What question did this study set out to answer?

The study aimed to identify optimal carbohydrate quality metrics associated with the lowest risk of type 2 diabetes and propose a new carbohydrate quality index.

May 5, 2026

Optimal Measures of Carbohydrate Quality to Lower the Risk of Type 2 Diabetes: Findings from Three Prospective Cohort Studies.

Key Points

The study aimed to identify optimal carbohydrate quality metrics associated with the lowest risk of type 2 diabetes and propose a new carbohydrate quality index.
Included participants from three prospective cohort studies with a total of 213,704 adults.
Compared 23 carbohydrate quality metrics in relation to incident type 2 diabetes cases during 5,628,955 person-years of follow-up.
Examined the associations between the suggested carbohydrate quality index and various cardiometabolic biomarkers.
Intake of cereal fiber, whole-fruit carbohydrates, and whole grain carbohydrates were associated with lower type 2 diabetes risk (RR:0.77, RR:0.80, RR:0.86 respectively).
The new carbohydrate quality index (aCQI) had a stronger association with type 2 diabetes risk (RR:0.71) compared to the existing index (RR:0.82).
Significant associations were found with changes in cardiometabolic biomarkers, including C-peptide and LDL-cholesterol (all P-trend ≤ 0.001).

Abstract

BACKGROUND: Numerous carbohydrate quality metrics (CQMs) have been suggested, yet the optimal one(s) associated with the lowest type 2 diabetes (T2D) risk remains unknown. OBJECTIVE: We aimed to systematically compare 23 CQMs with T2D risk, identify the five strongest associations, propose an alternate Carbohydrate Quality Index (aCQI), and compare it with the existing CQI regarding T2D risk and cardiometabolic biomarkers. METHODS: We included participants of three prospective cohort studies (Nurses' Health Study I (1984-2020) and II (1991-2019), and Health Professionals Follow-up Study (1986-2020), free of cancer, diabetes, and cardiovascular disease. Our primary outcome was incident T2D. We examined thirteen plasma biomarkers in relation to CQIs among a subset. RESULTS: During 5,628,955 person-years of follow-up among 213,704 adults, 22,351 cases of incident T2D were ascertained. In multivariable-adjusted models, comparing Q5 to Q1, intakes of cereal fiber (relative risk (RR):0.77 (0.74 - 0.81)), whole-fruit carbohydrates (RR:0.80 (0.76 -0.84)), glycemic index (RR:1.20 (1.14 -1.26)), sugar from sugar-sweetened beverages (RR:1.22 (1.17-1.28)), and whole grain carbohydrates (RR:0.86 (0.82 - 0.91)) had the strongest associations with T2D risk. The aCQI (RR:0.71 (0.68 - 0.75)), comprising these variables, had a larger magnitude of association with T2D risk than the original CQI (RR:0.82 (0.79 - 0.87)), which included total fiber intake, glycemic index, the ratios of whole to total grains and solid to total carbohydrates. The aCQI had significant associations with larger percentage of differences in cardiometabolic biomarker concentrations, such as C-peptide, leptin, and LDL-cholesterol, than the CQI (all P-trend ≤ 0.001). CONCLUSION: The novel aCQI, comprised of carbohydrates from whole fruits, whole grains, sugar-sweetened beverages, cereal fiber, and glycemic index, was more strongly associated with risk of T2D and cardiometabolic biomarkers than its individual components or the existing CQI, necessitating further research.

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