Abstract
IMPORTANCE: Dietary carbohydrate quality is inversely associated with risks of chronic disease and all-cause mortality. However, limited evidence exists regarding the role of carbohydrate quality and dietary carbohydrate types in promoting healthy aging. OBJECTIVE: To evaluate the long-term role of dietary carbohydrate intake and carbohydrate quality in healthy aging. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used data from the Nurses' Health Study (NHS) from January 1984 to December 2016 and included participants aged younger than 60 years in 1984. Data were analyzed from January 2023 to February 2025. EXPOSURE: Intakes of total carbohydrates; refined carbohydrates; high-quality carbohydrates from whole grains, fruits, vegetables, and legumes; dietary fiber; and the dietary glycemic index (GI) and glycemic load (GL). MAIN OUTCOMES AND MEASURES: Nutrient intakes were derived from 1984 and 1986 food frequency questionnaires. The primary outcome was healthy aging, defined as the absence of major chronic diseases, lack of cognitive and physical function impairments, and having good mental health, according to 2014 or 2016 NHS questionnaire data. Multivariate logistic regression was used to calculate associations of each carbohydrate variable with healthy aging. RESULTS: Among 47 513 participants (mean [SD] baseline age, 48.5 [6.2] years), 3706 (7.8%) met our healthy aging definition. Every 10%-calorie increment in intakes of total carbohydrates (odds ratio [OR], 1.17; 95% CI, 1.10-1.25) and high-quality carbohydrates (OR, 1.31; 95% CI, 1.22-1.41) was positively associated with healthy aging. Refined carbohydrates were associated with lower odds of healthy aging (OR, 0.87; 95% CI, 0.80-0.95). Intakes of carbohydrates from fruits, vegetables, and whole grains were positively associated with odds of healthy aging (ORs ranging from 1.11; 95% CI, 1.07-1.15 to 1.37; 95% CI, 1.20-1.57 per 5% energy increment). Additionally, intakes of total dietary fiber and fiber from fruits, vegetables, and cereals were associated with higher odds of healthy aging (ORs ranging from 1.07; 95% CI, 1.03-1.11 to 1.17; 95% CI, 1.13-1.22 per 1-SD increment). GL was positively associated with healthy aging, which was attenuated by dietary fiber adjustment. A higher GI (OR, 0.76; 95% CI, 0.67-0.87) and carbohydrate-to-fiber ratio (OR, 0.71; 95% CI, 0.62-0.81) were inversely associated with healthy aging when comparing extreme quintiles. There were positive associations for isocaloric replacements of refined carbohydrates, animal protein, total fat, or trans fats with high-quality carbohydrates (ORs ranging from 1.08; 95% CI, 1.01-1.16 to 1.16; 95% CI, 1.11-1.21). CONCLUSIONS AND RELEVANCE: In this cohort study of women, intakes of high-quality carbohydrates and dietary fiber were associated with positive health status in older adulthood, suggesting that dietary carbohydrate quality may be an important determinant of healthy aging.