A step closer to understanding how a diet high in simple carbohydrates may cause dysbiosis.

The gut microbiota is an integral part of the human metaorganism that is required to shape physiologic host immune responses including host defense against pathogens. Disease-associated gut dysbiosis has been characterized by blooms of pathobionts, which are bacterial species that can drive disease under certain conditions. Pathobionts like Enterobacteriaceae often bloom during flares of inflammatory bowel disease (IBD) and are causally linked with IBD in murine models. In this issue of the JCI, Hecht and colleagues investigated how simple carbohydrates are causally linked to the bloom of the gut pathobiont Klebsiella pneumoniae, which belong to the Enterobacteriaceae family. Notably, the presence of fiber reduced the dissemination of K. pneumoniae into the blood and liver in a colitis model. Their findings provide a diet-related mechanism for gut dysbiosis, which has implications in the management of IBD and other conditions in which gut dysbiosis is an underlying factor.

Energy intake, hydration status, and sleep of world-class male archers during competition.

BACKGROUND: Nutritional intake and sleep, play an important role for recovery and performance in elite sport but little work has been undertaken in archery. The present study aimed to assess energy intake (EI), hydration status, and sleep parameters in world-class male archers over the course of a four-day competition. METHODS: Results, Conclusions Six male, elite-standard archers participated in the study and measurements of hydration status, EI, competition load, and sleep were recorded throughout each day of competition. RESULTS: Daily energy, carbohydrate, and protein intake ranged between 2,563 and 3,986 kcal, 4 and 7.1 g/kg BM, 2.2 and 3.6 g/kg BM per day, respectively. Thus, archers practiced elements of periodized nutrition such that energy and carbohydrate intake was greater on the high-volume competition days (i.e. days 1 and 3; more numbers of arrows, longer duration, and walking distance) in comparison to low-volume days (days 2 and 4) over the tournament (all p > 0.01). Additionally, urine specific gravity was higher after waking, compared to pre- and post-competition, and before bed (all p < 0.05). This indicates that archers were euhydrated pre- and post-competition and before bedtime, while they were slightly hypohydrated after waking up. Sleep data show that disturbances were kept to a minimum. CONCLUSIONS: Collectively, archers appear capable of periodizing their nutritional intake according to daily physical loading during a tournament whilst, staying euhydrated and maintaining sleep quality. In part, such data can help to explain why these archers experience a sustained level of success.

Evaluation of different ratios of neutral detergent-soluble carbohydrate fractions on performance, ingestive behavior, and nitrogen balance in dairy goats.

Cell components soluble in neutral detergent are a diverse group, both compositionally and nutritionally. The present study aimed to evaluate production responses, behavior (eating, ruminating, and idling), and nitrogen balance of dairy goats fed different ratios of neutral detergent-soluble carbohydrate fractions. Five multiparous Alpine does with mean ± SD initial body mass of 49.5 ± 7.9 kg and 60 days of lactation were randomly assigned in a 5 × 5 Latin square design. The treatments were the ratios of starch (starch associated with soluble sugar [StSS]) to neutral detergent-soluble fiber (NDSF) (StSS:NDSF): 0.89, 1.05, 1.24, 1.73, and 2.92. No effect was observed (P > 0.05) of StSS:NDSF on the intakes of neutral detergent fiber (NDF) and NDSC. However, DM intake showed a quadratic behavior (P = 0.049). The ingestive behavior was affected by StSS:NDSF linearly increased (P = 0.002) the feeding efficiency. The increase in StSS:NDSF caused a linear increase in fecal (P = 0.011), urinary (P < 0.001), and milk nitrogen excretion (P = 0.024). The increase in StSS:NDSF affected (P = 0.048) milk yield and net energy lactation (P = 0.036). In conclusion, dairy goats experience reduced dry matter intake and milk yield when subjected to high-NDSC diets, specifically those above 1.24 StSS:NDSF ratio. Elevated NDSC levels in the diets lead to decreased feeding time, whereas rumination remains unaffected. Nitrogen losses in goats increase linearly with high-NDSC diets, and a significant impact on nitrogen balance.

The association between multiple trajectories of macronutrient intake and the risk of new-onset diabetes in Chinese adults.

BACKGROUND: The association between macronutrient intake and diabetes is unclear. We used data from the China Health and Nutrition Survey to explore the association between macronutrient intake trajectories and diabetes risk in this study. METHODS: We included 6755 participants who did not have diabetes at baseline and participated in at least three surveys. The energy supply ratio of carbohydrate, protein, and fat was further calculated from dietary data; different macronutrient trajectories were determined using multitrajectory models; and multiple Cox regression models were used to evaluate the association between these trajectories and diabetes. RESULTS: We found three multitrajectories: decreased low carbohydrate-increased moderate protein-increased high fat (DLC-IMP-IHF), decreased high carbohydrate-moderate protein-increased low fat (DHC-MP-ILF), and balanced-macronutrients (BM). Compared to the BM trajectory, DHC-MP-ILF trajectories were significantly associated with increased risk of diabetes (hazard ratio [HR]: 3.228, 95% confidence interval [CI]: 1.571-6.632), whereas no association between DLC-IMP-IHF trajectories and diabetes was found in our study (HR: 0.699, 95% CI: 0.351-1.392). CONCLUSIONS: The downward trend of high carbohydrate and the increasing trend of low fat increased the risk of diabetes in Chinese adults.

Diet and Meal Pattern Determinants of Glucose Levels and Variability in Adults with and without Prediabetes or Early-Onset Type 2 Diabetes: A Pilot Study.

This observational pilot study examined the association between diet, meal pattern and glucose over a 2-week period under free-living conditions in 26 adults with dysglycemia (D-GLYC) and 14 with normoglycemia (N-GLYC). We hypothesized that a prolonged eating window and late eating occasions (EOs), along with a higher dietary carbohydrate intake, would result in higher glucose levels and glucose variability (GV). General linear models were run with meal timing with time-stamped photographs in real time, and diet composition by dietary recalls, and their variability (SD), as predictors and glucose variables (mean glucose, mean amplitude of glucose excursions [MAGE], largest amplitude of glucose excursions [LAGE] and GV) as dependent variables. After adjusting for calories and nutrients, a later eating midpoint predicted a lower GV (ß = -2.3, SE = 1.0, p = 0.03) in D-GLYC, while a later last EO predicted a higher GV (ß = 1.5, SE = 0.6, p = 0.04) in N-GLYC. A higher carbohydrate intake predicted a higher MAGE (ß = 0.9, SE = 0.4, p = 0.02) and GV (ß = 0.4, SE = 0.2, p = 0.04) in N-GLYC, but not D-GLYC. In summary, our data suggest that meal patterns interact with dietary composition and should be evaluated as potential modifiable determinants of glucose in adults with and without dysglycemia. Future research should evaluate causality with controlled diets.

Carbohydrate-Mediated Pregnancy Gut Microbiota and Neonatal Low Birth Weight.

The effects of gut microbiota on the association between carbohydrate intake during pregnancy and neonatal low birth weight (LBW) were investigated. A prospective cohort study was conducted with 257 singleton-born mother-child pairs in Taiwan, and maternal dietary intake was estimated using a questionnaire, with each macronutrient being classified as low, medium, or high. Maternal fecal samples were collected between 24 and 28 weeks of gestation, and gut microbiota composition and diversity were profiled using 16S rRNA amplicon gene sequencing. Carbohydrates were the major source of total energy (56.61%), followed by fat (27.92%) and protein (15.46%). The rate of infant LBW was 7.8%, which was positively correlated with maternal carbohydrate intake. In the pregnancy gut microbiota, Bacteroides ovatus and Dorea spp. were indirectly and directly negatively associated with fetal growth, respectively; Rosenburia faecis was directly positively associated with neonatal birth weight. Maternal hypertension during pregnancy altered the microbiota features and was associated with poor fetal growth. Microbiota-accessible carbohydrates can modify the composition and function of the pregnancy gut microbiota, thus providing a potential marker to modulate deviations from dietary patterns, particularly in women at risk of hypertension during pregnancy, to prevent neonatal LBW.

Effects of Dietary Carbohydrate Concentration and Glycemic Index on Blood Glucose Variability and Free Fatty Acids in Individuals with Type 1 Diabetes.

Monitoring glycemic control status is the cornerstone of diabetes management. This study aimed to reveal whether moderate-carbohydrate (CHO) diets increase the risk of free fatty acid (FFA) levels, and it presents the short-term effects of four different diet models on blood sugar, glycemic variability (GV), and FFA levels. This crossover study included 17 patients with type 1 diabetes mellitus to identify the effects of four diets with different CHO contents and glycemic index (GI) on GV and plasma FFA levels. Diet 1 (D1) contained 40% CHO with a low GI, diet 2 (D2) contained 40% CHO with a high GI, diet 3 (D3) contained 60% CHO with a low GI, and diet 4 (D4) contained 60% CHO with a high GI. Interventions were performed with sensor monitoring in four-day periods and completed in four weeks. No statistical difference was observed among the groups in terms of blood glucose area under the curve (p = 0.78), mean blood glucose levels (p = 0.28), GV (p = 0.59), and time in range (p = 0.567). FFA and total triglyceride levels were higher in the D1 group (p < 0.014 and p = 0.002, respectively). Different diets may increase the risk of cardiovascular diseases by affecting GI, FFA, and blood glucose levels.

Association of fat-to-muscle mass ratio with physical activity and dietary protein, carbohydrate, sodium, and fiber intake in a cross-sectional study.

Higher fat-to-muscle mass ratio (FMR) is reported to be a risk factor for various diseases, including type 2 diabetes and cardiovascular diseases, and mortality. Although this association suggests that reducing FMR may help to prevent certain diseases and mortality, the relationship between FMR and lifestyle factors is unclear. Therefore, we performed a cross-sectional study with the aim to elucidate this relationship. This cross-sectional study included 1518 healthy Japanese adults aged 30 to 64 years. We measured FMR in the whole body, arms, legs, and trunk and assessed various lifestyle factors. Then, we performed forced entry multiple regression analyses for FMR with the following variables: sex, age, physical activity, dietary intake, sleep quality, cigarette smoking, stress levels, and body mass index. As a result, whole-body and regional FMRs were correlated with female sex (ß = 0.71); age (ß = 0.06); physical activity (ß = - 0.07); dietary intake of protein (ß = - 0.12), carbohydrate (ß = 0.04), sodium (ß = 0.13), and fiber (ß = - 0.16); and body mass index (ß = 0.70). The results suggest that in the Japanese middle-aged population, low FMR is associated with certain lifestyle factors, i.e. higher physical activity and a diet with higher protein and fiber and lower carbohydrate and sodium, independent of age, sex, and body mass index.

Target for lipid-to-carbohydrate intake minimizes cost of growth.

Many theoretical treatments of foraging use energy as currency, with carbohydrates and lipids considered interchangeable as energy sources. However, herbivores must often synthesize lipids from carbohydrates since they are in short supply in plants, theoretically increasing the cost of growth. We tested whether a generalist insect herbivore (Locusta migratoria) can improve its growth efficiency by consuming lipids, and whether these locusts have a preferred caloric intake ratio of carbohydrate to lipid (C : L). Locusts fed pairs of isocaloric, isoprotein diets differing in C and L consistently selected a 2C : 1L target. Locusts reared on isocaloric, isoprotein 3C : 0L diets attained similar final body masses and lipid contents to locusts fed the 2C : 1L diet, but they ate more and had a ~12% higher metabolic rate, indicating an energetic cost for lipogenesis. These results demonstrate that some animals can selectively regulate carbohydrate-to-lipid intake and that consumption of dietary lipids can improve growth efficiency.

[Gastrointestinal symptoms and dietary intake of patients with irritable bowel syndrome following a low FODMAP diet].

INTRODUCTION: High FODMAP (fermentable oligo-, di, monosaccharides and polyols) foods have been linked with worsening symptoms of IBS patients. The aim was to compare gastrointestinal symptoms and dietary intake of patients with irritable bowel syndrome following a low FODMAP diet, with or without individual nutrition therapy. MATERIALS AND METHODS: A total of 54 patients that met Rome IV criteria for IBS were randomized into two groups, guided group (individual nutrition therapy, n=28) and self-management group (learned about low FODMAP diet online, n=26). Both groups followed low FODMAP diet for 4 weeks. Four-day food records were used to assess dietary intake. Symptoms were assessed by the IBS-severity scoring system (ISB-SSS). RESULTS: The number of subjects who did not complete the study was 13, thereof five in the nutrition therapy and eight in the self-management group, leaving 23 and 18 subjects available for analysis, respectively. Symptoms declined from baseline to endpoint in both groups, by 183±101 points on average in the group receiving nutrition therapy (p< 0.001) and 132±110 points in the self-management group (p< 0.001), with no difference between groups. At baseline, about 80% of meals in both groups contained food high in FODMAP's. The corresponding proportion was 9% and 36% in week 3 in the nutrition therapy and self-management group, respectively (p< 0.001). CONCLUSION: Both groups experienced relieve of symptoms, but compliance to the low FODMAP diet was better in the group receiving individual nutrition therapy compared with the group who only received instructions on how to learn about low FODMAP diet online.

Effect of nonstructural carbohydrates on production performance, rumen metabolism and rumen health in lambs fed with isocaloric and isonitrogenous complete diets.

Nonstructural carbohydrates (NSC) are readily fermentable in the rumen and, are a critical factor while preparing protracted feed for higher animal performance. Four isocaloric and isonitrogenous complete feeds were prepared for this investigation to contain varying levels of nonstructural carbohydrates viz., 40.13 (NSC1), 45.21 (NSC2), 50.00 (NSC3) and 55.85 (NSC4) per cent, respectively. The four isocaloric and isonitrogenous complete feeds were tested in 32 Mecheri ram lambs (around three months of age) in a completely randomised block design (n = 8), and the lambs were fed their respective feed for six months. The study revealed that the increased NSC level in the complete diet increased the body weight and weight gain linearly (P < 0.05). The dietary NSC level affected the dry matter consumption in a quadratic manner (P < 0.05) and the lambs of the NSC4 group consumed significantly (P < 0.05) less DM compared to other dietary groups. The overall average feed conversion efficiency differed significantly (P < 0.05) among dietary groups. The correlation between dietary NSC level and faecal score was quadratic (r2 = 62.7, P < 0.05). The rumen pH, total nitrogen and NH3-N concentration were linearly decreased (P < 0.05) and the molar proportion of total short-chain fatty acids and propionic acid were increased (P < 0.05). The energy loss expressed as methane production was significantly (P < 0.01) lower for the high NSC diet-fed lambs. The lambs fed on a low NSC diet had significantly (P < 0.05) lower carcass weights, dressing percentage and loin eye area. The per cent share of rumen weight in the total fore stomach and the rumen papillae measurements length, width and surface area were significantly (P < 0.05) higher in high NSC diet-fed lambs. Increased levels of NSC in the diet increased (P < 0.05) fat deposition in the internal organs. The saturated fatty acids content in the meat was significantly (P < 0.05) lowered, whereas, the oleic acid and linoleic acid were increased (P < 0.05) as the NSC level increased in the diet. The study revealed that as the level of NSC increased in the complete diet there was a concomitant improvement in the final body weight, ADG and feed efficiency of post-weaned Mecheri lambs. It can therefore be recommended that the complete feed with 50 per cent NSC levels would be optimum to reap maximum returns from fattening Mecheri lambs.

Associated between cognition, brain-derived neurotrophic factor (BDNF) and macronutrients in normal and overweight postmenopausal women.

BDNF is a protein associated with cognitive dysfunction. The aim of the study was to determine the relationship between BDNF and cognitive functions and the intake of macronutrients in postmenopausal women. For this purpose, 72 postmenopausal women were recruited to the study and divided into two subgroups: overweight/obese and normal weight. Using a 3-day food record, nutrition was assessed. The markers studied were the level of BDNF, which was determined from the venous blood serum collected from women, and selected cognitive functions. We observed that in the normal BMI group macronutrient intake was correlated with BDNF levels, and only total fat and carbohydrate intake were inversely correlated with BDNF levels. There were inverse correlations observed among selected parameters of cognitive functioning. In the Ov/Ob group, macronutrient intake correlated with the BDNF level for several variables, e.g. vice versa with total protein, fat and carbohydrate intake, as well as dietary cholesterol. It has also been noted that there are links between the BDNF factor and excessive body weight.

Comparison of Australian Football League Women's athletes match day energy and nutrient intake to recommendations.

AIMS: This cross-sectional observational study quantified Australian Football League Women's athletes' match volume, and compared match-day dietary intakes against recommendations. METHODS: Self-report, direct observation, and fluid measurements determined dietary intake (n = 17, 25 ± 4.5 years, 22.8 ± 1.8 kg/m2) on five home match days (early or late starting). Global positioning system software captured match volume. Linear mixed effects models evaluated differences in early versus late match volume and nutrient intakes. Data are presented as mean ± standard deviation. RESULTS: Athletes covered 6712 ± 622 m during matches, with similar numbers of very high-intensity running efforts over equal distances in early and late matches (early vs. late efforts [no.]: 8.5 ± 4.9 vs. 9.5 ± 5.5; distance [m]: 203 ± 127 vs. 212 ± 113). Across all match days, 71% (n = 12) of athletes met their predicted daily energy requirements. However, 82% (n = 14) failed to meet minimum daily carbohydrate recommendations; intake was lower on early compared with late match days (4.7 g/day vs. 5.4 g/kg/day, p = 0.027). On average, no athletes met carbohydrate recommendations in the 2 h prior to a match and only 24% (n = 4) met recommendations during matches. All athletes met post-match carbohydrate and protein requirements. CONCLUSION: Athletes cover large distances during games with frequent bursts of high-intensity running. However, they do not adjust their intake to meet the energy demands of competition, with inadequate fuelling prior to and during matches. These findings emphasise the need for greater athlete education and dietary support to maximise strategic fuelling to optimise athletic performance.

Carbohydrate Ingestion before Exercise for Individuals with McArdle Disease: Survey Evidence of Implementation and Perception in Real-World Settings.

In individuals with McArdle disease (IWMD), the ingestion of carbohydrates before exercise has previously been shown in laboratory studies to significantly decrease the exercising symptoms of the condition and increase exercise tolerance during the early stages of exercise. As a result, carbohydrate ingestion pre-exercise is currently included in management guidelines, and often advised by medical professionals treating the condition. The aim of the current study was to determine whether positive lab-based results for the ingestion of carbohydrate before exercise in laboratory studies are being effectively translated into practice and produce perceptions of the same positive outcomes in real-world settings (RWS). An online survey method was used to collect responses from 108 IWMD. Data collected on the amount and type of carbohydrate consumed prior to exercise found that most surveyed participants (69.6%) who supplied qualitative data (n = 45) consumed less than the 37 g currently recommended in management guidelines. Survey data also revealed a large variation in the type and amount of carbohydrate ingested when IWMDs are applying carbohydrate ingestion before exercise in RWS. Consistent with these findings, only 17.5% of participants stated that they found carbohydrate ingestion before exercise relieved or minimised their MD symptoms. Results suggest that positive lab-based findings (increased exercise tolerance) of carbohydrate ingestion before exercise are not being effectively translated to RWS for many IWMD. There is a need for improved patient education of IWMD on the application of carbohydrate ingestion before exercise in RWS.

Effects of dietary forage neutral detergent fiber and rumen degradable starch ratios on chewing activity, ruminal fermentation, ruminal microbes and nutrient digestibility of Hu sheep fed a pelleted total mixed ration.

Pelleted total mixed ration (P-TMR) feeding, which has become a common practice in providing nutrition for fattening sheep, requires careful consideration of the balance between forage neutral detergent fiber (FNDF) and rumen degradable starch (RDS) to maintain proper rumen functions. The present study aimed to investigate the effects of the dietary FNDF/RDS ratio (FRR) on chewing activity, ruminal fermentation, ruminal microbes, and nutrient digestibility in Hu sheep fed a P-TMR diet. This study utilized eight ruminally cannulated male Hu sheep, following a 4 × 4 Latin square design with 31 d each period. Diets consisted of four FRR levels: 1.0 (high FNDF/RDS ratio, HFRR), 0.8 (middle high FNDF/RDS ratio, MHFRR), 0.6 (middle low FNDF/RDS ratio, MLFRR), and 0.4 (low FNDF/RDS ratio, LFRR). Reducing the dietary FRR levels resulted in a linear decrease in ruminal minimum pH and mean pH, while linearly increasing the duration and area of pH below 5.8 and 5.6, as well as the acidosis index. Sheep in the HFRR and MHFRR groups did not experience subacute ruminal acidosis (SARA), whereas sheep in another two groups did. The concentration of total volatile fatty acid and the molar ratios of propionate and valerate, as well as the concentrate of lactate in the rumen linearly increased with reducing dietary FRR, while the molar ratio of acetate and acetate to propionate ratio linearly decreased. The degradability of NDF and ADF for alfalfa hay has a quadratic response with reducing the dietary FRR. The apparent digestibility of dry matter, organic matter, neutral detergent fiber, and acid detergent fiber linearly decreased when the dietary FRR was reduced. In addition, reducing the dietary FRR caused a linear decrease in OTUs, Chao1, and Ace index of ruminal microflora. Reducing FRR in the diet increased the percentage of reads assigned as Firmicutes, but it decreased the percentage of reads assigned as Bacteroidetes in the rumen. At genus level, the percentage of reads assigned as Prevotella, Ruminococcus, Succinivibrio, and Butyrivibrio linearly decreased when the dietary FRR was reduced. The results of this study demonstrate that the dietary FRR of 0.8 is crucial in preventing the onset of SARA and promotes an enhanced richness of ruminal microbes and also improves fiber digestibility, which is a recommended dietary FRR reference when formulating P-TMR diets for sheep.

Forage neutral detergent fiber (FNDF) and rumen degradable starch (RDS) are key components of carbohydrates in the diet for ruminants, which would reflect saliva secretion and the acid production potential of feed. However, appropriate FNDF to RDS ratios (FRR) applicable to ruminants under the condition of pelleted total mixed ration (P-TMR) feeding have not been reported. In this study, we investigated the effects of the dietary FRR on chewing activity, ruminal fermentation, ruminal microbial communities, and nutrient digestibility of Hu sheep under P-TMR feeding. The results indicate that reducing dietary FRR levels would induce acidosis in sheep, which negatively affected fiber utilization and ruminal bacterial communities. The FRR of 0.8 was a recommended dietary FRR when formulating a P-TMR diet for fattening sheep, as indicated by decreased ruminal acidosis risk and increased richness of ruminal microbes in the rumen as well as nutrient digestibility.

Association between quality and quantity of carbohydrate intake with selected anthropometric indices among primary school girls in Kerman city, Iran: a cross-sectional study.

BACKGROUND: The school-age is a crucial period of physical and cognitive growth, which requires an assessment of dietary intake and its influence on body weight and height. This study aims to determine the association between the quality and quantity of carbohydrate intake with selected anthropometric indices in primary school girls in Kerman City, Iran. METHODS: This cross-sectional study was conducted on 330 primary school girls ages 6-12 years in Kerman. We used a validated and reliable dish-based 185-item food frequency questionnaire to evaluate people's food intake. We assessed the amount of carbohydrates in children's diets as the percentage of daily calories and grams per day. We used dietary fiber intake (grams/day), the glycemic load, the ratio of whole grain to total grain, and the ratio of solid carbohydrates to total carbohydrates to assess carbohydrate quality. Height, weight, and arm circumference were measured. We calculated body mass index (BMI) by dividing the weight in kilograms by the height in centimeters squared. We used the World Health Organization z-scores charts for girls 5 to 19 years old to assess z-scores for BMI-for-age (BAZ), height-for-age (HAZ), and weight-for-age (WAZ). Socioeconomic status and physical activity were assessed. We used ANOVA and ANCOVA statistical tests to assess the association between anthropometric indices and carbohydrate quantity and quality parameters. RESULTS: Participants with the highest amount of carbohydrate intake had significantly higher anthropometric indices, including arm circumference, BMI-for-age z score (BAZ), and Height-for-age z score (HAZ) (p < 0.001, p < 0.001, and p = 0.009, respectively). With the increase in glycemic load (GL) and dietary fiber intake, anthropometric indices including arm circumference (GL: p < 0.001, Fiber: p < 0.001), BAZ (GL: p < 0.001, Fiber: P < 0.001), and HAZ (GL: P = 0.009, Fiber: p < 0.001) increased significantly. CONCLUSIONS: We concluded that there was a positive association between the amount of carbohydrate intake and anthropometric indices (MUAC, BAZ, and HAZ). Also, with the increase in glycemic load and dietary fiber intake, the anthropometric indices including MUAC, BAZ, and HAZ increased.

Difference in association of carbohydrate intake with all-cause mortality between middle-aged and older Korean adults with and without diabetes mellitus: A prospective study.

BACKGROUND & AIMS: The relationship between diet and health, particularly the role of carbohydrates, has been extensively studied. However, carbohydrate intake based on individual health conditions remains unclear. Here, we aimed to investigate whether the association between carbohydrate intake and all-cause mortality varied between individuals with and without diabetes mellitus (DM). METHODS: This prospective cohort study used data from the Korean Genome and Epidemiology Study (KoGES). Overall, 143,050 participants were included, with 10.1% having DM. Dietary intake was assessed using a semiquantitative food frequency questionnaire. Cox proportional hazards regression models were used to assess the association between carbohydrate intake and mortality after adjusting for confounders. RESULTS: The study showed that 5436 deaths occurred during the median follow-up period of 10.1 years. A significant interaction between carbohydrate intake and DM was observed in the study population (interaction p = 0.061). Higher carbohydrate intake proportion was associated with an increased risk of all-cause mortality among individuals with DM (adjusted hazard ratio [HR], p-value = 1.10 [1.01-1.20], p = 0.032). Conversely, no association was observed between the proportion of carbohydrate intake and all-cause mortality in participants without DM. Additionally, both total sugar and added sugar intakes were associated with an increased risk of all-cause mortality in participants with DM (adjusted HR, p-value = 1.02 [1.01-1.04], p < 0.001 and 1.18 [1.13-1.24], p < 0.001). CONCLUSIONS: High carbohydrate (%) and added sugar intake were associated with an increased mortality risk in individuals with DM. Reducing carbohydrate intake and opting for healthy carbohydrates to mitigate mortality risk may be beneficial for individuals with DM, particularly when compared with the general population.

[Relationship between the percentage of energy intake from macronutrients and obesity among adult residents in 15 provinces of China in 1991-2018].

OBJECTIVE: To explore the relationship between the percentage of energy intake from macronutrients and obesity in Chinese adult residents, and analyze the cut-off values of macronutrients for predicting obesity. METHODS: Data was collected in China Health and Nutrition Survey(CHNS)in 1991-2018. Adults who participated in at least two waves of the surveys and were not obese at baseline were selected as the study subjects. Obesity was defined as body mass index(BMI)≥28.0 kg/m~2. Generalized estimating equation was used to analyze the relationship between the percentage of energy intake from macronutrients and BMI and obesity, and receiver operating characteristic curve(ROC) was used to analyze the cut-off values of percentage of energy intake from macronutrients to predict obesity. RESULTS: The percentage of energy intake from protein and fat of adult residents in 15 provinces(autonomous regions and municipalities) in China showed an increasing trend(P<0.01), and the percentage of energy intake from carbohydrate showed a decreasing trend(P<0.01) between 1991 and 2018. After adjusting for covariates, the group of percentage of energy intake from fat in 20%～30%(ß=0.05, 95%CI 0.01-0.08)and ≥30%(ß=0.15, 95%CI 0.11-0.18)were positively correlated with BMI compared with the group of percentage of energy intake from fat <20%, and the risk of obesity in 20%-30% and ≥ 30% was increased by 17%(OR=1.17, 95%CI 1.04-1.31)and 6%(OR=1.06, 95%CI 1.24-1.56), respectively. Compared with the group of the percentage of energy intake from carbohydrate < 50%, the group of 50% to 65%(ß=-0.08, 95% CI-0.11--0.05) and ≥ 65%(ß=-0.17, 95%CI-0.20--0.13) was negatively correlated with BMI, and the percentage of energy intake from carbohydrate ≥ 65% reduced the risk of obesity(OR=0.71, 95%CI 0.63-0.80). CONCLUSION: Carbohydrate intake was inversely correlated with the risk of obesity, and fat intake was positively correlated with the risk of obesity. Moderate intake of carbohydrates and reduced fat intake can prevent obesity.