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© 2004 by the American Diabetes Association, Inc.
Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes |
Glycemic Index and Dietary Fiber and the Risk of Type 2 Diabetes
1 Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
2 Menzies School of Health Research, and Institute of Advanced Studies, Charles Darwin University, Darwin, Australia
Address correspondence and reprint requests to Allison M. Hodge, The Cancer Council, Victoria, 1 Rathdowne St., Carlton, Victoria 3053, Australia. E-mail: allison.hodge{at}cancervic.org.au
OBJECTIVE—To examine associations between type 2 diabetes and fiber, glycemic load (GL), dietary glycemic index (GI), and fiber-rich foods.
RESEARCH DESIGN AND METHODS—This was a prospective study of 36,787 men and women aged 40–69 years without diabetes. For all self-reported cases of diabetes at 4-year follow-up, confirmation of diagnosis was sought from medical practitioners. Case subjects were those who reported diabetes at follow-up and for whom there was no evidence that they did not have type 2 diabetes. Data were analyzed with logistic regression, adjusting for country of birth, physical activity, family history of diabetes, alcohol and energy intake, education, 5-year weight change, sex, and age.
RESULTS—Follow-up was completed by 31,641 (86%) participants, and 365 cases were identified. The odds ratio (OR) for the highest quartile of white bread intake compared with the lowest was 1.37 (95% CI 1.04–1.81; P for trend = 0.001). Intakes of carbohydrate (OR per 200 g/day 0.58, 0.36–0.95), sugars (OR per 100 g/day 0.61, 0.47–0.79), and magnesium (OR per 500 mg/day 0.62, 0.43–0.90) were inversely associated with incidence of diabetes, whereas intake of starch (OR per 100 g/day 1.47, 1.06–2.05) and dietary GI (OR per 10 units 1.32, 1.05–1.66) were positively associated with diabetes. These relationships were attenuated after adjustment for BMI and waist-to-hip ratio.
CONCLUSIONS—Reducing dietary GI while maintaining a high carbohydrate intake may reduce the risk of type 2 diabetes. One way to achieve this would be to substitute white bread with low-GI breads.
Abbreviations: FFQ, food frequency questionnaire • GI, glycemic index • GL, glycemic load • WHR, waist-to-hip ratio
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