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What is an optimal diet? Relationship of macronutrient intake to obesity, glucose tolerance, lipoprotein cholesterol levels and the metabolic syndrome in the Whitehall II study

International Journal of Obesity volume 25, pages 45–53 (2001)Cite this article

Abstract

OBJECTIVE: Saturated fats have adverse effects on health. To investigate which is more beneficial for energy replacement, we compare the effects of polyunsaturated fatty acid and carbohydrate intake on obesity and metabolic variables (fasting triglycerides, HDL-cholesterol, LDL-cholesterol and 2 h glucose). Further, because the optimum diet may differ according to glucose tolerance, we examine the same associations in glucose tolerant and intolerant groups. Finally, we test the effect of macronutrient intake on the presence or absence of the metabolic syndrome.

DESIGN: Cross-sectional analysis.

SUBJECTS: A total of 4497 men and 1865 women aged 39–62 in the Whitehall II study.

RESULTS: In men, higher intakes of both polyunsaturated fats and carbohydrates were linked to lower waist–hip ratio, triglycerides and LDL-cholesterol. Higher carbohydrate intake alone was linked to decreased body mass index (for 10 g higher carbohydrate intake, −0.12 kg/m2, P<0.0001) and lower HDL-cholesterol (−0.01 mmol/l, P<0.01). In normoglycaemic men, higher carbohydrate intakes were associated with higher 2 h insulin and glucose levels (0.25 pmol/l, P<0.05 and 0.01 mmol/l, P=0.001, respectively). Dietary effects among women were similar, the exception being a positive association of polyunsaturated fat intake with body mass index and waist–hip ratio (0.47 kg/m2, P<0.05 and 0.006, P<0.05, respectively). Dietary components, with the exceptions of cholesterol and protein in men, were unrelated to prevalence of the metabolic syndrome, and adjustment for differences in macronutrient intake did not account for the strong inverse association between socioeconomic position and the metabolic syndrome.

CONCLUSION: Our observational data provide evidence that both polyunsaturated fatty acids and carbohydrates offer small metabolic benefits with few adverse effects compared with saturated fats.

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References

  1. Committee on Medical Aspects of Food Policy Nutritional Aspects of Cardiovascular Disease HMSO: London 1994 1–186.

  2. US Department of Health and Human Services PH Healthy people 2000. National health promotion and disease prevention objectives. US Department of Health and Human Services. Washington, DC 1990.

  3. Purnell JQ, Brunzell JD . The central role of dietary fat, not carbohydrate, in the insulin resistance syndrome Curr Opin Lipidol 1997 8: 17–22.

    Article  CAS  Google Scholar 

  4. Connor WE, Connor SL . The case for a low-fat, high carbohydrate diet New Engl J Med 1997 337: 562–563.

    Article  CAS  Google Scholar 

  5. Reaven GM . Do high carbohydrate diets prevent the development or attenuate the manifestations (or both) of syndrome X? A viewpoint strongly against Curr Opin Lipidol 1997 8: 23–27.

    Article  CAS  Google Scholar 

  6. Blades B, Garg A . Mechanisms of increase in plasma triacylglycerol concentrations as a result of high carbohydrate intakes in patients with non-insulin dependent diabetes mellitus Am J Clin Nutr 1995 62: 996–1002.

    Article  CAS  Google Scholar 

  7. Mensink RP, Katan MB . Effect of dietary fatty acids on serum lipids and lipoproteins: a meta-analysis of 27 trials Arterioscler Thromb 1992 12: 911–919.

    Article  CAS  Google Scholar 

  8. Willett WC, Sampson L, Stampfer MJ, Rosner B, Bain C, Witschi J, Hennekens CH, Speizer FE . Reproducibility and validity of a semiquantitative food frequency questionnaire Am J Epidemiol 1985 122: 51–65.

    Article  CAS  Google Scholar 

  9. Marmot MG, Davey Smith G, Stansfeld SA, Patel C, North F, Head J, White I, Brunner E, Feeney A . Health inequalities among British Civil Servants: the Whitehall II study Lancet 1991 337: 1387–1393.

    Article  CAS  Google Scholar 

  10. Brunner EJ, Marmot MG, Nanchahal K, Shipley MJ, Stansfels SA, Junega M, Alberti KG . Social inequality in coronary risk: central obesity and the metabolic syndrome. Evidence from the Whitehall II study Diabetologia 1997 40: 1341–1349.

    Article  CAS  Google Scholar 

  11. Willett W . Nutritional Epidemiology, 2nd edn, Oxford University Press: New York 1998 pp 111–514.

    Book  Google Scholar 

  12. Stallone DD, Brunner EJ, Bingham SA, Marmot MG . Dietary assessment in Whitehall II. The influence of reporting bias on apparent socioeconomic variation in nutrient intakes Eur J Clin Nutr 1997 51: 815–825.

    Article  CAS  Google Scholar 

  13. Willett WC, Stampfer MJ . Total energy intake: implications for epidemiologic analyses Am J Epidemiol 1986 124: 17–27.

    Article  CAS  Google Scholar 

  14. Marmot MG, Brunner EJ . Alcohol and cardiovascular disease: the status of the U shaped curve BMJ 1991 303: 565–568.

    Article  CAS  Google Scholar 

  15. Grey N, Kipnis DM . Effect of diet composition on the hyperinsulinemia of obesity New Engl J Med 1971 285: 827–831.

    Article  CAS  Google Scholar 

  16. Coulston AM, Liu GC, Reaven GM . Plasma glucose, insulin and lipid responses to high-carbohydrate low-fat diets in normal humans Metabolism 1983 32: 52–56.

    Article  CAS  Google Scholar 

  17. Borkman M, Campbell LV, Chrisholm DJ, Storlien LH . High-carbohydrate low-fat diets do not enhance insulin sensitivity in normal subjects J Clin Endocrinol Metab 1991 72: 432–437.

    Article  CAS  Google Scholar 

  18. Brunzell JD, Lerner RL, Porte D, Bierman EL . Effect of a fat free, high carbohydrate diet on diabetic subjects with fasting hyperglycemia Diabetes 1974 23: 138–142.

    Article  CAS  Google Scholar 

  19. Kiehm TG, Anderson TW, Ward K . Beneficial effects of a high carbohydrate, high fiber diet on hyperglycemic diabetic men Am J Clin Nutr 1976 29: 895–899.

    Article  CAS  Google Scholar 

  20. Hughes VA, Fiatarone MA, Fielding RA, Ferrara CM, Elahi D, Evans WJ . Long-term effects of a high-carbohydrate diet and exercise on insulin action in older subjects with impaired glucose tolerance Am J Clin Nutr 1995 62: 426–433.

    Article  CAS  Google Scholar 

  21. Garg A, Bantle JP, Henry RR, Coulston AM, Griver KA, Taatz SK, Brinkley L, Chen YD, Grundy SM, Huet BA . Effects of varying carbohydrate content of diet in patients with non-insulin dependent diabetes mellitus JAMA 1994 271: 1421–1428.

    Article  CAS  Google Scholar 

  22. Reaven GM . Role of insulin resistance in human disease Diabetes 1988 37: 1595–1607.

    Article  CAS  Google Scholar 

  23. Hu FB, Stampfer MJ, Manson JE, Rimm E, Colditz GA, Rosner BA, Hennekens CH, Willett WC . Dietary fat intake and the risk of coronary heart disease in women New Engl J Med 1997 337: 1491–1545.

    Article  CAS  Google Scholar 

  24. Ginsberg HN, Karmally W, Barr SL, Johnson C, Holleran S, Ramakrishnan R . Effects of increasing dietary polyunsaturated fatty acids within the guidelines of the AHA step 1 diet on plasma lipid and lipoprotein levels in normal males Arterioscler Thromb 1994 14: 892–901.

    Article  CAS  Google Scholar 

  25. Bonanome A, Visona A, Lusiani L, Beltramello G, Confortin L, Biffanti S, Sorgato F, Costa F, Pagnan A . Carbohydrate and lipid metabolism in patients with non-insulin dependent diabetes mellitus: effects of a low fat, high carbohydrate diet vs a diet high in monunsaturated fatty acids Am J Clin Nutr 1991 54: 586–590.

    Article  CAS  Google Scholar 

  26. Mensink RP, Katan MB . Effect of monounsaturated fatty acids versus complex carbohydrates on high-density lipoproteins in healthy men and women Lancet 1987 1: 122–125.

    Article  CAS  Google Scholar 

  27. Drewnowski A, Popkin BM . The nutrition transition: new trends in the global diet Nutr Rev 1997 55: 31–43.

    Article  CAS  Google Scholar 

  28. Larsson B, Svardsudd K, Welin L, Wilhelmsen L, Bjorntorp P, Tibblin G . Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913 BMJ 1984 288: 1401–1404.

    Article  CAS  Google Scholar 

  29. Folsom AR, Kaye SA, Sellers TA, Hong CP, Cerhan JR, Potter JD, Prineas RJ . Body fat distribution and 5-year risk of death in older women JAMA 1993 269: 483–487.

    Article  CAS  Google Scholar 

  30. McKeigue PM, Shah B, Marmot MG . Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians Lancet 1991 337: 382–386.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank Daryth Stallone, who supervised the nutritional analysis of the dietary data, and Alan Harding who wrote the data entry and nutrient analysis programs. The Whitehall II study is supported by grants from the Medical Research Council, British Heart Foundation, Health and Safety Executive, Health Education Authority, National Heart Lung and Blood Institute (HL36310), National Institute on Ageing (AG13196), Agency for Health Care Policy Research (HS06516), The New England Medical Centre, Division of Health Improvement, Institute for Work and Health, Toronto, and the John D and Catherine T MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health. MM is supported by an MRC Research Professorship. EB is supported by the BHF. We also thank all participating civil service departments and their welfare, personnel and establishment officers; the Occupational Health and Safety Agency; the Council of Civil Service Unions; all participating civil servants in the Whitehall II study; and all members of the Whitehall II study team.

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  1. Department of Epidemiology and Public Health, International Centre for Health and Society, University College, London, UK

    EJ Brunner, H Wunsch & MG Marmot

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Correspondence to EJ Brunner.

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Brunner, E., Wunsch, H. & Marmot, M. What is an optimal diet? Relationship of macronutrient intake to obesity, glucose tolerance, lipoprotein cholesterol levels and the metabolic syndrome in the Whitehall II study. Int J Obes 25, 45–53 (2001). https://doi.org/10.1038/sj.ijo.0801543

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