Ito
Nutrition Clinic, Kagawa Nutrition University, Tokyo 170-8481, Japan. clinic@eiyo.ac.jp.
Akira
A
Tanaka
Department of Integrated Science and Engineering of Sustainable Society, Chuo University, Tokyo 113-0033, Japan. ohashi@epistat.m.u-tokyo.ac.jp.
Yasuo
Y
Ohashi
The Institute for Adult Diseases, Asahi Life Foundation, Tokyo 103-0002, Japan. y-akanuma@asahi-life.or.jp.
Yasuo
Y
Akanuma
Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata 951-8510, Japan. sone@med.niigata-u.ac.jp.
Hirohito
H
Sone
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000032:analysis; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D006442:Glycated Hemoglobin; D014280:Triglycerides
carbohydrate intake; diabetes complications; type 2 diabetes