• Salome A Rebello, Hiromi Koh, Cynthia Chen, Nasheen Naidoo, Andrew O Odegaard, Woon-Puay Koh, Lesley M Butler, Jian-Min Yuan, and Rob M van Dam.
• From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore (SAR, HK, CC, NN, W-PK, and RMvD); the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (AOO), the Duke-National University of Singapore Graduate Medical School, Singapore (W-PK); the Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute and Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (J-MY and LMB); the Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore (RMvD); and the Department of Nutrition, Harvard School of Public Health, Boston, MA (RMvD).
• Am. J. Clin. Nutr. 2014 Jul 1; 100 (1): 53-64.

BackgroundThe relation between carbohydrate intake and risk of ischemic heart disease (IHD) has not been fully explored in Asian populations known to have high-carbohydrate diets.ObjectiveWe assessed whether intakes of total carbohydrates, different types of carbohydrates, and their food sources were associated with IHD mortality in a Chinese population.DesignWe prospectively examined the association of carbohydrate intake and IHD mortality in 53,469 participants in the Singapore Chinese Health Study with an average follow-up of 15 y. Diet was assessed by using a semiquantitative food-frequency questionnaire. HRs and 95% CIs were calculated by using a Cox proportional hazards analysis.ResultsWe documented 1660 IHD deaths during 804,433 person-years of follow-up. Total carbohydrate intake was not associated with IHD mortality risk [men: HR per 5% of energy, 0.97 (95% CI: 0.92, 1.03); women: 1.06 (95% CI: 0.99, 1.14)]. When types of carbohydrates were analyzed individually, starch intake was associated with higher risk [men: 1.03 (95% CI: 0.99, 1.08); women: 1.08, (95% CI: 1.02, 1.14)] and fiber intake with lower risk of IHD mortality [men: 0.94 (95% CI: 0.82, 1.08); women: 0.71 (95% CI: 0.60, 0.84)], with stronger associations in women than men (both P-interaction < 0.01). In substitution analyses, the replacement of one daily serving of rice with one daily serving of noodles was associated with higher risk (difference in HR: 26.11%; 95% CI: 10.98%, 43.30%). In contrast, replacing one daily serving of rice with one of vegetables (-23.81%; 95% CI: -33.12%, -13.20%), fruit (-11.94%; 95% CI: -17.49%, -6.00%), or whole-wheat bread (-19.46%; 95% CI: -34.28%, -1.29%) was associated with lower risk of IHD death.ConclusionsIn this Asian population with high carbohydrate intake, the total amount of carbohydrates consumed was not substantially associated with IHD mortality. In contrast, the shifting of food sources of carbohydrates toward a higher consumption of fruit, vegetables, and whole grains was associated with lower risk of IHD death.© 2014 American Society for Nutrition.

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