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Meta-Analysis
. 2014 Jul;100(1):218-32.
doi: 10.3945/ajcn.113.079533. Epub 2014 Apr 30.

Glycemic index, glycemic load, and risk of type 2 diabetes: results from 3 large US cohorts and an updated meta-analysis

Shilpa N Bhupathiraju  1 , Deirdre K Tobias  1 , Vasanti S Malik  1 , An Pan  1 , Adela Hruby  1 , JoAnn E Manson  1 , Walter C Willett  1 , Frank B Hu  1
Affiliations
Meta-Analysis

Glycemic index, glycemic load, and risk of type 2 diabetes: results from 3 large US cohorts and an updated meta-analysis

Shilpa N Bhupathiraju et al. Am J Clin Nutr. 2014 Jul.

Abstract

Background: Epidemiologic evidence for the relation between carbohydrate quality and risk of type 2 diabetes (T2D) has been mixed.

Objective: We prospectively examined the association of dietary glycemic index (GI) and glycemic load (GL) with T2D risk.

Design: We prospectively followed 74,248 women from the Nurses' Health Study (1984-2008), 90,411 women from the Nurses' Health Study II (1991-2009), and 40,498 men from the Health Professionals Follow-Up Study (1986-2008) who were free of diabetes, cardiovascular disease, and cancer at baseline. Diet was assessed by using a validated questionnaire and updated every 4 y. We also conducted an updated meta-analysis, including results from our 3 cohorts and other studies.

Results: During 3,800,618 person-years of follow-up, we documented 15,027 cases of incident T2D. In pooled multivariable analyses, those in the highest quintile of energy-adjusted GI had a 33% higher risk (95% CI: 26%, 41%) of T2D than those in the lowest quintile. Participants in the highest quintile of energy-adjusted GL had a 10% higher risk (95% CI: 2%, 18%) of T2D. Participants who consumed a combination diet that was high in GI or GL and low in cereal fiber had an ~50% higher risk of T2D. In the updated meta-analysis, the summary RRs (95% CIs) comparing the highest with the lowest categories of GI and GL were 1.19 (1.14, 1.24) and 1.13 (1.08, 1.17), respectively.

Conclusion: The updated analyses from our 3 cohorts and meta-analyses provide further evidence that higher dietary GI and GL are associated with increased risk of T2D.

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Figures

FIGURE 1.
FIGURE 1.
RRs (95% CIs) for type 2 diabetes according to joint categories of GI (tertiles; A), GL (tertiles; B), and cereal fiber (tertiles) in all 3 cohorts combined. Multivariable RRs were adjusted for age (y), BMI (in kg/m2; <21, 21–22.9, 23–24.9, 25–26.9, 27–29.9, 30–34.9, 35–39.9, or ≥40), race (white or nonwhite), smoking (never; past; current: 1–14, 15–24, or >24 cigarettes/d), alcohol intake (0, 0.1–4.9, 5–9.9, 10–14.9, or ≥15 g/d), postmenopausal hormone use (women only; premenopausal, postmenopausal current user, or postmenopausal never/past user), oral contraceptive use (women only; never, past, or current), physical activity (<3, 3–8.9, 9–17.9, 18–26.9, or ≥27 metabolic equivalent task hours/wk), family history of diabetes (yes or no), total energy intake (quintiles), and intakes of total coffee (quintiles), energy-adjusted PUFAs (quintiles), energy-adjusted trans fatty acids (quintiles), energy-adjusted SFAs (quintiles), energy-adjusted MUFAs (quintiles), and energy-adjusted protein (quintiles; only for panel A). Results were combined with the use of a fixed-effects model. All statistical tests were conducted by using Cox proportional hazards regression models. Low GI, high cereal fiber: n = 19,524; medium GI, high cereal fiber: n = 24,491; high GI, high cereal fiber: n = 24,367; low GI, medium cereal fiber: n = 21,392; medium GI, medium cereal fiber: n = 24,029; high GI, medium cereal fiber: n = 22,793; low GI, low cereal fiber: n = 27,474; medium GI, low cereal fiber: n = 19,862; high GI, low cereal fiber: n = 21,224. P-interaction >0.20 in all 3 cohorts. Low GL, high cereal fiber: n = 9826; medium GL, high cereal fiber: n = 23,669; high GL, high cereal fiber: n = 34,888; low GL, medium cereal fiber: n = 22,326; medium GL, medium cereal fiber: n = 26,486; high GL, medium cereal fiber: n = 19,403; low GL, low cereal fiber: n = 36,270; medium GL, low cereal fiber: n = 18,150; high GL, low cereal fiber: n = 14,140. P-interaction >0.10 in all 3 cohorts. GI, glycemic index; GL, glycemic load; REF, reference.
FIGURE 2.
FIGURE 2.
Association of glycemic index with type 2 diabetes risk (highest compared with lowest category) and I2 for the proportion of heterogeneity between studies. The dashed vertical line represents the pooled estimate. The pooled estimate is based on fixed-effects meta-analysis. ES, effect size.
FIGURE 3.
FIGURE 3.
Association of glycemic load with type 2 diabetes risk (highest compared with lowest category) and I2 for the proportion of heterogeneity between studies. The dashed vertical line represents the pooled estimate. The pooled estimate is based on fixed-effects meta-analysis. ES, effect size.
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