Carbohydrate food structure before sugar dose in metabolic ageing after hypertension or diabetes

Abstract

Hypertension and diabetes make large populations candidates for dietary counseling, yet carbohydrate advice is often narrowed to reducing sugar intake. This study asked whether carbohydrate food structure should be assessed before sugar dose using biological ageing and renal risk as cardiometabolic readouts. In UK Biobank adults with hypertension ( n = 34,179), diabetes ( n = 5768) or both ( n = 3772), higher whole-grain/fiber/lower-refined-grain matrix quality was associated with lower PhenoAge acceleration (−0.39, −0.45 and −0.53 years per standard-deviation increment) and lower CardioMetAge-marker burden (−0.28, −0.37 and −0.36 years). Matrix quality improved sugar-only ageing-marker models more consistently than sugar dose improved matrix-only models, and low-matrix/low-sugar profiles remained biologically older than high-matrix/low-sugar profiles. Prospective chronic kidney disease analyses translated the same hierarchy into 0.8, 1.8 and 3.1 percentage-point 10-year absolute-risk differences across the three anchors. These findings support evaluating a public-health assessment sequence in which chronic-disease nutrition review starts with carbohydrate food structure, then interprets reported sugars within that structure.