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Dietary Glycemic Load and Glycemic Index and Risk of Coronary Heart Disease and Stroke in Dutch Men and Women: The EPIC-MORGEN Study

Published on Oct 5, 2011in PLOS ONE 2.77
· DOI :10.1371/journal.pone.0025955
Koert N.J. Burger34
Estimated H-index: 34
(Utrecht University),
Joline W.J. Beulens48
Estimated H-index: 48
(Utrecht University)
+ 2 AuthorsDaphne L. van der A41
Estimated H-index: 41
Background The associations of glycemic load (GL) and glycemic index (GI) with the risk of cardiovascular diseases (CVD) are not well-established, particularly in men, and may be modified by gender. Objective To assess whether high dietary GL and GI increase the risk of CVD in men and women. Methods A large prospective cohort study (EPIC-MORGEN) was conducted within the general Dutch population among 8,855 men and 10,753 women, aged 21–64 years at baseline (1993–1997) and free of diabetes and CVD. Dietary intake was assessed with a validated food-frequency questionnaire and GI and GL were calculated using Foster-Powell's international table of GI. Information on morbidity and mortality was obtained through linkage with national registries. Cox proportional hazards analysis was performed to estimate hazard ratios (HRs) for incident coronary heart disease (CHD) and stroke, while adjusting for age, CVD risk factors, and dietary factors. Results During a mean follow-up of 11.9 years, 581 CHD cases and 120 stroke cases occurred among men, and 300 CHD cases and 109 stroke cases occurred among women. In men, GL was associated with an increased CHD risk (adjusted HR per SD increase, 1.17 [95% CI, 1.02–1.35]), while no significant association was found in women (1.09 [0.89–1.33]). GI was not associated with CHD risk in both genders, while it was associated with increased stroke risk in men (1.27 [1.02–1.58]) but not in women (0.96 [0.75–1.22]). Similarly, total carbohydrate intake and starch intake were associated with a higher CHD risk in men (1.23 [1.04–1.46]; and 1.24 [1.07–1.45]), but not in women. Conclusion Among men, high GL and GI, and high carbohydrate and starch intake, were associated with increased risk of CVD.
  • References (52)
  • Citations (49)
Published on Feb 1, 2011in Nutrition Metabolism and Cardiovascular Diseases 3.32
Jaakko Mursu31
Estimated H-index: 31
Jyrki K. Virtanen28
Estimated H-index: 28
+ 5 AuthorsSari Voutilainen40
Estimated H-index: 40
Background and aim: The role of dietary glycemic index (GI) and glycemic load (GL) in coronary heart disease (CHD) is unclear. Our aim was to study the association between the dietary GI and GL and the risk of acute myocardial infarction (AMI). Methods and results: The study population consisted of 1981 Finnish men from the prospective population-based Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study, aged 42e60 years and free of CHD at baseline. During an average follow-up time of 16.1 y...
27 Citations Source Cite
Published on Nov 4, 2010in BMJ 23.56
Markus Schürks31
Estimated H-index: 31
(Brigham and Women's Hospital),
Robert J. Glynn122
Estimated H-index: 122
(Harvard University)
+ 2 AuthorsTobias Kurth69
Estimated H-index: 69
(Harvard University)
Objective To evaluate the effect of vitamin E supplementation on incident total, ischaemic, and haemorrhagic stroke. Design Systematic review and meta-analysis of randomised, placebo controlled trials published until January 2010. Data sources Electronic databases (Medline, Embase, Cochrane Central Register of Controlled Trials) and reference lists of trial reports. Selection criteria Randomised, placebo controlled trials with ≥1 year of follow-up investigating the effect of vitamin E on stroke....
176 Citations Source Cite
Published on Nov 1, 2010in Metabolism-clinical and Experimental 5.96
Shino Oba16
Estimated H-index: 16
(Gifu University),
Chisato Nagata46
Estimated H-index: 46
(Gifu University)
+ 4 AuthorsHiroyuki Shimizu48
Estimated H-index: 48
(Gifu University)
Abstract We assessed the relationship of the dietary glycemic index (GI), glycemic load (GL), and intake of carbohydrate and rice, and risk of mortality from stroke and its subtypes. The cohort consisted of 12 561 men and 15 301 women residing in Takayama, Japan, in 1992. At the baseline, a food frequency questionnaire was administered; and the dietary GI, GL, and intake of carbohydrates and rice were estimated. Deaths from stroke occurring in the cohort were prospectively noted until 1999 with ...
56 Citations Source Cite
Published on Oct 1, 2010in The American Journal of Clinical Nutrition 6.55
Ivonne Sluijs28
Estimated H-index: 28
Y. T. van der Schouw88
Estimated H-index: 88
+ 4 AuthorsJoline W.J. Beulens48
Estimated H-index: 48
Background: Carbohydrate quantity and quality may play an important role in the development of type 2 diabetes. Objective: We investigated the associations of dietary glycemic load (GL), glycemic index (GI), carbohydrate, and fiber intake with the incidence of type 2 diabetes. Design: A prospective cohort study was conducted in 37,846 participants of the EPIC-NL (European Prospective Investigation into Cancer and Nutrition‐Netherlands) study, aged 21‐70 y at baseline and free of diabetes. Dietar...
92 Citations Source Cite
Published on Sep 1, 2010in American Journal of Cardiology 3.17
Steven G. Chrysant27
Estimated H-index: 27
(University of Oklahoma),
George S. Chrysant6
Estimated H-index: 6
(University of Oklahoma)
The concept of the J-curve effect has been around for a long time and is a subject of contention among various investigators. The J-curve effect describes an inverse relation between low blood pressure (BP) and cardiovascular complications. Because the coronary arteries are perfused during diastole, this effect is seen mostly with low diastolic BP in the range of 70 to 80 mm Hg, depending on preexisting coronary artery disease, hypertension, or left ventricular hypertrophy. Although national and...
39 Citations Source Cite
Published on Jun 1, 2010in The American Journal of Clinical Nutrition 6.55
Marianne Uhre Jakobsen32
Estimated H-index: 32
Claus Dethlefsen24
Estimated H-index: 24
+ 4 AuthorsKim Overvad111
Estimated H-index: 111
Background: Studies have suggested that replacing saturated fatty acids (SFAs) with carbohydrates is modestly associated with a higher risk of ischemic heart disease, whereas replacing SFAs with polyunsaturated fatty acids is associated with a lower risk of ischemic heart disease. The effect of carbohydrates, however, may depend on the type consumed. Objectives: By using substitution models, we aimed to investigate the risk of myocardial infarction (MI) associated with a higher energy intake fro...
147 Citations Source Cite
Published on Apr 12, 2010in JAMA Internal Medicine 19.99
Sabina Sieri59
Estimated H-index: 59
V. Krogh77
Estimated H-index: 77
+ 15 AuthorsCarlotta Sacerdote78
Estimated H-index: 78
(University of Turin)
Background Dietary glycemic load (GL) and glycemic index (GI) in relation to cardiovascular disease have been investigated in a few prospective studies with inconsistent results, particularly in men. The present EPICOR study investigated the association of GI and GL with coronary heart disease (CHD) in a large and heterogeneous cohort of Italian men and women originally recruited to the European Prospective Investigation into Cancer and Nutrition study. Methods We studied 47 749 volunteers (15 1...
100 Citations Source Cite
Published on Apr 1, 2010in British Journal of Nutrition 3.66
Emily B. Levitan37
Estimated H-index: 37
(University of Alabama at Birmingham),
Murray A. Mlttleman86
Estimated H-index: 86
(Beth Israel Deaconess Medical Center),
Alicja Wolk110
Estimated H-index: 110
(Karolinska Institutet)
Glycaemic index (GI), the relative increase in blood glucose due to carbohydrate in a test food compared to a reference food, was initially developed as a meal planning tool for people with diabetes mellitus (1). More recently, there have been experimental and observational studies examining whether carbohydrate quality influences the risk of cardiovascular diseases. Randomized diet trials have demonstrated that diets with reduced GI or glycaemic load (GL), the product of GI and carbohydrate con...
20 Citations Source Cite
Published on Mar 1, 2010in Vascular Health and Risk Management
Ajikumar V Aryangat1
Estimated H-index: 1
John E. Gerich79
Estimated H-index: 79
Hyperglycemia is a major risk factor for both the microvascular and macrovascular complications in patients with type 2 diabetes. This review summarizes the cardiovascular results of large outcomes trials in diabetes and presents new evidence on the role of hyperglycemia, with particular emphasis on postprandial hyperglycemia, in adverse cardiovascular outcomes in patients with type 2 diabetes. Treatment options, including the new dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 mim...
57 Citations Source Cite
Cited By49
Published on Mar 1, 2019in Advances in Nutrition 6.85
Matthew Snelson1
Estimated H-index: 1
(Monash University),
Nicole Kellow8
Estimated H-index: 8
(Monash University),
Melinda T. Coughlan30
Estimated H-index: 30
(Monash University)
Source Cite
Geoffrey Livesey24
Estimated H-index: 24
Helen Livesey1
Estimated H-index: 1
Abstract Objective To clarify the role of dietary carbohydrate, glycemic index (GI), and glycemic load (GL) in progression from health to coronary heart disease (CHD) by determining disease-nutrient risk relation (RR) values needed for intake ranges within jurisdictions and across the globe. Methods We performed a literature search of MEDLINE and EMBASE for prospective cohort studies that used truly valid dietary instruments in heathy adults published from January 1, 2000, to June 5, 2018. Relev...
Source Cite
Published on Oct 1, 2018in American Journal of Epidemiology 4.32
Natasha Tasevska12
Estimated H-index: 12
(Arizona State University),
Mary Pettinger44
Estimated H-index: 44
(Fred Hutchinson Cancer Research Center)
+ 12 AuthorsBarbara V. Howard113
Estimated H-index: 113
(Memorial Hospital of South Bend)
2 Citations Source Cite
Published on Sep 22, 2018in Nutrients 4.20
Sonia Vega-López20
Estimated H-index: 20
Bernard J. Venn19
Estimated H-index: 19
(University of Otago),
Joanne L. Slavin57
Estimated H-index: 57
Despite initial enthusiasm, the relationship between glycemic index (GI) and glycemic response (GR) and disease prevention remains unclear. This review examines evidence from randomized, controlled trials and observational studies in humans for short-term (e.g., satiety) and long-term (e.g., weight, cardiovascular disease, and type 2 diabetes) health effects associated with different types of GI diets. A systematic PubMed search was conducted of studies published between 2006 and 2018 with key w...
2 Citations Source Cite
Published on Jan 1, 2018in Journal of Clinical Neurology 2.85
Tae-Jin Song11
Estimated H-index: 11
(Ewha Womans University),
Yoonkyung Chang6
Estimated H-index: 6
(Ewha Womans University)
+ 4 AuthorsYong-Jae Kim8
Estimated H-index: 8
(Ewha Womans University)
Source Cite
Published on Jan 1, 2018
Globally coronary heart disease (CHD) is the leading cause of death and morbidity in adults. The type of dietary pattern consumed plays an important role in the risk of developing CHD. Healthy dietary patterns (or higher nutrient quality diets) which are associated with decreased risk of CHD include higher Healthy Eating Indices scores, Mediterranean diet (MedDiet), Dietary Approaches to Stop Hypertension (DASH) and vegetarian diets and are characterized by higher consumption of vegetables, frui...
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Published on Nov 1, 2017in The Lancet 53.25
Mahshid Dehghan22
Estimated H-index: 22
(Population Health Research Institute),
Andrew Mente30
Estimated H-index: 30
(McMaster University)
+ 352 AuthorsAnders H. Rosengren84
Estimated H-index: 84
(University of Gothenburg)
Summary Background The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear. Methods The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35–70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median fo...
168 Citations Source Cite
Roberto Salvia5
Estimated H-index: 5
(University of Bari),
Simona D’Amore3
Estimated H-index: 3
(University of Bari)
+ 6 AuthorsMicheleVacca15
Estimated H-index: 15
(University of Bari)
AbstractThe Mediterranean diet (MeD) is believed to promote health; nevertheless, changes in the nutritional patterns in the Mediterranean area (increased intake of refined carbohydrates/saturated fats; reduced fibers intake; main calorie load shifted to dinner) led to reduced MeD benefits in recent decades. We retrospectively investigated the effects of a MeD with a low intake of refined carbohydrates in the evening (“MeDLowC”) on body weight (BW) and metabolic profile of overweight/obese subje...
1 Citations Source Cite
Published on Jan 1, 2017in Nutrition Reviews 5.79
James M. Rippe26
Estimated H-index: 26
John L. Sievenpiper1
Estimated H-index: 1
+ 3 AuthorsTheodore J. Angelopoulos25
Estimated H-index: 25
8 Citations Source Cite
Published on Nov 1, 2016in The American Journal of Clinical Nutrition 6.55
Danxia Yu16
Estimated H-index: 16
(Vanderbilt University Medical Center),
Xianglan Zhang25
Estimated H-index: 25
(Vanderbilt University Medical Center)
+ 8 AuthorsWei Zheng110
Estimated H-index: 110
(Vanderbilt University Medical Center)
Epidemiologic evidence on dietary carbohydrates and stroke risk remains controversial. Very few prospective cohort studies have been conducted in Asian populations, who usually consume a high-carbohydrate diet and have a high burden of stroke.We examined dietary glycemic index (GI), glycemic load (GL), and intakes of refined and total carbohydrates in relation to risks of total, ischemic, and hemorrhagic stroke and stroke mortality.This study included 64,328 Chinese women, aged 40-70 y, with no ...
6 Citations Source Cite