British Journal of Nutrition

Full Papers

Dietary Surveys and Nutritional Epidemiology

Association between dietary carbohydrate intake quality and micronutrient intake adequacy in a Mediterranean cohort: the SUN (Seguimiento Universidad de Navarra) Project

Itziar Zazpea1a2a3, Ana Sánchez-Taíntaa1, Susana Santiagoa2, Carmen de la Fuente-Arrillagaa1, Maira Bes-Rastrolloa1a3, J. Alfredo Martíneza2a3 and Miguel Ángel Martínez-Gonzáleza1a3 c1 on behalf of the SUN Project Investigators

a1 Department of Preventive Medicine and Public Health, School of Medicine-Clínica Universidad de Navarra, University of Navarra, Irunlarrea 1, Pamplona 31008, Navarra, Spain

a2 Department of Nutrition and Food Sciences and Physiology, University of Navarra, Navarra, Spain

a3 Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain


Epidemiological research confirms that the prevalence of suboptimal micronutrient intakes across Europe is an emerging concern in terms of public health. The aim of the present study was to investigate the association between a new index of carbohydrate (CHO) quality and micronutrient intake adequacy in the ‘Seguimiento Universidad de Navarra (SUN)’ cohort. The baseline assessment extended from 1999 to March 2012. We assessed 16 841 participants who completed a validated 136-item semi-quantitative FFQ at baseline. We created a new index to evaluate CHO quality for the following four criteria: dietary fibre intake; glycaemic index; whole grains:total grains ratio; solid CHO:total CHO ratio. The subjects were classified into quintiles according to this index. We evaluated the intakes of Zn, I, Se, Fe, Ca, K, P, Mg, Cr and vitamins B1, B2, B3, B6, B12, C, A, D, E and folic acid. The probability of intake adequacy was evaluated using the estimated average requirement cut-point approach and the probabilistic approach. Logistic regression analysis was used to assess the nutritional adequacy according to the CHO quality index (CQI). Participants in the highest quintile of CQI were found to have the lowest prevalence of inadequacy. A higher quality of CHO intake was found to be associated with a lower risk of nutritional inadequacy in comparison with the lowest quintile of CQI (adjusted OR 0·06, 95 % CI 0·02, 0·16; P for trend < 0·001). A higher CQI was found to be strongly associated with better micronutrient intake adequacy in the young Mediterranean cohort, stressing the importance of focusing nutritional education not only on CHO quantity, but also on quality.

(Received August 22 2013)

(Revised November 15 2013)

(Accepted December 03 2013)

(Online publication March 25 2014)

Key Words:

  • Carbohydrate quality;
  • Micronutrient intake adequacy;
  • Mediterranean cohort


c1 Corresponding author: Dr M. Á. Martínez-González, fax +34 948425740, email


  Abbreviations: CHO, carbohydrate; CQI, carbohydrate quality index; DRI, dietary recommended intakes; EAR, estimated average requirements; FQI, fat quality index; MeDiet, Mediterranean diet; SUN, Seguimiento Universidad de Navarra