Glycemic index, glycemic load, and chronic disease risk-a meta-analysis of observational studies. Am J Clin Nutr

Human Nutrition Unit, University of Sydney, Sydney, Australia.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 04/2008; 87(3):627-37.
Source: PubMed


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.

Download full-text


Available from: Jennie C Brand-Miller
    • "The associations between GI or GL and diet quality indices are important, since diet quality per se is related to obesity and different chronic diseases (Azadbakht & Esmaillzadeh, 2011; Jovanovic et al., 2010), and it is probable that adverse effects of GI/GL on health outcomes (Barclay et al., 2008; Murakami et al., 2007) mediated by nutrient-poor diets. Indeed, restriction in consuming some foods in low GI/GL diets might be associated with lower intakes of some nutrients, which could be risk factors for chronic diseases. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess the association between dietary glycemic index (GI), glycemic load (GL) and dietary quality indices in Iranian adults. This cross section was conducted among 1571 Iranian adults aged ≥19 years. GI, GL and diet quality indices were estimated by 24-h recall and DDS was calculated using a validated 48-item food frequency questionnaire. Participants who were in the top tertile of GI had lower healthy eating index (HEI) (57.2 ± 7.8 versus 55.6 ± 8.7; p < 0.001), dietary diversity score (DDS) (3.6 ± 0.9 versus 3.3 ± 1.1; p < 0.001) and nutrient adequacy ratios (NARs) for Zn, Ca, vitamin C and B2. Individuals in the lowest tertile of GL had lower HEI, MAR and NARs for Zn, vitamin B2, B3, B6, B12, vitamin D. Both GI and GL were positively related to dietary diversity score (DED) (p < 0.001). The inverse associations for GI and GL with diet quality indices may suggest the relevance of carbohydrate source in determining the diet quality indices.
    No preview · Article · Jan 2016 · International Journal of Food Sciences and Nutrition
  • Source
    • "In a meta-analysis of case–control and cohort studies , a higher risk for breast cancer was found for the highest intakes of dietary GL; however, this association disappeared when suggestions of publication bias were taken into account (Gnagnarella et al., 2008). In another review of prospective studies, Barclay et al. (2008) found a moderately higher risk for breast cancer when comparing the highest versus lowest quantiles of dietary GI. Likewise, a recent meta-analysis that examined 10 cohort studies showed an increased risk for breast cancer when comparing the highest with the lowest category of dietary GI, but no significant association was found for GL (Dong and Qin, 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to evaluate the prospective associations between dietary glycemic index (GI) and glycemic load (GL) and the risk for invasive breast cancer incidence in postmenopausal women at high cardiovascular disease (CVD) risk. This study was conducted within the framework of the PREvención con DIeta MEDiterránea (PREDIMED) study, a nutritional intervention trial for primary cardiovascular prevention. We included 4010 women aged between 60 and 80 years who were initially free from breast cancer but at high risk for CVD disease. Dietary information was collected using a validated 137-item food frequency questionnaire. We assigned GI values using the International Tables of GI and GL values. Cases were ascertained through yearly consultation of medical records and through consultation of the National Death Index. Only cases confirmed by results from cytology tests or histological evaluation were included. We estimated multivariable-adjusted hazard ratios for invasive breast cancer risk across tertiles of energy-adjusted dietary GI/GL using Cox regression models. We repeated our analyses using yearly repeated measures of GI/GL intakes. No associations were found between baseline dietary GI/GL and invasive breast cancer incidence. The multivariable hazard ratio and 95% confidence interval (CI) for the top tertile of dietary GI was 1.02 (95% CI: 0.42-2.46) and for dietary GL was 1.00 (95% CI: 0.44-2.30) when compared with the bottom tertile. Repeated-measures analyses yielded similar results. In sensitivity analyses, no significant associations were observed for women with obesity or diabetes. Dietary GI and GL did not appear to be associated with an increased risk for invasive breast cancer in postmenopausal women at high CVD risk.
    Full-text · Article · Dec 2015 · European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP)
    • "Interestingly, fruits and vegetables were included as part of the diet, and they may have cancelled out any negative effects of white rice (Liu, 2003). High glycemic index of white rice is likely the reason behind the worsening of cardiometabolic risks due to its consumption (Barclay et al., 2008; Jenkins et al., 2002; Miller et al., 1992). High glycemic index will promote postprandial hyperglycemia, glucose‐induced oxidative stress, and eventually, cardiometabolic risk (Ludwig, 2002; Rebolledo and Dato, 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: White rice is a major staple food for people in low to middle income countries and it can increase the risk of cardiometabolic disease. Brown rice, especially when germinated, is a healthier alternative. Various functional properties have been documented for the bioactive-rich germinated brown rice. Nutrigenomic studies, dwelling on interactions at diet-genome interface, have expanded our understanding of the role of diets on health. The nutrigenomic basis for the functional properties of GBR have also been reported; its antihyperglycemic, hypocholesterolemic, and antioxidative effects are mediated by its bioactives, partly via transcriptional regulation of genes involved in gluconeogenesis, cholesterol metabolism, and oxidative stress, respectively. Additionally, GBR's ability to improve menopausal symptoms is reported to be due to its ability to upregulate bone metabolism and uterine estrogen related genes, and downregulate inflammatory genes. Food synergy plays a role in the overall functional effects of GBR. Further studies on proteomics, metabolomics, nutrikinetics, and nutridynamics are indicated.
    No preview · Chapter · Aug 2015
Show more