Metrics details. Dietary carbohydrate quality may play an important role in disease development. In this case-control study, we analyzed data using T2DM subjects. We obtained dietary information using 2-day h dietary recalls. Also, a positive correlation was found between the CQI and fiber, but the CQI showed a negative relationship with dietary glycemic index.
The CQI approach of dietary recommendation may be a useful strategy for dietary carbohydrate selection for the prevention of MetS. Peer Review reports. The MetS is associated with higher rates of mortality [ 8 ], cardiovascular disease CVD and cancers [ 9 ], and infertility in both men [ 10 ] and women [ 11 ]. Diet and lifestyle interventions may be more effective in the prevention of MetS development than pharmacological agents [ 12 , 13 , 14 , 15 ].
Moreover, lifestyle modifications such as increased physical activity, adherence to a healthy diet, and weight loss are said to be associated with the reversion of MetS and its risk components [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. However, previous studies have mainly focused on investigating associations between limited indicators of dietary carbohydrate CHO quality [glycemic index GI , glycemic load GL , fiber content, sugar-sweetened beverage intake and whole-grain food consumption] and the odds of MetS amongst T2DM subjects [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].
The above previous approaches [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] of evaluating dietary CHO quality are narrow and may not be representative of a holistic metabolic capacity of CHO diets. Therefore, a more comprehensive assessment of dietary CHO quality may be a better alternative in investigating relationships between the quality of dietary CHO consumed and the odds of MetS in T2DM subjects. Although the CQI brings together several dimensions of dietary CHO quality and may be an effective tool for nutrition counseling, very few studies have examined its relationship with metabolic outcomes [ 34 , 35 , 36 ].
Obesity is considered an important risk for the development of MetS [ 37 ]. In the recent past, we reported an inverse association between the CQI and general and abdominal obesity in Ghanaian healthy women [ 34 ]. However, this was a healthy population. Previous studies among the T2DM subjects in Africa only focused on assessing the level of physical activity [ 38 ], and the barriers to adequate nutrition in Ghana [ 39 , 40 ].
