Carbohydrate intake is associated with diet quality and risk factors for cardiovascular disease in U.S. adults: NHANES III

J Am Coll Nutr. 2003 Feb;22(1):71-9. doi: 10.1080/07315724.2003.10719278.


Objectives: To determine if carbohydrate intake, as a % of energy, was related to diet quality and risk factors for cardiovascular disease (CVD) in adults in a cross-sectional and population-based study in the U.S.

Methods: Data from the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) were utilized. The nationally representative sample of the U.S. population (3,754 men, 4,074 women, ages 25 to 64 years) was divided into quintiles of carbohydrate intake (% of energy), which was examined in relation to risk factors for CVD: systolic blood pressure, body mass index (BMI), and concentrations of serum triglyceride, serum total and HDL cholesterol and plasma glucose.

Results: When covariates (age, ethnicity, smoking, alcohol intake and total energy intake) were adjusted in multivariate analyses, carbohydrate intakes (% of energy) were inversely associated with BMI and serum total cholesterol concentration in men and BMI in women and positively associated with serum triglyceride concentration in women. When total sugar intake (% of energy) was further controlled as a step to understand the quality of carbohydrate, carbohydrate intakes (% of energy) was a stronger predictor of BMI and plasma glucose in men and BMI in women. A high carbohydrate diet (>57.4% of energy in men and >59.1% of energy in women) was associated with a low serum HDL-cholesterol concentration in men and high serum triglyceride in women.

Conclusion: Moderately high carbohydrate (50% to 55% of energy) diets were associated with low CVD risks with favorable lipid profiles.

MeSH terms

  • Adult
  • Blood Pressure
  • Body Mass Index*
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / etiology*
  • Cholesterol / blood
  • Confidence Intervals
  • Confounding Factors, Epidemiologic
  • Cross-Sectional Studies
  • Diet / standards*
  • Diet, Fat-Restricted
  • Dietary Carbohydrates / administration & dosage*
  • Female
  • Humans
  • Lipids / blood*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nutrition Surveys
  • Odds Ratio
  • Risk Factors
  • Triglycerides / blood
  • United States


  • Dietary Carbohydrates
  • Lipids
  • Triglycerides
  • Cholesterol