Glycemic index, glycemic load, and risk of coronary heart disease: a pan-European cohort study

Sabina Sieri, Claudia Agnoli, Sara Grioni, Elisabete Weiderpass, Amalia Mattiello, Ivonne Sluijs, Maria Jose Sanchez, Marianne Uhre Jakobsen, Michael Sweeting, Yvonne T van der Schouw, Lena Maria Nilsson, Patrik Wennberg, Verena A Katzke, Tilman Kühn, Kim Overvad, Tammy Y N Tong, Moreno-Iribas Conchi, José Ramón Quirós, Juan Manuel García-Torrecillas, Olatz MokoroaJesús-Humberto Gómez, Anne Tjønneland, Emiliy Sonestedt, Antonia Trichopoulou, Anna Karakatsani, Elissavet Valanou, Jolanda M A Boer, W M Monique Verschuren, Marie-Christine Boutron-Ruault, Guy Fagherazzi, Anne-Laure Madika, Manuela M Bergmann, Matthias B Schulze, Pietro Ferrari, Heinz Freisling, Hannah Lennon, Carlotta Sacerdote, Giovanna Masala, Rosario Tumino, Elio Riboli, Nicholas J Wareham, John Danesh, Nita G Forouhi, Adam S Butterworth, Vittorio Krogh

Research output: Contribution to journalArticle

Abstract

BACKGROUND: High carbohydrate intake raises blood triglycerides, glucose, and insulin; reduces HDLs; and may increase risk of coronary heart disease (CHD). Epidemiological studies indicate that high dietary glycemic index (GI) and glycemic load (GL) are associated with increased CHD risk.

OBJECTIVES: The aim of this study was to determine whether dietary GI, GL, and available carbohydrates are associated with CHD risk in both sexes.

METHODS: This large prospective study-the European Prospective Investigation into Cancer and Nutrition-consisted of 338,325 participants who completed a dietary questionnaire. HRs with 95% CIs for a CHD event, in relation to intake of GI, GL, and carbohydrates, were estimated using covariate-adjusted Cox proportional hazard models.

RESULTS: After 12.8 y (median), 6378 participants had experienced a CHD event. High GL was associated with greater CHD risk [HR 1.16 (95% CI: 1.02, 1.31) highest vs. lowest quintile, p-trend 0.035; HR 1.18 (95% CI: 1.07, 1.29) per 50 g/day of GL intake]. The association between GL and CHD risk was evident in subjects with BMI (in kg/m2) ≥25 [HR: 1.22 (95% CI: 1.11, 1.35) per 50 g/d] but not in those with BMI <25 [HR: 1.09 (95% CI: 0.98, 1.22) per 50 g/d) (P-interaction = 0.022). The GL-CHD association did not differ between men [HR: 1.19 (95% CI: 1.08, 1.30) per 50 g/d] and women [HR: 1.22 (95% CI: 1.07, 1.40) per 50 g/d] (test for interaction not significant). GI was associated with CHD risk only in the continuous model [HR: 1.04 (95% CI: 1.00, 1.08) per 5 units/d]. High available carbohydrate was associated with greater CHD risk [HR: 1.11 (95% CI: 1.03, 1.18) per 50 g/d]. High sugar intake was associated with greater CHD risk [HR: 1.09 (95% CI: 1.02, 1.17) per 50 g/d].

CONCLUSIONS: This large pan-European study provides robust additional support for the hypothesis that a diet that induces a high glucose response is associated with greater CHD risk.

Original languageEnglish
JournalThe American journal of clinical nutrition
Early online date03 Jul 2020
DOIs
Publication statusEarly online date - 03 Jul 2020
Externally publishedYes

Bibliographical note

Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.

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    Sieri, S., Agnoli, C., Grioni, S., Weiderpass, E., Mattiello, A., Sluijs, I., Sanchez, M. J., Jakobsen, M. U., Sweeting, M., van der Schouw, Y. T., Nilsson, L. M., Wennberg, P., Katzke, V. A., Kühn, T., Overvad, K., Tong, T. Y. N., Conchi, M-I., Quirós, J. R., García-Torrecillas, J. M., ... Krogh, V. (2020). Glycemic index, glycemic load, and risk of coronary heart disease: a pan-European cohort study. The American journal of clinical nutrition. https://doi.org/10.1093/ajcn/nqaa157