Associations of dietary sugar and glycemic index with adiposity and insulin dynamics in overweight Latino youth

BACKGROUND: Few studies have examined the relation between dietary carbohydrate quality, adiposity, and insulin dynamics in children. OBJECTIVE: The objective of the study was to determine which aspects of dietary carbohydrate, specifically dietary sugar, fiber, glycemic index, or glycemic load, are associated with adiposity and insulin dynamics in overweight Latino children. DESIGN: We examined 120 overweight Latino children (10-17 y old) with a family history of type 2 diabetes. Dietary intake was determined by repeated 24-h diet recalls. Adiposity was assessed by using total-body dual-energy X-ray absorptiometry. Insulin dynamics [insulin sensitivity (SI), acute insulin response, and disposition index (an index of beta-cell function)] were measured by using a frequently sampled intravenous-glucose-tolerance test. RESULTS: After adjustment for covariates, total sugar (g/d) was positively correlated with body mass index (BMI; in kg/m(2)), BMI z scores, and total fat mass (r = 0.20, r = 0.22, and r = 21, respectively; P < 0.05) and negatively correlated with SI and disposition index (r = -0.29 and r = -0.24, respectively; P < 0.05). Dietary fiber, glycemic index, and glycemic load were not significantly correlated with adiposity or insulin dynamics before or after control for covariates. Regression analyses showed that total sugar intake explained an additional 3.4%, 4.6%, and 2.4% of the variance in BMI, BMI z scores, and total fat mass, respectively, and an additional 5.6% and 4.8% of the variance in SI and disposition index (P < 0.05), respectively, after control for covariates. CONCLUSION: In this cohort, total sugar intake, rather than glycemic index or glycemic load, was associated with higher adiposity measures, lower SI, and lower measures of insulin secretion.     

Vegetable Consumption Is Linked to Decreased Visceral and Liver Fat and Improved Insulin Resistance in Overweight Latino Youth

There are limited data on the influence of vegetable consumption on adiposity and metabolic health, specifically nonstarchy vegetables and vegetables that are dark green and deep orange/yellow (also known as nutrient-rich vegetables). Our study examines the relationship between vegetable intake and adiposity, liver fat, and insulin dynamics in overweight Latino youth. This cross-sectional study of 175 overweight (body mass index ≥85th percentile) Latino youth (aged 8 to 18 years), with data collected during 2006-2011, included the following: dietary intake via multiple 24-hour recalls, total body fat via dual-energy x-ray absorptiometry, adipose tissue distribution and liver fat via magnetic resonance imaging, and insulin dynamics via frequently sampled intravenous glucose tolerance test. Linear regression and analysis of covariance were used for analysis, with the following a priori covariates: age, sex, energy intake, and total body fat. Participants who consumed the most nonstarchy vegetables (mean intake=1.7±1.0 servings/day) compared with the least (mean intake=0.1±0.1 servings/day) had 44% less liver fat (10.0%±8.5% vs 5.6%±8.7%; P=0.01). Nutrient-rich vegetable intake was positively correlated with insulin sensitivity (r=0.19; P=0.03). Consumers of nutrient-rich vegetables (mean intake=0.3±0.4 servings/day [n=107]), compared with nonconsumers (n=68), had 31% increased insulin sensitivity (1.6±1.6 vs 2.1±1.3×10^–4/min/μU/mL; P=0.03) and 17% less visceral adipose tissue (2.3±0.9 vs 1.9±0.7 L; P=0.01). Consumption of specific vegetable types by overweight Latino youth is associated with positive metabolic outcomes, including reduced visceral and liver fat and risk factors for type 2 diabetes, even when consumed in small quantities. These may be relevant targets for interventions.     

Whole-grain intake and insulin sensitivity: the Insulin Resistance Atherosclerosis Study

BACKGROUND: Increased intake of whole-grain foods has been related to a reduced risk of developing diabetes and heart disease. One underlying pathway for this relation may be increased insulin sensitivity. OBJECTIVE: We assessed the relation between dietary intake of whole grain-containing foods and insulin sensitivity (S(I)). DESIGN: We evaluated data from the Insulin Resistance Atherosclerosis Study (IRAS Exam I, 1992-1994). Usual dietary intakes in 978 middle-aged adults with normal (67%) or impaired (33%) glucose tolerance were ascertained by using an interviewer-administered, validated food-frequency questionnaire. Whole-grain intake (servings per day) was derived from dark breads and high-fiber and cooked cereals. S(I) was assessed by minimal model analyses of the frequently sampled intravenous-glucose-tolerance test. Fasting insulin was measured by using a radioimmunoassay. We modeled the relation of whole-grain intake to log(S(I) + 1) and to log(insulin) by using multivariable linear regression. RESULTS: On average, IRAS participants consumed 0.8 servings of whole grains/d. Whole-grain intake was significantly associated with S(I) (beta = 0.082, P = 0.0005) and insulin (beta = -0.0646, P = 0.019) after adjustment for demographics, total energy intake and expenditure, smoking, and family history of diabetes. The addition of body mass index and waist circumference attenuated but did not explain the association with S(I). The addition of fiber and magnesium resulted in a nonsignificant association that is consistent with the hypothesis that these constituents account for some of the effect of whole grains on S(I). CONCLUSION: Higher intakes of whole grains were associated with increases in insulin sensitivity.     

Role of dietary factors in ethnic differences in early risk of cardiovascular disease and type 2 diabetes

BACKGROUND: The disparity in the prevalence of cardiovascular disease and type 2 diabetes between African Americans and whites has been well established, and ethnic differences in several risk factors for these diseases are evident in childhood. OBJECTIVE: The current study explored whether dietary factors explain ethnic differences in serum lipids and insulin profiles in children, independent of body composition and social class background. DESIGN: The sample included 95 African American and white children (mean age: 10.0 y). Macronutrient and food group intakes were derived from three 24-h recalls. Cardiovascular disease and type 2 diabetes risk were determined on the basis of total cholesterol, triacylglycerol, insulin sensitivity (S(i)), and acute insulin response (AIR). Data were analyzed by using t tests, analysis of covariance, and multiple regression. RESULTS: African American children had lower triacylglycerol (P < 0.01), lower S(i) (P < 0.001), and higher AIR (P < 0.001) than whites. Intake of fruit and vegetables was significantly higher, and dairy intake lower, in African American than in white children after adjustment for social class and total energy intake. Several direct relations were observed between diet and insulin action: carbohydrate and fruit intakes were positively associated with S(i) (P = 0.02), and vegetable intake was negatively associated with AIR (P = 0.01). However, neither macronutrient nor food group intake accounted for the ethnic differences in triacylglycerol and AIR. CONCLUSIONS: The African American children in our sample showed a greater disease risk than did the white children, even after body composition, social class background, and dietary patterns were adjusted for.     

Comparison between omega-3 and omega-6 polyunsaturated fatty acid intakes as assessed by a food frequency questionnaire and erythrocyte membrane fatty acid composition in young children

OBJECTIVE: We conducted a dietary validation study in youth aged 1-11 years by comparing dietary intake of omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) as assessed by a parent-completed semiquantitative food frequency questionnaire (FFQ) over time to erythrocyte membrane composition of the same fatty acids. DESIGN: The study population included youth aged 1-11 years who were participants in the Diabetes Autoimmunity Study in the Young (DAISY), a longitudinal study in Denver, Colorado that is following a cohort of youth at risk for developing type I diabetes. Four hundred and four children who had erythrocyte membrane fatty acid data matched to an FFQ corresponding to the same time frame for a total of 917 visits (matches) were included. PUFA intake was expressed both as g/day (adjusted for total energy) and as percent of total fat intake. We used mixed models to test the association and calculate the correlation between the erythrocyte membrane estimates and PUFA intake using all records of data for each youth. RESULTS: Intakes of total omega-3 fatty acids (beta=0.52, P<0.0001, rho=0.23) and marine PUFAs (beta=1.62, P<0.0001, rho=0.42), as a percent of total fat in the diet, were associated with percent of omega-3 and marine PUFAs in the erythrocyte membrane. Intakes of omega-6 PUFAs (beta=0.04, P=0.418, rho=0.05) and arachidonic acid (beta=0.31, P=0.774, rho=0.01) were not associated. CONCLUSIONS: In these young children, an FFQ using parental report provided estimates of average long-term intakes of marine PUFAs that correlated well with their erythrocyte cell membrane fatty acid status.     

Central adiposity and protein intake are associated with arterial stiffness in overweight children

Being overweight is associated with vascular abnormalities, which are important in the development of atherosclerosis. However, little is known about dietary and lifestyle determinants of vascular function in overweight children. In adults, dietary protein and milk intake are associated with reduced blood pressure and reduced risk of metabolic syndrome. This study examined the associations between dietary protein, milk intake, physical activity, and adiposity on arterial stiffness in overweight children. In a cross-sectional study, overweight children with habitual milk intakes ≤ 250 mL/d were examined by DXA scans, pedometer counts, anthropometry, and metabolic variables. Dietary intake was registered for 4 d. The outcomes were arterial stiffness measured by pulse wave velocity (PWV) (n = 182) and augmentation index (Aix) (n = 183). The PWV (mean ± SD) was 4.78 ± 0.72 m/s and the Aix was -0.77 ± 9.44%. In multivariate models, the android fat:gynoid fat and android fat:body fat ratios were positively associated with PWV (β = 1.49 and β = 10.3, both P < 0.05) and Aix (β = 28.3, P < 0.01 and β = 153, P < 0.05), whereas the gynoid fat:body fat ratio was negatively associated with the Aix (β = -134; P < 0.001). Protein intake (percentage energy) was positively associated with PWV (β = 0.05; P < 0.01). Milk intake (L/d) tended to be negatively associated with PWV (β = -0.64; P = 0.05). Pedometer counts were negatively associated with the Aix; however, the association became nonsignificant after controlling for HOMA, which was positively associated with the Aix (β = 0.95; P < 0.01). In conclusion, central adiposity and protein intake are associated with increased arterial stiffness measured as PWV in overweight children independent of blood pressure and heart rate. The effect of protein intake may be caused by meat, because the milk intake was low.     

Dietary intakes of fat and antioxidant vitamins are predictors of subclinical inflammation in overweight Swiss children

BACKGROUND: In obese children, subclinical inflammation is often present and is correlated with the metabolic syndrome. Dietary factors, such as fatty acids and antioxidants, potentially modulate the association between adiposity and subclinical inflammation, but few data are available in children. OBJECTIVE: The aim of the study was to determine whether dietary fat or antioxidant intakes influence circulating tumor necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), C-reactive protein (CRP), and leptin concentrations in overweight children. DESIGN: In a cross-sectional study of 6-14-y-old normal-weight (n = 33), overweight (n = 19), and obese (n = 27) Swiss children, nutritional intakes were assessed from two 24-h dietary recalls and a 1-d dietary record. Percentage body fat from skinfold thicknesses, waist-hip ratio, and blood pressure were measured. Fasting blood samples were collected for the measurement of insulin, glucose, HDL-cholesterol, triacylglycerol, CRP, IL-6, TNF-alpha, and leptin concentrations. RESULTS: CRP, IL-6, and leptin increased significantly (P < 0.02) with increasing adiposity, independent of age; TNF-alpha did not increase. Total dietary fat and the percentage of energy from fat were significant predictors of CRP concentration, independent of body mass index (P < 0.05). Meat intake was a significant predictor of IL-6 and leptin, independent of body mass index (P < 0.05). Intakes of antioxidant vitamins (vitamins E and C and beta-carotene) were significant predictors of leptin (P < 0.05) but not of CRP, IL-6, or TNF-alpha. CONCLUSIONS: Overweight Swiss children as young as 6 y have elevated concentrations of inflammatory markers. Intakes of total fat and antioxidant vitamins are determinants of subclinical inflammation in this age group.     

Dietary intake and the metabolic syndrome in overweight Latino children

Little is known about the relationship between diet and metabolic health in Latino children, a population at increased risk for diabetes. The present study evaluates diet composition and the metabolic syndrome in a cross-sectional sample of 109 overweight Latino children aged 10 to 17 years with a family history of type 2 diabetes. Dietary intake was assessed by two 24-hour recalls. Associations between nutrients and features of the metabolic syndrome were examined using multiple linear regression and analysis of covariance. Log cholesterol intake was positively associated with log systolic blood pressure (beta=0.034, P=0.017) and log soluble dietary fiber intake was inversely associated with log waist circumference (beta=-0.069, P=0.036). Log soluble fiber intake was significantly higher in participants with 0 features compared to those with 3+ features of the metabolic syndrome (P=0.046), which translates to 5.2 g vs 4.1 g soluble fiber daily. No other significant associations were found between dietary variables and either the individual features of the metabolic syndrome or the clustering of metabolic syndrome components. Increases in soluble fiber through the daily consumption of fruits, vegetables, and beans may improve metabolic health in Latino children.     

Whole-grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study

BACKGROUND: The influence of whole grains on cardiovascular disease risk may be mediated through multiple pathways, eg, a reduction in blood lipids and blood pressure, an enhancement of insulin sensitivity, and an improvement in blood glucose control. OBJECTIVE: The objective was to examine the association between diets rich in whole- or refined-grain foods and several metabolic markers of disease risk in the Framingham Offspring Study cohort. DESIGN: Whole-grain intake and metabolic risk markers were assessed in a cross-sectional study of 2941 subjects. RESULTS: After adjustment for potential confounding factors, whole-grain intake was inversely associated with body mass index (: 26.9 in the lowest and 26.4 in the highest quintile of intake; P for trend = 0.06), waist-to-hip ratio (0.92 and 0.91, respectively; P for trend = 0.005), total cholesterol (5.20 and 5.09 mmol/L, respectively; P for trend = 0.06), LDL cholesterol (3.16 and 3.04 mmol/L, respectively; P for trend = 0.02), and fasting insulin (205 and 199 pmol/L, respectively; P for trend = 0.03). There were no significant trends in metabolic risk factor concentrations across quintile categories of refined-grain intake. The inverse association between whole-grain intake and fasting insulin was most striking among overweight participants. The association between whole-grain intake and fasting insulin was attenuated after adjustment for dietary fiber and magnesium. CONCLUSION: Increased intakes of whole grains may reduce disease risk by means of favorable effects on metabolic risk factors.     

A longitudinal study of children's juice intake and growth: the juice controversy revisited

OBJECTIVES: To determine associations between children's longitudinal juice intake and growth parameters at age 72 months and to determine children's beverage intake patterns over time. SUBJECTS/SETTING: White children (n = 72) residing in the vicinity of a Southern US city participated in a longitudinal study. METHODS: Seven in-home interviews were conducted per child when each child was between 24 and 72 months of age. The 7 sets of 3-day dietary data were analyzed for beverage intake, categorized as juice (100% juice only), milk, carbonated beverages, and other drinks (e.g., lemonade, tea, juice drinks). The following growth parameters were determined for each child at age 72 months: height, weight, body mass index (measured as kg/m2), and ponderal index (measured as kg/m3); the 3 latter are measures of overweight. STATISTICAL ANALYSES: Associations between longitudinal juice intake and each growth parameter were tested with general linear models. Repeated measures analysis of variance tested changes in beverage intakes over time. RESULTS: There were no statistically significant associations between juice and children's height, weight, or body mass index, as tested by general linear models. Children's longitudinal juice intake was negatively related to ponderal index (beta = 0.065, P = .050). Children's juice intake decreased significantly between ages 2 and 6 years, from 6.8 to 3.6 oz/day (P = .0001); intakes of carbonated beverages and other drinks increased from 1.7 to 3.8 oz/day (P = .0016) and from 2.7 to 6.2 oz/day (P = .0001), respectively. APPLICATIONS/CONCLUSIONS: Children's longitudinal juice intake was not associated with either short stature or overweight. As juice consumption decreased, intakes of less nutritious beverages increased. Consumption of 100% juices should be encouraged by health professionals and parents/caregivers.     

中国7~17岁儿童青少年宏量营养素摄入与超重肥胖的关系

  目的  探讨7~17岁儿童青少年宏量营养素摄入与超重肥胖的关系。  方法  1997—2011年基于“中国居民健康与营养调查”的6轮调查数据,纳入膳食及BMI数据完整的7~17岁儿童青少年为研究对象。依照中国肥胖问题工作组制定标准判定超重肥胖,采用Logistic回归分析模型分析宏量营养素摄入与儿童青少年超重肥胖的关系。  结果  最终纳入6 360名研究对象,其中7~＜12岁儿童青少年3 529人(55.5%),男生3 360人(52.8%),超重肥胖1 060人(16.7%)。校正相关混杂因素后,与脂肪供能比 < 25%组相比,≥30%组增加20%肥胖风险(OR=1.20, 95% CI:1.03~1.41, P=0.023);与蛋白质供能比 < 10%组相比,≥15%组增加61%肥胖风险(OR=1.61, 95% CI:1.25~2.04, P < 0.001);与碳水化合物供能比 < 55%组相比,55%~ < 65%组降低20%肥胖风险(OR=0.80, 95% CI:0.68~0.95, P=0.011),≥65%组降低21%肥胖风险(OR=0.79, 95% CI:0.66~0.94, P=0.010);脂肪及蛋白质供能比越高、碳水化合物供能比越低,发生超重肥胖的风险越高(P < 0.05);男生摄入过量蛋白质更可能发生肥胖(P=0.034)。  结论  儿童青少年摄入过量脂肪和蛋白质可增加超重肥胖发生风险。     

Beverage consumption is not associated with changes in weight and body mass index among low-income preschool children in North Dakota

OBJECTIVE: To examine prospectively the association between beverage consumption (fruit juice, fruit drinks, milk, soda, and diet soda) and changes in weight and body mass index among preschool children. DESIGN: A prospective cohort study that collected dietary, anthropometric, and sociodemographic data.Subjects/Setting The study population included 1,345 children age 2 to 5 years participating in the North Dakota Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on two visits between 6 to 12 months apart.Statistical analyses We performed linear regression analyses to examine whether beverage consumption was associated with annual change in weight and body mass index. Intakes were measured as continuous (oz/day) and we also dichotomized fruit juice, fruit drinks, and milk at high intakes. RESULTS: In multivariate regression analyses adjusted for age, sex, energy intake, change in height, and additional sociodemographic variables, weight change was not significantly related to intakes (per ounce) of fruit juice (beta=0.01 lb/year, 95% CI: -0.01 to 0.20, P=.28), fruit drinks (beta=-0.03 lb/year, 95% CI: -0.07 to 0.01, P=.28), milk (beta=0.00 lb/year, 95% CI: -0.02 to 0.02, P=.86), soda (beta=-0.00 lb/year, 95% CI: -0.08 to 0.08, P=.95), or diet soda (beta=0.01 lb/year, 95% CI: -0.11 to 0.13, P=.82). Findings remained null when we examined associations with body mass index and when fruit juice, fruit drinks, and milk were dichotomized at high intake levels in both analyses. CONCLUSIONS: Our study does not show an association between beverage consumption and changes in weight or body mass index in this population of low-income preschool children in North Dakota.     

Carbohydrate intake and biomarkers of glycemic control among US adults: the third National Health and Nutrition Examination Survey (NHANES III)

BACKGROUND: Recommendations for preventing and treating type 2 diabetes include consuming carbohydrates, predominantly from whole grains, fruit, vegetables, and low-fat milk. However, the quantity and type of carbohydrates consumed may contribute to disorders of glycemic control. OBJECTIVE: We evaluated the association between carbohydrate intakes and biomarkers of glycemic control in a nationally representative sample of healthy US adults who participated in a cross-sectional study, the third National Health and Nutrition Examination Survey. DESIGN: The sample (5730 men and 6125 women aged > or = 20 y) was divided into quintiles of carbohydrate intake (as a percentage of energy). Carbohydrate intakes were examined in relation to glycated hemoglobin (Hb A(1c)), plasma glucose, serum C-peptide, and serum insulin concentrations by using logistic regression. RESULTS: Carbohydrate intakes were not associated with Hb A(1c), plasma glucose, or serum insulin concentrations in men or women after adjustment for confounding variables. Carbohydrate intakes were inversely associated with serum C-peptide concentrations in men and women. Odds ratios for elevated serum C-peptide concentrations for increasing quintiles of carbohydrate intake were 1.00, 0.88, 0.57, 0.39, and 0.75 (P for trend = 0.016) in men, and 1.00, 0.69, 0.57, 0.36, and 0.41 (P for trend = 0.007) in women. When carbohydrate intakes were further adjusted for intakes of total and added sugar, the association of serum C-peptide with carbohydrate intakes was strengthened in men. CONCLUSIONS: Carbohydrate intakes were not associated with Hb A(1c), plasma glucose, or serum insulin concentrations but were inversely associated with the risk of elevated serum C-peptide; this supports current recommendations regarding carbohydrate intake in healthy adults.     

Dietary glycemic load, added sugars, and carbohydrates as risk factors for pancreatic cancer: the Multiethnic Cohort Study

BACKGROUND: Because elevated blood glucose concentrations have been shown to be associated with greater risk of pancreatic cancer, a high dietary glycemic load, which is based on an empirical measure of blood glucose response after food consumption, has been hypothesized as a pancreatic cancer risk factor. However, results so far are scarce and inconsistent. OBJECTIVE: We analyzed data for 162 150 participants in the Hawaii-Los Angeles Multiethnic Cohort Study to investigate associations between glycemic load, dietary carbohydrates, sucrose, fructose, total sugars, and added sugars and the risk of pancreatic cancer. DESIGN: Dietary intake was assessed at baseline by using a quantitative food-frequency questionnaire. During 8 y of follow-up, 434 incident pancreatic cancer cases occurred. RESULTS: Glycemic load and added sugars were not significantly associated with pancreatic cancer risk. The risk increased with higher intakes of total sugars, fructose, and sucrose, and the association with fructose was significant when the highest and lowest quartiles were compared (relative risk: 1.35; 95% CI: 1.02, 1.80; P for trend = 0.046). A significant association was found with fruit and juices intake (1.37; 1.02, 1.84; P for trend = 0.04) but not with soda intake. Statistical evidence of a significant interaction with body mass index was present only for sucrose intake (P = 0.04). A comparison of the highest and lowest quartiles of sucrose intake in overweight or obese participants gave a relative risk of 1.46 (0.95-2.25; P for trend = 0.04), but the comparison was not significant in normal-weight participants. CONCLUSIONS: High fructose and sucrose intakes may play a role in pancreatic cancer etiology. Conditions such as overweight or obesity in which a degree of insulin resistance may be present may also be important.     

Interactions of dietary fat intake and the hepatic lipase -480C-->T polymorphism in determining hepatic lipase activity: the Hoorn Study

BACKGROUND: Gene-nutrient interactions affecting hepatic lipase (HL) activity may contribute to the interindividual variability of the cardiovascular disease risk associated with dietary fat intake. OBJECTIVE: We determined the associations of dietary fat intake with postheparin HL activity and the possible modifying effect of the HL -480C-->T polymorphism on these associations. DESIGN: Subjects were recruited from participants in the 2000-2001 follow-up examination of the Hoorn Study. HL activity was determined in postheparin plasma in a sample of 211 men and 218 women aged 60-87 y. Information about dietary intake of the participants was obtained with a validated food-frequency questionnaire. Linear regression was performed, adjusted for age. RESULTS: Total dietary fat was positively associated with HL activity (standardized beta: 0.11; 95% CI: 0.02, 0.21), and this association was also seen for saturated fat (0.10; 0.01, 0.20) and monounsaturated fatty acid (0.10; 0.01, 0.19). We observed a significant interaction of the HL polymorphism with the relation between total fat intake and HL activity. The association of total fat with HL activity was stronger in subjects with CT (0.27; 0.11, 0.43) and TT (0.39; -0.22, 1.00) genotypes than in subjects with the CC genotype (0.06; -0.06, 0.18; P for interaction < 0.10). The interaction remained statistically significant in models that included age, sex, carbohydrate and protein intakes, and insulin or body mass index. CONCLUSIONS: Higher intakes of total and saturated fat were positively associated with higher HL activity. In addition, the observed association of total fat with HL activity was modified by the HL-480C-->T polymorphism, after adjustment for age, sex, carbohydrate and protein intakes, and insulin or body mass index.     

Metabolic markers in relation to nutrition and growth in healthy 4-y-old children in Sweden

BACKGROUND: The worldwide increase in overweight and obesity probably involves dietary factors, and early indicators of risk must be identified. OBJECTIVE: We aimed to analyze metabolic markers in relation to dietary intake and anthropometry in healthy 4-y-old children. DESIGN: A cross-sectional study of nutritional intake was performed in 95 children by use of 7-d food records. Fasting blood samples were analyzed for glucose, insulin, and lipids. RESULTS: The study population was representative of Swedish children except that more parents than the average had a university education. The boys' mean energy intake was higher (6.6 +/- 0.75 MJ) than the girls' (5.7 +/- 0.79 MJ). Significant associations were found between the percentage of energy from carbohydrates and that from fat (r = -0.91) and sucrose (r = 0.59). High body mass index was associated with a low percentage of energy from fat (r = -0.32). Serum triacylglycerol, insulin, and the HOMA (homeostatic model assessment) index were higher in girls than in boys. In girls, HOMA beta-cell function was significantly negatively associated with fat intake and serum fasting insulin, and HOMA insulin resistance indexes were significantly associated with the increment in z scores for height and weight from birth to age 4 y. Compared with children with fasting insulin concentrations below the group mean + SD, the children with concentrations above that value were smaller as newborns and had larger increments in growth z scores from birth to age 4 y. CONCLUSION: In healthy Swedish 4-y-olds from well-educated families, low fat intake was related to high body mass index. Upward weight and height percentile crossings were related to insulin resistance, especially in girls.     

Relation of dietary glycemic index, glycemic load, added sugar intake, or fiber intake to the development of body composition between ages 2 and 7 y

BACKGROUND: Observational studies in adults suggest that a diet with a high glycemic index (GI) or glycemic load (GL), a high intake of sugary foods, or a low fiber intake may increase the risk of overweight. OBJECTIVES: We aimed to examine prospectively whether dietary GI, GL, added sugar intake, or fiber intake between age 2 and 7 y are associated with the development of body composition. If so, we aimed to ascertain whether these associations are modified by meal frequency. DESIGN: Linear mixed-effect regression analyses were performed in 380 participants of the DOrtmund Nutrition and Anthropometric Longitudinally Designed (DONALD) Study for whom 4-6 weighed 3-d dietary records and anthropometric data were obtained between ages 2 and 7 y. RESULTS: Changes in dietary GI, GL, or added sugar intake between ages 2 and 7 y were not associated with concurrent changes in percentage body fat (%BF, as estimated from skinfold thicknesses) or body mass index SD scores. An increase in fiber intake was related to a concurrent decrease in %BF between ages 2 and 7 y only in children who consumed <6 meals/d as toddlers (beta +/- SE from fully adjusted model: -0.26 +/- 0.09%BF per 1-SD increase in fiber intake, P = 0.005), whereas children with a higher meal frequency had no concurrent change (0.07 +/- 0.07%BF per 1-SD increase in fiber intake, P = 0.3). CONCLUSIONS: Dietary GI, GL, or added sugar intake between ages 2 and 7 y does not appear to influence the development of body composition. Potential benefits associated with increasing fiber intake throughout childhood may be limited to toddlers with a lower meal frequency.     

Fructose intake is a predictor of LDL particle size in overweight schoolchildren

BACKGROUND: High amounts of dietary fructose may contribute to dyslipidemia in adults, but there are few data in children. Childhood adiposity is associated with smaller LDL particle size, but the dietary predictors of LDL size in overweight children have not been studied. OBJECTIVES: We aimed to determine whether LDL particle size is associated with dietary factors and specifically with fructose intake in normal-weight and overweight children. DESIGN: In a cross-sectional study of normal-weight and overweight 6-14 y-old Swiss children (n = 74), dietary intakes were assessed by using two 24-h-recalls and a 1-d dietary record. Body mass index (BMI) and waist-hip ratio (WHR) were measured, and plasma lipid profile and LDL particle size were determined. RESULTS: Compared with the normal-weight group, overweight children had significantly higher plasma triacylglycerol concentrations, lower HDL-cholesterol concentrations, and smaller LDL particle size (P < 0.05). LDL particle size was inversely correlated to BMI SD scores and WHR (P = 0.007). Although there were no significant differences in total fructose intake, the overweight children consumed a significantly (P < 0.05) higher percentage of fructose from sweets and sweetened drinks than did the normal-weight children. After control for adiposity, the only dietary factor that was a significant predictor of LDL particle size was total fructose intake (P = 0.024). CONCLUSIONS: In school-age children, greater total and central adiposity are associated with smaller LDL particle size and lower HDL cholesterol. Overweight children consume more fructose from sweets and sweetened drinks than do normal-weight children, and higher fructose intake predicts smaller LDL particle size.     

Carbohydrate intake, glycemic index, glycemic load, and risk of postmenopausal breast cancer in a prospective study of French women

BACKGROUND: Diets high in carbohydrates may result in chronically elevated insulin concentrations and may affect breast cancer risk by stimulation of insulin receptors or through insulin-like growth factor I (IGF-I)-mediated mitogenesis. Insulin response to carbohydrate intake is increased in insulin-resistant states such as obesity. OBJECTIVE: We sought to evaluate carbohydrate intake, glycemic index (GI), and glycemic load (GL) and subsequent overall and hormone-receptor-defined breast cancer risk among postmenopausal women. DESIGN: A prospective cohort analysis of dietary carbohydrate and fiber intakes was conducted among 62 739 postmenopausal women from the E3N French study who had completed a validated dietary history questionnaire in 1993. During a 9-y period, 1812 cases of pathology-confirmed breast cancer were documented through follow-up questionnaires. Nutrients were categorized into quartiles and energy-adjusted with the regression-residual method. Cox model-derived relative risks (RRs) were adjusted for known determinants in breast cancer. RESULTS: Dietary carbohydrate and fiber intakes were not associated with overall breast cancer risk. Among overweight women, we observed an association between GI and breast cancer (RR(Q1-Q4): 1.35; 95% CI: 1.00, 1.82; P for trend = 0.04). For women in the highest category of waist circumference, the RR(Q1-Q4) was 1.28 (95% CI: 0.98, 1.67; P for trend = 0.10) for carbohydrates, 1.35 (95% CI: 1.04, 1.75; P for trend = 0.01) for GI, and 1.37 (95% CI: 1.05, 1.77; P for trend = 0.003) for GL. We also observed a direct association between carbohydrate intake, GL, and estrogen receptor-negative breast cancer risk. CONCLUSIONS: Rapidly absorbed carbohydrates are associated with postmenopausal breast cancer risk among overweight women and women with large waist circumference. Carbohydrate intake may also be associated with estrogen receptor-negative breast cancer.     

Whole-grain intake and carotid artery atherosclerosis in a multiethnic cohort: the Insulin Resistance Atherosclerosis Study

BACKGROUND: Whole-grain intake has been shown to be inversely associated with cardiovascular events, but an association with atherosclerosis is less well established. OBJECTIVE: We sought to evaluate the association of whole-grain intake with carotid intimal medial thickness (IMT) and IMT progression in a multiethnic cohort. DESIGN: This study evaluated 1178 participants in the Insulin Resistance Atherosclerosis Study. Baseline whole-grain intake was estimated on the basis of intake of dark breads, cooked cereals, and high-fiber cereals assessed with a validated food-frequency questionnaire. Bilateral carotid IMT was evaluated ultrasonographically, yielding 16 IMT measures at baseline and year 5. Multivariate models evaluated the independent association of whole-grain intake with common carotid artery (CCA) and internal carotid artery (ICA) IMT and IMT progression. RESULTS: The cohort had a mean (+/-SD) age of 55.2 +/- 8.4 y and was 56% female. The baseline median whole-grain intake was 0.79 servings/d. Whole-grain intake was inversely associated with CCA IMT (beta +/- SE: -0.043 +/- 0.013, P = 0.005) and IMT progression (beta +/- SE: -0.019 +/- 0.011, P = 0.09) in models adjusted for demographics, energy intake, energy expenditure, cardiovascular disease risk factors, and medication use. This association was less significant for ICA IMT (beta +/- SE: -0.049 +/- 0.023, P = 0.05) and not significant for ICA IMT progression (beta +/- SE: -0.013 +/- 0.014, P = 0.35). The relation between whole-grain intake and CCA IMT remained significant after adjustment for mediating pathways (lipids, adiposity, and insulin resistance), nutrient constituents, and a principal components-derived healthy dietary pattern. CONCLUSIONS: Whole-grain intake is inversely associated with CCA IMT, and this relation is not attributable to individual risk intermediates, single nutrient constituents, or larger dietary patterns.