Table 3.
Hazard ratios of Coronary Heart Disease by Intake of Carbohydrates of Varying Quality as Percentages of Total Energy Intake
|
Quintile Categories of Carbohydrate Intake as a Percentage of Total Energy Intake
|
p Trend | ||||||
|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | |||
| Total carbohydrates | |||||||
| NHS | Median (%E) | 34.7 | 41.7 | 45.8 | 49.4 | 54.5 | |
| Cases | 560 | 647 | 705 | 740 | 840 | ||
| Age-adjusted | 1 (ref.) | 0.94 (0.84-1.05) | 0.90 (0.81-1.01) | 0.85 (0.76-0.96) | 0.84 (0.75-0.94) | 0.0009 | |
| Multivariate* | 1 (ref.) | 1.02 (0.90-1.14) | 1.03 (0.91-1.17) | 1.03 (0.90-1.17) | 1.09 (0.94-1.25) | 0.26 | |
| HPFS | Median (%E) | 38.7 | 44.6 | 48.5 | 52.3 | 58.1 | |
| Cases | 818 | 780 | 848 | 857 | 877 | ||
| Age-adjusted | 1 (ref.) | 0.93 (0.84-1.02) | 0.95 (0.86-1.05) | 0.91 (0.83-1.00) | 0.88 (0.80-0.97) | 0.009 | |
| Multivariate* | 1 (ref.) | 0.98 (0.88-1.08) | 1.02 (0.92-1.14) | 0.99 (0.89-1.11) | 1.00 (0.88-1.14) | 0.92 | |
| Pooled | Multivariate* | 1 (ref.) | 0.99 (0.92-1.07) | 1.02 (0.94-1.11) | 1.01 (0.92-1.10) | 1.04 (0.94-1.14) | 0.41 |
| Carbohydrates from refined starches/added sugars | |||||||
| NHS | Median (%E) |
14.8 | 19.4 | 22.5 | 25.5 | 30.3 | |
| Cases | 594 | 683 | 712 | 762 | 741 | ||
| Age- adjusted |
1 (ref.) | 1.00 (0.89-1.11) | 1.03 (0.92-1.15) | 1.14 (1.02-1.28) | 1.24 (1.11-1.39) | <0.0001 | |
| Multivariate * |
1 (ref.) | 1.01 (0.90-1.14) | 1.02 (0.90-1.15) | 1.10 (0.96-1.25) | 1.10 (0.95-1.28) | 0.15 | |
| HPFS | Median (%E) |
16.7 | 20.9 | 23.8 | 26.8 | 31.6 | |
| Cases | 849 | 836 | 833 | 824 | 833 | ||
| Age- adjusted |
1 (ref.) | 1.00 (0.91-1.10) | 1.04 (0.95-1.15) | 1.07 (0.97-1.18) | 1.21 (1.10-1.33) | <0.0001 | |
| Multivariate * |
1 (ref.) | 1.02 (0.93-1.13) | 1.04 (0.94-1.16) | 1.04 (0.93-1.16) | 1.10 (0.97-1.25) | 0.15 | |
| Pooled | Multivariate * |
1 (ref.) | 1.02 (0.95-1.10) | 1.03 (0.95-1.12) | 1.06 (0.98-1.16) | 1.10 (1.00-1.21) | 0.04 |
| Carbohydrates from whole grains | |||||||
| NHS | Median (%E) |
0.4 | 1.0 | 1.8 | 2.8 | 4.6 | |
| (%E) Cases | 598 | 731 | 680 | 715 | 768 | ||
| Age- adjusted |
1 (ref.) | 0.95 (0.85-1.06) | 0.74 (0.66-0.83) | 0.67 (0.60-0.76) | 0.62 (0.55-0.69) | <0.0001 | |
| Multivariate * |
1 (ref.) | 1.05 (0.94-1.18) | 0.90 (0.80-1.01) | 0.90 (0.79-1.02) | 0.92 (0.81-1.05) | 0.08 | |
| HPFS | Median (%E) |
0.8 | 2.0 | 3.1 | 4.4 | 7.0 | |
| Cases | 895 | 868 | 820 | 840 | 752 | ||
| Age- adjusted |
1 (ref.) | 0.94 (0.85-1.03) | 0.82 (0.74-0.90) | 0.80 (0.73-0.88) | 0.69 (0.63-0.76) | <0.0001 | |
| Multivariate * |
1 (ref.) | 1.03 (0.93-1.13) | 0.96 (0.87-1.07) | 0.99 (0.90-1.10) | 0.88 (0.79-0.99) | 0.01 | |
| Pooled | Multivariate * |
1 (ref.) | 1.04 (0.96-1.11) | 0.94 (0.87-1.01) | 0.95 (0.88-1.03) | 0.90 (0.83-0.98) | 0.003 |
The multivariate model was adjusted for total energy intake, the energy contribution from protein, cholesterol intake, alcohol intake, smoking status, body mass index, physical activity, use of vitamins and aspirin, family history of MI and diabetes, and presence of baseline hypercholesterolemia and hypertension. Except for total carbohydrate models, models were also further adjusted for the percentage of energy from carbohydrates from whole grains, from refined starches/sugars, and from other foods simultaneously. Multivariate models thus represent the effect of substituting a percentage of energy from total carbohydrates or the specific carbohydrate type for an equivalent percentage of energy from total fat.