{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:03:12Z","timestamp":1784782992837,"version":"3.55.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The role of diet in lung cancer is increasingly recognized, but it remains unclear whether carbohydrate quality or carbohydrate quantity is more relevant to risk. We therefore examined the associations of the carbohydrate quality index (CQI) and low-carbohydrate diet score (LCD) with incident lung cancer in a population-based prospective cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included 101,755 participants from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. CQI and LCD were used to assess carbohydrate quality and quantity, respectively. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer across quartiles of CQI and LCD. Restricted cubic spline, subgroup, and sensitivity analyses were conducted to assess dose\u2013response relationships and the robustness of the findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During 897,809.4 person-years of follow-up, 1,706 incident lung cancer cases were identified. Higher CQI was significantly associated with a lower risk of lung cancer after multivariable adjustment. In the fully adjusted model, compared with the lowest quartile, the HRs (95% CIs) for lung cancer were 0.82 (0.72, 0.93), 0.78 (0.68, 0.89), and 0.73 (0.64, 0.84) for the second, third, and fourth quartiles of CQI, respectively (\n                      <jats:italic>P<\/jats:italic>\n                      for trend &amp;lt;0.001). By contrast, LCD was not significantly associated with lung cancer risk after multivariable adjustment, with corresponding HRs (95% CIs) of 0.93 (0.81, 1.07), 1.02 (0.89, 1.17), and 1.09 (0.95, 1.25) across increasing quartiles (\n                      <jats:italic>P<\/jats:italic>\n                      for trend\u202f=\u202f0.117). Restricted cubic spline analyses showed a significant non-linear inverse association for CQI (\n                      <jats:italic>P<\/jats:italic>\n                      for nonlinearity\u202f=\u202f0.006), but not for LCD (\n                      <jats:italic>P<\/jats:italic>\n                      for nonlinearity\u202f=\u202f0.150). The inverse association for CQI remained robust in multiple sensitivity analyses, including further adjustment for LCD and alternative smoking exposure models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher carbohydrate quality, but not carbohydrate quantity, was associated with a lower risk of lung cancer, suggesting a greater relevance of carbohydrate quality to lung cancer risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1857838","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:30:04Z","timestamp":1784781004000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Higher carbohydrate quality, but not quantity, is associated with lower lung cancer risk in a population-based prospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Xiaoxiang","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, Jiangsu, China"]},{"name":"Department of Emergency Medicine, The Affiliated Suqian Hospital of Xuzhou Medical University","place":["Suqian, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Tang","sequence":"additional","affiliation":[{"name":"Center of Urology and Nephrology, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanbo","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Zhan","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Xiao","sequence":"additional","affiliation":[{"name":"Center for Lipid Research, The Second Affiliated Hospital, Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxiang","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center","place":["Rotterdam, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linguo","family":"Shen","sequence":"additional","affiliation":[{"name":"Center of Urology and Nephrology, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenkui","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1038\/s41571-023-00798-3","article-title":"The global burden of lung cancer: current status and future trends","volume":"20","author":"Leiter","year":"2023","journal-title":"Nat Rev Clin Oncol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1038\/nrc2190","article-title":"Lung cancer in never smokers--a different disease","volume":"7","author":"Sun","year":"2007","journal-title":"Nat Rev 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between dietary approaches to stop hypertension eating pattern and lung cancer risk in 98,459 participants: results from a large prospective study","volume":"10","author":"Zhu","year":"2023","journal-title":"Front Nutr"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2264","DOI":"10.1016\/j.clnu.2022.08.008","article-title":"Longitudinal association of dietary carbohydrate quality with visceral fat deposition and other adiposity indicators","volume":"41","author":"Zamanillo-Campos","year":"2022","journal-title":"Clinic Nutr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2246185","DOI":"10.1080\/19490976.2023.2246185","article-title":"Carbohydrate quality, fecal microbiota and cardiometabolic health in older adults: a cohort study","volume":"15","author":"Atzeni","year":"2023","journal-title":"Gut Microbes"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1016\/j.ajcnut.2025.07.026","article-title":"Associations of diet composition and 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Microbes"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1007\/s10552-020-01344-7","article-title":"\"investigating the associations of glycemic load and glycemic index with lung cancer risk in the southern community cohort study,\" (in eng)","volume":"31","author":"Shu","year":"2020","journal-title":"Cancer Causes Control"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1607358","DOI":"10.3389\/fnut.2025.1607358","article-title":"Dietary carbohydrate intake and risks of overall and 21 site-specific cancers: a prospective cohort study","volume":"12","author":"Chen","year":"2025","journal-title":"Front Nutr"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1097\/cej.0000000000000913","article-title":"Carbohydrate quality indices and lung cancer risk: a case-control study from Iran","volume":"34","author":"Mohammadzadeh","year":"2025","journal-title":"Europ J Cancer Prevent"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1080\/27697061.2023.2289520","article-title":"Associations between two dietary quality scores and pancreatic cancer risk in a US National Prospective Cohort Study","volume":"43","author":"Hoyt","year":"2024","journal-title":"J Am Nutr Assoc"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1857838\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:30:05Z","timestamp":1784781005000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1857838\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":34,"alternative-id":["10.3389\/fnut.2026.1857838"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1857838","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"article-number":"1857838"}}