Metabolic risk factors cause substantial impact on global disease burden and require policy monitoring. In the last two decades body mass index (BMI), blood pressure, fasting plasma glucose and total cholesterol increased significantly and varied patterns were identified across countries, even at countries in the same level of development. Diet plays a central role in the promotion of health and prevention of diseases. Diets with high glycemic index, rich in liquid and refined carbohydrates, but poor in fiber and whole grains are related to deleterious health effects. The carbohydrate quality index is a global measure of carbohydrate quality and a new proposal to assess the relation between carbohydrate intake and disease. Considering that diet quality and metabolic risk factors varies across nations, the aim of this study is to compare the carbohydrate quality index and its association with prevalence of cardiometabolic risk factors between the population of São Paulo (Brazil) and the population of United States of America. Data come from two population-based studies: 2015 Health Survey of São Paulo with focus in Nutrition (ISA-Nutrition), with 901 participants aged 12 years or more; and 2015-2016 National Health and Nutrition Examination Survey (NHANES), with 7,035 participants aged 12 years or more. Socioeconomic, anthropometric, clinic and lifestyle data as well as blood samples were collected by face-to-face interviews and by phone. Two 24-hour dietary recall were used to assess nutrient intake and will be used to estimate the carbohydrate quality index. The association of the carbohydrate quality index with cardiometabolic risk factors will be evaluated using multiple regression models adjusted for appropriate socio-demographic and lifestyle confounders and considering the mediation effect of waist circumference.
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