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Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes

Carbohydrate Nutrition, Insulin Resistance, and the Prevalence of the Metabolic Syndrome in the Framingham Offspring Cohort

  1. Nicola M. McKeown, PHD1,
  2. James B. Meigs, MD, MPH2,
  3. Simin Liu, MD, SCD3,
  4. Edward Saltzman, MD1,
  5. Peter W.F. Wilson, MD4 and
  6. Paul F. Jacques, SCD1
  1. 1Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
  2. 2General Medicine Division and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
  3. 3Department of Epidemiology, Harvard School of Public Health and Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  4. 4Department of Endocrinology, Diabetes, and Medical Genetics, Medical University of South Carolina, Charleston, South Carolina
  1. Address correspondence and reprint requests to Paul Jacques, Epidemiology Program, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111-1524. E-mail: paul.jacques{at}tufts.edu
Diabetes Care 2004 Feb; 27(2): 538-546. https://doi.org/10.2337/diacare.27.2.538
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Tables

  • Table 1—

    Characteristics of subjects in the Framingham Offspring Cohort across quintile categories of HOMA-IR insulin resistance

    HOMA-IRQuintile categories
    P value*
    <4.834.84–5.715.72–6.796.79–8.64>8.64
    Participants (n)568565567568565
    Characteristics
      Women (%)7164514641<0.0001
      Age (years)5253545556<0.0001
      BMI (kg/m2)24.225.426.628.431.3<0.0001
      Physical activity score34.634.734.835.234.50.74
      Alcohol use (%)7875767367<0.0001
      Current cigarette smoking (%)21201920160.07
      Estrogen replacement therapy (women only) (%)182118149<0.001
      Normal glucose tolerance (%)†9491907750<0.0001
      Impaired fasting glucose/impaired glucose tolerance (%)†6892033<0.0001
      Undiagnosed diabetes (%)†011317<0.0001
      Fasting serum insulin (μU/ml)1.94.36.810.019.3<0.0001
    Insulin resistance phenotype
      Abnormal waist circumference (%)‡1325315072<0.0001
      Low HDL cholesterol (%)§1924354564<0.0001
      Elevated triglycerides (%)‖1219294161<0.0001
      Elevated fasting glucose (%)¶0221138<0.0001
      Abnormal blood pressure (%)#1014182942<0.0001
      Metabolic syndrome ≥3 components (%)27112859<0.0001
    • Data are means unless otherwise indicated. Geometric means are given for levels of fasting insulin.

    • *

      ↵* P values for trend for continuous variables or Mantel-Haenzel χ2 for categorical variables across quintiles of HOMA-IR.

    • †

      ↵† Previously undiagnosed diabetes was defined as a fasting plasma glucose concentration ≥126 mg/dl (7.0 mmol/l) or a 2-h postchallenge glucose concentration ≥200 mg/dl (11.1 mmol/l). Impaired fasting glucose was defined as a fasting plasma glucose concentration of 110–126 mg/dl (6.1–7.0 mmol/l). Impaired glucose tolerance was defined as a 2-h postchallenge glucose concentration of 140–200 mg/dl (11.1 mmol/l). Normal glucose tolerance was defined as a fasting glucose concentration of <110 mg/dl (6.1 mmol/l) and a 2-h postchallange glucose concentration of <140 mg/dl (7.8 mmol/l).

    • ‡

      ↵‡ Waist circumference >40 inches in men and >35 inches in women.

    • §

      ↵§ Serum HDL cholesterol <40 mg/dl or <50 mg/dl in men and women, respectively.

    • ‖

      ↵‖ Triglyceride level ≥150 mg/dl.

    • #

      ↵# Blood pressure of at least 130/85 mmHg or taking hypertensive medication.

    • ¶

      ↵¶ Fasting plasma glucose concentration ≥6.1 mmol/l.

  • Table 2—

    Multivariate adjusted geometric mean HOMA-IR and prevalence OR of metabolic syndrome across quintiles of carbohydrate-related dietary factors

    Quintiles of carbohydrate source§
    P for trend
    Quintile 1Quintile 2Quintile 3Quintile 4Quintile 5
    n566567567567567
    Total carbohydrate
      Median intake (g/day)179207226244272
      Range of intake (g/day)<194195–217218–234235–257>258
      Mean HOMA-IR*6.8 (6.5–7.1)6.7 (6.5–7.0)6.6 (6.3–6.8)6.7 (6.5–7.0)6.9 (6.6–7.2)0.52
      OR IRS†1.000.90 (0.65–1.23)0.76 (0.53–1.09)1.03 (0.69–1.52)0.92 (0.57–1.49)0.97
    Dietary fiber
      Median intake (g/day)11.614.917.420.125.5
      Range of intake (g/day)<13.513.6–16.016.1–18.618.6–22.1>22.2
      Mean HOMA-IR7.0 (6.8–7.3)6.7 (6.5–7.0)6.7 (6.5–7.0)6.7 (6.5–7.0)6.4 (6.1–6.6)<0.001
      OR IRS1.00.81 (0.61–1.09)0.88 (0.65–1.19)0.81 (0.59–1.07)0.73 (0.51–1.03)0.11
    Cereal fiber
      Median intake (g/day)2.63.74.65.88.0
      Range of intake (g/day)<3.13.2–4.24.3–5.15.2–6.7>6.8
      Mean HOMA-IR6.8 (6.5–7.0)6.9 (6.7–7.2)6.8 (6.6–7.0)6.6 (6.4–6.9)6.5 (6.3–6.8)0.02
      OR IRS1.00.87 (0.65–1.16)0.88 (0.66–1.18)0.74 (0.54–1.00)0.62 (0.45–0.86)0.002
    Fruit fiber
      Median intake (g/day)0.71.72.84.25.8
      Range of intake (g/day)<1.21.2–2.22.2–3.43.4–5.1>5.2
      Mean HOMA-IR7.0 (6.7–7.2)6.8 (6.5–7.0)6.8 (6.5–7.0)6.6 (6.4–6.8)6.5 (6.2–6.7)<0.001
      OR IRS1.01.07 (0.80–1.43)0.74 (0.55–1.01)0.89 (0.65–1.21)0.88 (0.64–1.22)0.36
    Vegetable fiber
      Median intake (g/day)2.43.74.86.18.4
      Range of intake (g/day)<3.13.1–4.24.2–5.35.3–6.9>6.9
      Mean HOMA-IR6.7 (6.4–6.9)6.9 (6.6–7.2)6.7 (6.4–6.9)6.8 (6.5–7.0)6.8 (6.5–7.0)0.64
      OR IRS1.01.08 (0.81–1.45)1.04 (0.77–1.40)1.00 (0.74–1.36)1.15 (0.84–1.57)0.51
    Legume fiber
      Median intake (g/day)0.230.691.01.42.5
      Range of intake (g/day)<0.50.6–0.80.8–1.21.2–1.8>1.8
      Mean HOMA-IR6.8 (6.5–7.0)6.8 (6.6–7.1)6.8 (6.5–7.0)6.7 (6.5–6.9)6.7 (6.5–7.0)0.58
      OR IRS1.000.91 (0.68–1.23)0.90 (0.67–1.20)1.00 (0.75–1.34)0.96 (0.72–1.29)0.98
    Glycemic index‡
      Median intake (per day)7276788184
      Range of intake (per day)<7474–7777–7979–8282–98
      Mean HOMA-IR6.4 (6.2–6.7)6.7 (6.5–7.0)6.8 (6.5–7.0)6.8 (6.5–7.0)7.0 (6.7–7.2)<0.001
      OR IRS1.001.17 (0.86–1.59)1.21 (0.89–1.64)1.19 (0.88–1.62)1.41 (1.04–1.91)0.04
    Glycemic load
      Median intake (g/day)131158.6174.5190.8220.3
      Range of intake (g/day)<147.0147.1–166.3166.4–182.3182.3–202.1>202.2
      Mean HOMA-IR6.7 (6.4–7.0)6.5 (6.2–6.7)6.7 (6.5–7.0)6.8 (6.6–7.1)7.0 (6.7–7.3)0.03
      OR IRS1.000.74 (0.53–1.02)0.71 (0.50–1.00)1.00 (0.69–1.46)0.82 (0.52–1.27)0.74
    Whole grains
      Median intake (serving/week)0.903.56.49.520.4
      Range of intake (serving/week)<1.51.9–4.44.5–7.57.9–12.9>13
      Mean HOMA-IR6.8 (6.6–7.1)6.9 (6.6–7.1)6.7 (6.5–7.0)6.6 (6.4–6.8)6.6 (6.4–6.9)0.05
      OR IRS1.00.81 (0.60–1.08)1.09 (0.82–1.44)0.82 (0.61–1.10)0.67 (0.48–0.91)0.01
    Refined grains
      Median intake (serving/week)6.911.916.723.738.8
      Range of intake (serving/week)<9.79.7–13.914.0–19.819.9–29.3>29.3
      Mean HOMA-IR6.8 (6.6–7.1)6.6 (6.4–6.9)6.8 (6.6–7.1)6.8 (6.5–7.0)6.7 (6.5–7.0)0.81
      OR IRS1.01.13 (0.84–1.52)1.01 (0.74–1.38)1.03 (0.75–1.42)0.76 (0.53–1.09)0.05
    • *

      ↵* Geometric mean HOMA-IR adjusted for sex, age, BMI, waist-to-hip ratio, cigarette dose, total energy intake, alcohol intake, percentage saturated fat, percentage polyunsaturated fat, multivitamin use, physical activity, and treatment for blood pressure. Results were essentially the same when the analysis was repeated using fasting insulin rather than the HOMA-IR.

    • †

      ↵† Adjusted for sex, age, cigarette dose, total energy intake, alcohol intake, percentage saturated fat, percentage polyunsaturated fat, multivitamin use, and physical activity.

    • ‡

      ↵‡ Values are based on a white bread standard.

    • §

      ↵§ Quintile categories are based on energy-adjusted values using the residual method, with the exception of whole and refined grains. IRS, insulin resistance syndrome.

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Carbohydrate Nutrition, Insulin Resistance, and the Prevalence of the Metabolic Syndrome in the Framingham Offspring Cohort
Nicola M. McKeown, James B. Meigs, Simin Liu, Edward Saltzman, Peter W.F. Wilson, Paul F. Jacques
Diabetes Care Feb 2004, 27 (2) 538-546; DOI: 10.2337/diacare.27.2.538

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Carbohydrate Nutrition, Insulin Resistance, and the Prevalence of the Metabolic Syndrome in the Framingham Offspring Cohort
Nicola M. McKeown, James B. Meigs, Simin Liu, Edward Saltzman, Peter W.F. Wilson, Paul F. Jacques
Diabetes Care Feb 2004, 27 (2) 538-546; DOI: 10.2337/diacare.27.2.538
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