application) This is a resubmission of DK02767 """"""""High glycemic diet and risk of type 2 DM and CRD, """""""" a K08 program for advanced training and research leading to a career as an independent clinical scientist in diabetes and cardiovascular epidemiology with particular emphasis on nutrition and prevention of chronic disease. The candidate will develop, refine, and validate the Nurses' Health Study (NHS) database for both the glycemic and insulin indices to assess each NHS participant's long term dietary glycemic load and insulin demand and evaluate their potential effects on the incidence of type 2 diabetes mellitus (DM) and coronary heart disease (CHD). In this resubmission, we have substantially revised the proposal, taking into account each of the major concerns raised by the reviewers. We continue to focus on a comprehensive evaluation of the effects of carbohydrates on disease risk using prospectively collected dietary data and blood samples in the NHS. We have added two new components including a) validating the two dietary variables-glycemic index and insulinemic index-using a series of biomarkers including glycosylated hemoglobin Alc (HbAlc), C-peptide, triglyceride (TG), and insulin; and b) expanding the scope of the nested case-control studies to further understand the relations of dietary carbohydrate, glycemic index and load, and insulin index and load with risk of type 2 LIM and CHD. Further, we provide new preliminary data relating dietary glycemic index and carbohydrate intake assessed by our food frequency questionnaire to fasting TG in a sample of nurses without DM and CHD who provided fasting blood samples. In addition, we provide a critical review of the available literature regarding the clinical usefulness of glycemic index. We believe that the detailed exposure information and multiple dietary assessments in this large prospective cohort of 121, 700 women offer a unique opportunity to study the controversial topic of the health effects of carbohydrate quality. Through the process, Dr. Liu will acquire ample skills and experience to become an independent clinician scientist and educator in the field of nutrition and chronic disease prevention and control.
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