Relationship between carbohydrate intake (quantity, quality, and time eaten) and mortality (total, cardiovascular and diabetes): Assessment of 2003-2014 National Health and Nutrition Examination Survey participants

Objective

This study investigated the association of the quantity, quality, and timing of carbohydrate intake with all-cause, cardiovascular disease(CVD) and diabetes mortality.

Research design and methods

This secondary data analysis used National Health and Nutrition Examination Survey(2003-2014) and National Death Index data from adults(n = 27,623) to examine the association of total daily and differences in carbohydrate intake with mortality. Participants were categorized into four carbohydrate-intake-patterns based on the median values of daily high- and low-quality carbohydrate intake. The differences(△) in carbohydrate intake between dinner and breakfast were calculated(△=dinner-breakfast). Cox regression models were employed.

Results

The participants who consumed more high-quality carbohydrates throughout the day had a lower all-cause mortality risk(hazard ratio(HR)=0.88; 95%confidence interval(CI):0.79-0.99), whereas more daily intake of low-quality carbohydrates was related to a greater all-cause mortality risk(HR=1.13; 95%CI:1.01-1.26). Among participants whose daily high- and low-quality carbohydrate intake were both below the median, the participants who consumed more high-quality carbohydrates at dinner had a lower CVD(HR=0.70; 95%CI:0.52-0.93) and all-cause mortality risk(HR=0.82; 95%CI:0.70-0.97); an isocaloric substitution of 1 serving of low-quality carbohydrates intake at dinner with high-quality reduced the CVD and all-cause mortality risks by 25% and 19%. The participants who consumed more low-quality carbohydrates at dinner had greater diabetes mortality(HR=1.78; 95%CI:1.02-3.11), although their daily high-quality carbohydrate intake was above the median.

Conclusions

Consuming more low-quality carbohydrates at dinner was associated with greater diabetes mortality, whereas consuming more high-quality carbohydrates at dinner was associated with lower all-cause and CVD mortality irrespective of the total daily quantity and quality of carbohydrates.