Glycemic index, glycemic load, and risk of coronary heart disease: a pan-European cohort study
Sieri, Sabina; Agnoli, Claudia; Grioni, Sara; Weiderpass, Elisabete; Mattiello, Amalia; Sluijs, Ivonne; Sanchez, Maria Jose; Jakobsen, Marianne Uhre; Sweeting, Michael; van der Schouw, Yvonne T.; Nilsson, Lena Maria; Wennberg, Patrik; Katzke, Verena A.; Kuhn, Tilman; Overvad, Kim; Tong, Tammy Y. N.; Conchi, Moreno-Iribas; Ramon Quiros, Jose; Manuel Garcia-Torrecillas, Juan; Mokoroa, Olatz; Gomez, Jesus-Humberto; Tjonneland, Anne; Sonestedt, Emiliy; Trichopoulou, Antonia; Karakatsani, Anna; Valanou, Elissavet; Boer, Jolanda M. A.; Verschuren, W. M. Monique; Boutron-Ruault, Marie-Christine; Fagherazzi, Guy; Madika, Anne-Laure; Bergmann, Manuela M.; Schulze, Matthias B.; Ferrari, Pietro; Freisling, Heinz; Lennon, Hannah; Sacerdote, Carlotta; Masala, Giovanna; Tumino, Rosario; Riboli, Elio; Wareham, Nicholas J.; Danesh, John; Forouhi, Nita G.; Butterworth, Adam S.; Krogh, Vittorio
(2020) American Journal of Clinical Nutrition, volume 112, issue 3, pp. 631 - 643
(Article)
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
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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/m 2) =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.
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Keywords: EPIC study, EPIC-CVD study, cohort study, coronary heart disease, glycemic index, glycemic load
ISSN: 0002-9165
Publisher: American Society for Nutrition
Note: Funding Information: EPIC-Asturias was supported by the Regional Government of Asturias. EPIC-Greece was supported by the Hellenic Health Foundation. EPIC-Heidelberg was supported by German Cancer Aid, the German Cancer Research Centre, and the German Federal Ministry of Education and Research. EPIC-Oxford was supported by the UK Medical Research Council (grant MR/M012190/1) and Cancer Research UK (grant 570/A16491). EPIC-Ragusa was supported by the Sicilian Regional Government, the Iblean Charitable Association for Epidemiological Research Ragusa and the Italian Association of Blood Donors Ragusa. EPIC-Turin was supported by the Compagnia di San Paolo and the Human Genetics Foundation Turin. EPIC-NL was supported by the Dutch Ministry of Public Health, Welfare, and Sports; the Netherlands Organisation for Health Research and Development; and the World Cancer Research Fund. EPIC-Umeå was supported by the Swedish Cancer Society, the Swedish Scientific Council, and the Regional Government of Västerbotten. Funding Information: EPIC-CVD was supported by the European Union Framework 7 (grant HEALTH-F2-2012-279233), the European Research Council (grant 268834), the UK Medical Research Council (grants G0800270 and MR/L003120/1), the British Heart Foundation (grants SP/09/002, RG/08/014, and RG13/13/30194), and the UK National Institute of Health Research. The establishment of the study subcohort was supported by the EU Sixth Framework Programme (grant LSHM_CT_2006_037197 to the InterAct project) and the Medical Research Council Epidemiology Unit (grants MC_UU_12015/1 and MC_UU_12015/5). NJW and NGF acknowledge support from NIHR Biomedical Research Centre Cambridge: Nutrition, Diet, and Lifestyle Research Theme (grant IS-BRC-1215-20014). Publisher Copyright: Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.
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