Investigating the Role of Carbohydrates Quantity and Quality in the Incidence of Metabolic Syndrome: A Two-Year Cohort Study : Short title: Fat and Sleep Quality.

Background: Metabolic syndrome (MetS) defines as a cluster of risk factors and is a global public health problem. Quality and quantity of carbohydrates (CHOs) intake plays a crucial role in the development of MetS. This study aimed to investigate the role of CHOs quantity and quality in relation to MetS. Materials and Methods: This prospective cohort study was conducted among healthy adults aged 18-65 years in Kerdabad, Isfahan, Iran. Participants (n=1904) were selected through a census-based sampling method. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (FFQ). CHOs quantity and quality were evaluated using measures such as dietary glycemic index (DGI), dietary glycemic load (DGL), and fiber intake. MetS was defined by established clinical criteria ATPΙΙΙ and assessed annually over a two-year follow-up. Anthropometric measurements, blood pressure, and fasting blood samples were collected at baseline and yearly to monitor metabolic parameters. Statistical analyses included multivariate logistic regression models adjusting for potential confounders including age, sex, energy intake, physical activity, socioeconomic factors, and BMI. Results: Among 1904 participants (45% male; mean age: 39.6 ± 10.2 years; mean BMI: 27.1 ± 4.9 kg/m²), in fully adjusted models, none of the dietary CHOs quantity or quality indices were significantly associated with MetS during the two-year follow-up. Conclusion: quantity and quality of CHOs not significantly associated with MetS after adjusting for confounders. Although some trends indicated potential metabolic effects, these were not statistically significant. Further long-term research with more detailed dietary assessments is needed to clarify these relationships.