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Association between Carbohydrate Intake and Serum Lipids

Division of Preventive and Behavioral Medicine (Y.M., D.E.C., B.C.O., W.L., K.G., A.R.H.)
Division of Cardiovascular Medicine (Y.L., I.S.O.)
University of Massachusetts Medical School, Worcester, Massachusetts, Department of Biostatistics and Epidemiology, University of South Carolina, Columbia, South Carolina (J.R.H.)

Address correspondence to: Yunsheng Ma, MD, Ph.D., Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. E-mail: Yunsheng.Ma{at}umassmed.edu

Background: The effect of dietary carbohydrate on blood lipids has received considerable attention in light of the current trend in lowering carbohydrate intake for weight loss.

Objectives: To evaluate the association between carbohydrate intake and serum lipids.

Methods: Blood samples and 24-hour dietary and physical activity recall interviews were obtained from each subject at quarterly intervals for five consecutive quarters between 1994 and 1998 from 574 healthy adults in Central Massachusetts. Relationships between serum lipids and dietary carbohydrate factors were assessed using linear mixed models and adjusting for other risk factors known to be related to blood lipids. Both cross-sectional and longitudinal results were reported.

Results: Cross-sectional analysis results from this study suggest that higher total carbohydrate intake, percentage of calories from carbohydrate, glycemic index (GI) and/or glycemic load (GL) are related to lower high-density lipoprotein cholesterol (HDL-C) and higher serum triacylglycerol levels, while higher total carbohydrate intake and/or GL are related to lower total and low-density lipoprotein cholesterol (LDL-C) levels. In a one-year longitudinal analysis, GL was positively associated with total and LDL-C levels, and there was an inverse association between percentage of calories from carbohydrate and HDL-C levels.

Conclusions: Results suggest that there is a complex and predominantly unfavorable effect of increased intake of highly processed carbohydrate on lipid profile, which may have implications for metabolic syndrome, diabetes, and coronary heart disease. Further studies in the form of randomized controlled trials are required to investigate these associations and determine the implications for lipid management.

Key words: dietary carbohydrates, LDL cholesterol, glycemic index, longitudinal studies

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