Association and substitution analyses of dietary sugars, starch and fiber for indices of body fat and cardiometabolic risk– a NoHoW sub-study

Purpose: To examine the associations and substitutions of dietary sugars [extrinsic (free) or intrinsic (non-free)] as well as dietary starch and fiber intakes for indices of body fat and cardiometabolic health. Methods: Dietary intake was assessed at multiple times using multi-day 24-hour recalls over 18-months for indices of body fat (body fat %, waist circumference, BMI, and weight change) (n = 1066) and at baseline and 12 months for cardiometabolic outcomes (LDL, HDL, HbA1c) (n = 736). Bayesian modeling was applied to analyze the probabilistic impact of dietary carbohydrate components using credible intervals for association and substitution analyses with repeated measures random effects modeling. Results: A higher starch intake significantly associated with higher body fat %, BMI and waist circumference (WC) (all CrI > 0). Conversely, intrinsic sugar and fiber intakes were significantly linked to lower body fat indices, while free sugar showed no association. A 20 g substitution of free sugars with intrinsic sugars significantly associated with lower body fat (CrI: -4.2; -1.0%), BMI (CrI: -1.8; -0.4) and WC (CrI: -4.2; -1.0 cm), while substituting intrinsic sugars with starch resulted in significantly higher body fat, BMI, WC and weight change. Replacing starch with fiber associated with higher HDL-C (CrI: -0.0; 0.3) and lower LDL-C (CrI: -0.6; 0.1). Replacing free sugars with starch associated with a higher HbA1c level (CrI: 0.0;0.2). Conclusion: These results underscore the importance of distinguishing between intrinsic versus extrinsic sugars and highlight the potential benefits of increasing intrinsic sugars and fiber while reducing starch for better body fat management and cardiometabolic health.