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Review
. 2012;7(12):e52182.
doi: 10.1371/journal.pone.0052182. Epub 2012 Dec 20.

Dietary glycemic index, glycemic load, and risk of coronary heart disease, stroke, and stroke mortality: a systematic review with meta-analysis

Jingyao Fan  1 , Yiqing Song, Yuyao Wang, Rutai Hui, Weili Zhang
Affiliations
Review

Dietary glycemic index, glycemic load, and risk of coronary heart disease, stroke, and stroke mortality: a systematic review with meta-analysis

Jingyao Fan et al. PLoS One. 2012.

Abstract

Background: The relationship between dietary glycemic index, glycemic load and risk of coronary heart disease (CHD), stroke, and stroke-related mortality is inconsistent.

Methods: We systematically searched the MEDLINE, EMBASE, and Science Citation Index Expanded databases using glycemic index, glycemic load, and cardiovascular disease and reference lists of retrieved articles up to April 30, 2012. We included prospective studies with glycemic index and glycemic load as the exposure and incidence of fatal and nonfatal CHD, stroke, and stroke-related mortality as the outcome variable. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated using random-effects models.

Results: Fifteen prospective studies with a total of 438,073 participants and 9,424 CHD cases, 2,123 stroke cases, and 342 deaths from stroke were included in the meta-analysis. Gender significantly modified the effects of glycemic index and glycemic load on CHD risk, and high glycemic load level was associated with higher risk of CHD in women (RR=1.49, 95%CI 1.27-1.73), but not in men (RR=1.08, 95%CI 0.91-1.27). Stratified meta-analysis by body mass index indicated that among overweight and obese subjects, dietary glycemic load level were associated with increased risk of CHD (RR=1.49, 95%CI 1.27-1.76; P for interaction=0.003). Higher dietary glycemic load, but not glycemic index, was positively associated with stroke (RR=1.19, 95% CI 1.00-1.43). There is a linear dose-response relationship between dietary glycemic load and increased risk of CHD, with pooled RR of 1.05 (95%CI 1.02-1.08) per 50-unit increment in glycemic load level.

Conclusion: High dietary glycemic load is associated with a higher risk of CHD and stroke, and there is a linear dose-response relationship between glycemic load and CHD risk. Dietary glycemic index is slightly associated with risk of CHD, but not with stroke and stroke-related death. Further studies are needed to verify the effects of gender and body weight on cardiovascular diseases.

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Conflict of interest statement

Competing Interests: Weili Zhang is a PLOS ONE Editorial Board member. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Selection of studies for meta-analysis.
Literatures search was conducted to identify articles up to April 30, 2012. Abbreviation: GI, glycemic index; GL, glycemic load; CHD, coronary heart disease; MI, myocardial infraction; CVD, cardiovascular disease.
Figure 2
Figure 2. Relative risks for the association between dietary GI or GL and risk of CHD.
The risk estimate and 95%CI were calculated by comparing the highest category with lowest.
Figure 3
Figure 3. Relative risks for the association between dietary GI or GL and risk of CHD among women.
The risk estimate and 95%CI were calculated by comparing the highest category with lowest.
Figure 4
Figure 4. Relative risks for the association between dietary GI or GL and risk of stroke.
The risk estimate and 95%CI were calculated by comparing the highest category with lowest.
Figure 5
Figure 5. Dose-response relationship plot between GL, GI and risk of CHD and stroke.
Dotted lines represent the 95% confidence intervals for the predicted relative risk. Dietary GL and GI values were converted to take glucose as the reference food. The dose-response relationship plot was conducted using the generalized least-squares trend estimation (GLST) analysis , based on available data for categories of dietary GL and GI on median dose, number of cases and participants, and effect estimates with corresponding standard errors. A: dietary GL and CHD risk (5 studies [10], [12], [13], [15], [16]); B: dietary GI and CHD risk (4 studies [12], [13], [15], [16]); C: dietary GL and stroke risk (2 studies [15], [23]); D: dietary GI and stroke risk (2 studies [15], [23]). The P values for nonlinear response test were 0.97 (A), 0.31 (B), 0.30 (C), and 0.42 (D).
Figure 6
Figure 6. Relative risks of CHD and stroke by continuous dietary GL level.
The 2-stage generalized least-squares trend estimation (GLST) method was used to evaluate the relative risks of CHD and stroke by continuous dietary GL level, which allowed combining the GLST-estimated study-specific slopes with the results from studies that only reported effect estimates for continuous associations. The per 50-unit increment in dietary GI level was approximately equivalent to the difference between the medians of the highest and the lowest categories of the included studies.
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Substances

Grants and funding

This work was supported by grants from the Ministry of Science and Technology of China (2011CB503901 to R. Hui) and from the National Natural Science of China (81070172 to W. Zhang). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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