Carbohydrate nutrition differs by diabetes status and is associated with dyslipidemia in Boston Puerto Rican adults without diabetes

Abstract

Puerto Rican adults have a greater prevalence of type 2 diabetes (T2D) and lower HDL-cholesterol (HDL-C) than the general U.S. population. Carbohydrate nutrition may play a role in this disparity. Cross-sectional analyses included data from 1219 Puerto Ricans aged 45-75 y enrolled in the Boston Puerto Rican Health Study. Using the Pearson chi-square test and ANCOVA, lifestyle characteristics and dietary intake, as assessed by semiquantitative FFQ, were compared by T2D status based on fasting plasma glucose concentration and medication use. Food source rankings for carbohydrate, dietary glycemic load (GL), and fiber were obtained using the SAS procedure PROC RANK. Geometric mean plasma HDL-C and TG concentrations were compared across quintiles of dietary carbohydrate, glycemic index (GI), GL, and fiber by using ANCOVA and tests for linear trend. In multivariable analyses, individuals with T2D (39.5%) had lower dietary carbohydrate, GL, and total sugar intake from lower intake of sugar, fruit drinks, and soda compared with those without T2D. In individuals without T2D, dietary carbohydrate and GL were inversely associated with HDL-C (P < 0.0001). Associations between dietary fiber and HDL-C were confounded by carbohydrate intake, apparently from concurrent consumption of legumes with white rice, a refined carbohydrate food. No associations were observed between carbohydrate, dietary GI, GL, or fiber and TG. In conclusion, individuals with T2D showed evidence of dietary modification. Among those without diabetes, a high intake of refined carbohydrates was associated with decreased HDL-C. Longitudinal research on carbohydrate nutrition in relation to diabetes risk factors and blood lipids in Puerto Ricans is warranted.

Conflict of interest statement

Author disclosures: M. I. Van Rompay, N. M. McKeown, C. Castaneda-Sceppa, J. M. Ordovás, and K. L. Tucker, no conflicts of interest.

Figures

FIGURE 1

Adjusted mean plasma HDL-C concentrations across quintiles of carbohydrate and dietary GL in Puerto Rican adults without T2D, n = 738. Carbohydrate and dietary GL were energy adjusted using the residual method before creating quintiles. Values are geometric means obtained by back-transforming logged HDL-C concentrations and using ANCOVA, adjusted for age, sex, education level, smoking, alcohol use, physical activity, waist circumference, lipid-lowering medication use, total energy, total fat, and dietary fiber intake. P-trend < 0.0001 for both. GL, glycemic load; HDL-C, HDL-cholesterol; T2D, type 2 diabetes.