Pasta meal intake in relation to risks of type 2 diabetes and atherosclerotic cardiovascular disease in postmenopausal women : findings from the Women's Health Initiative

Mengna Huang, Kenneth Lo, Jie Li, Matthew Allison, Wen-Chih Wu, Simin Liu, Mengna Huang, Kenneth Lo, Jie Li, Matthew Allison, Wen-Chih Wu, Simin Liu

Abstract

Objective: To evaluate the association between pasta meal intake and long-term risk of developing diabetes or atherosclerotic cardiovascular disease (ASCVD, including coronary heart disease (CHD) and stroke) in postmenopausal women.

Design: Prospective cohort study.

Setting: Women's Health Initiative (WHI) in the USA.

Participants: 84 555 postmenopausal women aged 50-79 in 1994, who were free of diabetes, ASCVD and cancer at baseline who were not in the dietary modification trial of the WHI, completed a validated food frequency questionnaire, and were evaluated for incident diabetes and ASCVD outcomes during the follow-up until 2010.

Main outcome measure: Diabetes and ASCVD.

Results: Cox proportional hazards models were used to estimate the association (HR) between quartiles of pasta meal consumption (residuals after adjusting for total energy) and the risk of incidence diabetes, CHD, stroke or ASCVD, accounting for potential confounding factors, with testing for linear trend. We then statistically evaluated the effect of substituting white bread or fried potato for pasta meal on disease risk. When comparing the highest to the lowest quartiles of residual pasta meal intake, we observed significantly reduced risk of ASCVD (HR=0.89, 95% CI 0.83 to 0.96, p trend=0.002), stroke (HR=0.84, 95% CI 0.75 to 0.93, p trend=0.001), CHD (HR=0.91, 95% CI 0.83 to 1.00, p trend=0.058) and no significant alteration in diabetes risk (HR=1.02, 95% CI 0.96 to 1.07, p trend=0.328). Replacing white bread or fried potato with pasta meal was statistically associated with decreased risk of stroke and ASCVD.

Conclusions: Pasta meal intake did not have adverse effects on long-term diabetes risk and may be associated with significant reduced risk of stroke and ASCVD. The potential benefit of substituting pasta meal for other commonly consumed starchy foods on cardiometabolic outcomes warrants further investigation in additional high-quality and large prospective studies of diverse populations.

Keywords: diabetes mellitus; nutrition assessment.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Analytical sample flow chart. BMI, body mass index; CaD, calcium and vitamin D; CHD, coronary heart disease; CVD, cardiovascular disease; FFQ, food frequency questionnaire; HT, hormone therapy; OS, observational study; WHI, Women’s Health Initiative.
Figure 2
Figure 2
Estimates of relative risk and 95% CIs of outcomes of interest according to quartiles of pasta meal intake from model 3 (adjusted for age, race, region, study indicators, body mass index (BMI), total energy intake, per cent energy from carbohydrates, smoking status, alcohol consumption, physical activity, Healthy Eating Index (HEI) 2005 and family history of the respective disease outcome). ASCVD, atherosclerotic cardiovascular disease; CHD, coronary heart disease.

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