Glycemic index, glycemic load, and chronic disease risk—A meta-analysis of observational studies

Human Nutrition Unit, University of Sydney, Sydney, Australia.
American Journal of Clinical Nutrition (Impact Factor: 6.92). 04/2008; 87(3):627-37.
Source: PubMed

ABSTRACT Inconsistent findings from observational studies have prolonged the controversy over the effects of dietary glycemic index (GI) and glycemic load (GL) on the risk of certain chronic diseases.
The objective was to evaluate the association between GI, GL, and chronic disease risk with the use of meta-analysis techniques.
A systematic review of published reports identified a total of 37 prospective cohort studies of GI and GL and chronic disease risk. Studies were stratified further according to the validity of the tools used to assess dietary intake. Rate ratios (RRs) were estimated in a Cox proportional hazards model and combined by using a random-effects model.
From 4 to 20 y of follow-up across studies, a total of 40 129 incident cases were identified. For the comparison between the highest and lowest quantiles of GI and GL, significant positive associations were found in fully adjusted models of validated studies for type 2 diabetes (GI RR = 1.40, 95% CI: 1.23, 1.59; GL RR = 1.27, 95% CI: 1.12, 1.45), coronary heart disease (GI RR = 1.25, 95% CI: 1.00, 1.56), gallbladder disease (GI RR = 1.26, 95% CI: 1.13, 1.40; GL RR = 1.41, 95% CI: 1.25, 1.60), breast cancer (GI RR = 1.08, 95% CI: 1.02, 1.16), and all diseases combined (GI RR = 1.14, 95% CI: 1.09, 1.19; GL RR = 1.09, 95% CI: 1.04, 1.15).
Low-GI and/or low-GL diets are independently associated with a reduced risk of certain chronic diseases. In diabetes and heart disease, the protection is comparable with that seen for whole grain and high fiber intakes. The findings support the hypothesis that higher postprandial glycemia is a universal mechanism for disease progression.

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Available from: Jennie C Brand-Miller, Jul 22, 2015
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    • "In recent years, research around the world has provided evidence for the benefits of following a low GI diet. A meta-analysis by Barclay et al. (2008) concluded that a low GI diet was associated with reduced risks of type 2 diabetes, coronary heart disease, gallbladder disease and breast cancer. Recent meta-analyses (Fleming and Godwin, 2013; Greenwood et al., 2013; Livesey et al., 2013; Mirrahimi et al., 2012; Rouhani et al., 2013; Schwingshackl and Hoffmann, 2013) on the topic have reached similar conclusions that a low GI/GL eating pattern is beneficial. "
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    ABSTRACT: We aimed to produce an updated Australian glycaemic index (GI) database based on a systematic method. GI values were assigned to the 3871 unique foods in an Australian food composition database. Following the method, 1124 (29%) foods had less than 2.5 g of available carbohydrates per 100 g and were assigned a GI of 0, and 416 (11%) foods had a direct match in one of the three data tables used. The GI value of a ‘closely related’ food was assigned to 1793 (46%) foods; 135 foods (3%) had their GI values calculated using the weighted average GI method; 391 (10%) foods were assigned the median GI of their corresponding food subgroup, and 12 (<1%) foods were assigned a GI of 0 because they were not significant sources of carbohydrates in a typical diet. For the 3634 foods which received a GI value in the 2009 assignment, 1954 (53.8%) had an updated GI value, and the mean ± SD difference between the 2009 and current assigned values was +3.0 ± 16.0 units (paired sample t-test p < 0.001). Acknowledging some limitations, this database will enhance the utility of the GI concept in research and clinical settings in Australia (199 words).
    Journal of Food Composition and Analysis 11/2014; 38. DOI:10.1016/j.jfca.2014.06.002 · 2.26 Impact Factor
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    • "Epidemiological studies have also shown positive associations of GI, GL, with body mass index (BMI) and risk for chronic diseases (Barclay et al., 2008). Hence, a low- GI diet may be potentially beneficial for insulin-resistant healthy individuals, in managing cardio-metabolic risks (Riccardi, Rivellese & Giacco, 2008). "
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    ABSTRACT: Introduction: Gestational diabetes mellitus (GDM) increases risks for type 2 diabetes and cardiovascular diseases. Low glycaemic index (GI) diets improve cardio-metabolic outcomes in insulin-resistant individuals. We examined the feasibility of lowering GI through GI-based-education among Asian post-GDM women. Methods: A 3-month investigation was carried out on 60 Malaysian women with a mean age of 31.0±4.5 years and a history of GDM. Subjects were randomised into two groups: LGIE and CHDR. The CHDR group received conventional healthy dietary recommendations only. The LGIE group received GI based-education in addition to conventional healthy dietary recommendations. At baseline and after 3-months, dietary intake of energy and macronutrient intakes including GI diet and glycaemic load was assessed using 3-day food records. Diabetes-Diet and GI-concept scores and physical activity levels were assessed using a questionnaire. Adherence to dietary instructions was measured at the end of 3 months. Results: At the end of 3 months, the LGIE group had significant reductions in energy intake (241.7±522.4Kcal, P=0.037, ES=0.463), total carbohydrate (48.7±83.5g, P=0.010, ES=0.583), GI (3.9±7.1, P=0.017, ES=0.549) and GL (39.0±55.3, P=0.003, ES=0.705) and significant increases in protein (3.7±5.4g, 0.003, ES=0.685) and diet fibre (4.6±7.3g, P=0.06). The CHDR group had a significant reduction in fat only (5.7±9.4g, P=0.006, ES=0.606). There was a 30% increase in GI-concept scores in the LGIE group (p< 0.001). Changes in GI-concept scores correlated significantly to the reduction in dietary GI (r = -0.642, P=0.045). Dietary adherence was comparable in both groups. Conclusion: GI-education improves GI-concept knowledge and helps lower dietary glycaemic index among women with a history of GDM.
    Malaysian Journal of Nutrition 04/2013; 19(1):9-23.
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    • "Nevertheless, as obesity is known to be accompanied by diabetes [10] [11], it is reasonable to suspect that diabetes related endocrine perturbations may be responsible for a significant proportion of obesity-cancer ISRN Oncology risk [12]. Diets with high glycemic index and high glycemic load are well established risk factors for type II diabetes [13] [14], and they have been suggested to increase risk of breast [15], pancreatic [16], colorectal, and endometrial [17] cancer. Furthermore, diets rich in fruit, vegetables, fish, and whole grain have been reported as protective from diabetes [18] as well as from neoplasms [19] [20]. "
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    ABSTRACT: Diabetes and cancer represent two complex, diverse, chronic, and potentially fatal diseases. Cancer is the second leading cause of death, while diabetes is the seventh leading cause of death with the latter still likely underreported. There is a growing body of evidence published in recent years that suggest substantial increase in cancer incidence in diabetic patients. The worldwide prevalence of diabetes was estimated to rise from 171 million in 2000 to 366 million in 2030. About 26.9% of all people over 65 have diabetes and 60% have cancer. Overall, 8-18% of cancer patients have diabetes. In the context of epidemiology, the burden of both diseases, small association between diabetes and cancer will be clinically relevant and should translate into significant consequences for future health care solutions. This paper summarizes most of the epidemiological association studies between diabetes and cancer including studies relating to the general all-site increase of malignancies in diabetes and elevated organ-specific cancer rate in diabetes as comorbidity. Additionally, we have discussed the possible pathophysiological mechanisms that likely may be involved in promoting carcinogenesis in diabetes and the potential of different antidiabetic therapies to influence cancer incidence.
    02/2013; 2013:583786. DOI:10.1155/2013/583786
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