Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes : A Systematic Review and Updated Meta-Analyses of Prospective Cohort Studies

Published on Jun 5, 2019in Nutrients4.171
· DOI :10.3390/nu11061280
Geoffrey Livesey25
Estimated H-index: 25
Richard J. K. Taylor64
Estimated H-index: 64
+ 22 AuthorsJennie Brand-Miller52
Estimated H-index: 52
Published meta-analyses indicate significant but inconsistent incident type-2 diabetes (T2D)-dietary glycemic index (GI) and glycemic load (GL) risk ratios or risk relations (RR). It is now over a decade ago that a published meta-analysis used a predefined standard to identify valid studies. Considering valid studies only, and using random effects dose–response meta-analysis (DRM) while withdrawing spurious results (p 1.20 with a lower 95% confidence limit >1.10 across typical intakes (approximately 10th to 90th percentiles of population intakes). The combined T2D–GI RR was 1.27 (1.15–1.40) (p < 0.001, n = 10 studies) per 10 units GI, while that for the T2D–GL RR was 1.26 (1.15–1.37) (p < 0.001, n = 15) per 80 g/d GL in a 2000 kcal (8400 kJ) diet. The corresponding global DRM using restricted cubic splines were 1.87 (1.56–2.25) (p < 0.001, n = 10) and 1.89 (1.66–2.16) (p < 0.001, n = 15) from 47.6 to 76.1 units GI and 73 to 257 g/d GL in a 2000 kcal diet, respectively. In conclusion, among adults initially in good health, diets higher in GI or GL were robustly associated with incident T2D. Together with mechanistic and other data, this supports that consideration should be given to these dietary risk factors in nutrition advice. Concerning the public health relevance at the global level, our evidence indicates that GI and GL are substantial food markers predicting the development of T2D worldwide, for persons of European ancestry and of East Asian ancestry.
  • References (75)
  • Citations (10)
📖 Papers frequently viewed together
163 Citations
118 Citations
761 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
#1Alessio Crippa (KI: Karolinska Institutet)H-Index: 9
#2Andrea Discacciati (KI: Karolinska Institutet)H-Index: 12
Last. Nicola Orsini (KI: Karolinska Institutet)H-Index: 45
view all 5 authors...
The standard two-stage approach for estimating non-linear dose–response curves based on aggregated data typically excludes those studies with less than three exposure groups. We develop the one-stage method as a linear mixed model and present the main aspects of the methodology, including model specification, estimation, testing, prediction, goodness-of-fit, model comparison, and quantification of between-studies heterogeneity. Using both fictitious and real data from a published meta-analysis, ...
12 CitationsSource
The quality of carbohydrate-rich foods rather than quantity has the strongest effect on major health outcomes. Systematic reviews and meta-analyses of prospective studies report lower mortality and reduced incidence of cardiovascular diseases, type 2 diabetes mellitus and colorectal cancer in people who habitually consume diets rich in fibre and whole grain.
2 CitationsSource
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...
8 CitationsSource
#1Andrew N. Reynolds (University of Otago)H-Index: 4
#2J. John MannH-Index: 142
Last. Lisa Te Morenga (University of Otago)H-Index: 11
view all 6 authors...
Summary Background Previous systematic reviews and meta-analyses explaining the relationship between carbohydrate quality and health have usually examined a single marker and a limited number of clinical outcomes. We aimed to more precisely quantify the predictive potential of several markers, to determine which markers are most useful, and to establish an evidence base for quantitative recommendations for intakes of dietary fibre. Methods We did a series of systematic reviews and meta-analyses ...
62 CitationsSource
#1Lifeng Lin (UMN: University of Minnesota)H-Index: 7
#2Haitao Chu (UMN: University of Minnesota)H-Index: 35
Last. James S. Hodges (UMN: University of Minnesota)H-Index: 49
view all 3 authors...
Summary Meta-analysis has become a widely used tool to combine results from independent studies. The collected studies are homogeneous if they share a common underlying true effect size; otherwise, they are heterogeneous. A fixed-effect model is customarily used when the studies are deemed homogeneous, while a random-effects model is used for heterogeneous studies. Assessing heterogeneity in meta-analysis is critical for model selection and decision making. Ideally, if heterogeneity is present, ...
11 CitationsSource
7 CitationsSource
#1David UnwinH-Index: 1
#2David Haslam (National Obesity Forum)H-Index: 4
Last. Geoffrey Livesey (Royal Society)H-Index: 1
view all 3 authors...
Background: The low-carbohydrate diet for diabetes and obesity is over 200 years old. A new lease of life comes with evidence for its beneficial effects supplied by research into the value of low-glycaemic index (GI) foods in diabetes control. While trialling this approach it became evident that professionals and patients had previously misunderstood the index leading to errors in food choices. Aim: To explore the importance of the GI for those with T2D and improve understanding of the likely ef...
6 CitationsSource
#1David C. Hoaglin (UMMS: University of Massachusetts Medical School)H-Index: 28
Many meta-analyses report using ‘Cochran's Q test' to assess heterogeneity of effect-size estimates from the individual studies. Some authors cite work by W. G. Cochran, without realizing that Cochran deliberately did not use Q itself to test for heterogeneity. Further, when heterogeneity is absent, the actual null distribution of Q is not the chi-squared distribution assumed for ‘Cochran's Q test'. This paper reviews work by Cochran related to Q. It then discusses derivations of the asymptotic ...
59 CitationsSource
#1Hala B AlEssaH-Index: 4
Last. Frank B. Hu (Brigham and Women's Hospital)H-Index: 205
view all 8 authors...
Carbohydrate quality may be an important determinant of type 2 diabetes (T2D); however, relations between various carbohydrate quality metrics and T2D risk have not been systematically investigated.The purpose of this study was to prospectively examine the association between carbohydrates, starch, fibers, and different combinations of these nutrients and risk of T2D in women.We prospectively followed 70,025 women free of cardiovascular disease, cancer, and diabetes at baseline from the Nurses' ...
26 CitationsSource
#1L.S.A. Augustin (St. Michael's Hospital)H-Index: 6
#2Cyril W. C. Kendall (U of S: University of Saskatchewan)H-Index: 61
Last. Andrea PoliH-Index: 23
view all 21 authors...
Abstract Background and aims The positive and negative health effects of dietary carbohydrates are of interest to both researchers and consumers. Methods International experts on carbohydrate research held a scientific summit in Stresa, Italy, in June 2013 to discuss controversies surrounding the utility of the glycemic index (GI), glycemic load (GL) and glycemic response (GR). Results The outcome was a scientific consensus statement which recognized the importance of postprandial glycemia in ov...
131 CitationsSource
Cited By10
There is no question that elevated postprandial glycemia is a significant driver of common chronic diseases globally [...]
#1Dariush Mozaffarian (Tufts University)H-Index: 120
The world faces a global nutrition crisis, most clearly evidenced by the twin pandemics of obesity and type 2 diabetes (T2DM). Yet, substantial confusion and controversy exist about optimal dietary priorities and policy approaches to address these challenges. This paper reviews the evolution of nutritional evidence, emerging areas and corresponding policy lessons to address obesity and T2DM. This includes the complexity of diet–health pathways for long-term weight maintenance and metabolic healt...
#1Dale S. Hardy (Morehouse School of Medicine)
#2Jane T. GarvinH-Index: 2
Last. Hongyan XuH-Index: 2
view all 3 authors...
Abstract Background and Aims Despite the proven evidence of high glycemic index (GI) and glycemic load (GL) diets to increase cardiometabolic risks, knowledge about the meta-evidence for carbohydrate quality within world geographic regions is limited. We conducted a meta-analysis to synthesize the evidence of GI/GL studies and carbohydrate quality, gathering additional exposures for carbohydrate, high glycemic carbohydrate, total dietary fiber, and cereal fiber and risks for type 2 diabetes (T2D...
Evidence of the role that dietary carbohydrates (total carbohydrates, dietary fiber, total sugars, dietary glycemic index (GI) and glycemic load (GL)) exerts on insulin levels in adolescents is controversial. Thus, the aim of this study was to assess the association between dietary carbohydrates and insulin resistance in adolescents from Chiapas, Mexico. A cross-sectional study was conducted in 217 adolescents. Sociodemographic, anthropometric, dietary and biochemical data were obtained. Total c...
In the 1940s, the diet-heart hypothesis proposed that high dietary saturated fat and cholesterol intake promoted coronary heart disease in “at-risk” individuals. This hypothesis prompted federal recommendations for a low-fat diet for “high risk” patients and as a preventive health measure for everyone except infants. The low carbohydrate diet, first used to treat type 1 diabetes, became a popular obesity therapy with the Atkins diet in the 1970s. Its predicted effectiveness was based largely on ...
Blood glucose concentration increases after the consumption of any carbohydrate-containing meal. Several factors affect the course of glucose metabolism, including nutritional status. This study evaluated the effect of the nutritional statuses of adults on their glycaemic responses after the consumption of some vegetarian meals (dumplings with potato and curd cheese stuffing; curd cheese dumplings; pancakes with curd cheese), prepared according to the traditional recipe and a partly modified rec...
#1Barry M. Popkin (Harvard University)H-Index: 323
#2Simin Liu (Brown University)H-Index: 104
2 CitationsSource
#2Alexandra MeynierH-Index: 6
Last. Sophie VinoyH-Index: 10
view all 10 authors...
An official method for determining food glycemic index (GI) was published by the Organization for International Standardization (ISO) in 2010, but its performance has not been assessed. Therefore, we aimed to determine the intra- and inter-laboratory variation of food GI values measured using the 2010 ISO method. Three laboratories (Australia, Canada and France) determined the GI and insulinemic-index (II) of six foods in groups of 13–15 participants using the 2010 ISO method and intra- and inte...
#1Hana KahleovaH-Index: 12
Last. John L. SievenpiperH-Index: 44
view all 6 authors...
The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD) conducted a review of existing systematic reviews and meta-analyses to explain the relationship between different dietary patterns and patient-important cardiometabolic outcomes. To update the clinical practice guidelines for nutrition therapy in the prevention and management of diabetes, we summarize the evidence from these evidence syntheses for the Mediterranean, Dietary Approaches to St...
2 CitationsSource
#1Margherita Dall’Asta (University of Parma)H-Index: 15
#2Daniele Del Rio (University of Parma)H-Index: 40
Last. Furio Brighenti (University of Parma)H-Index: 47
view all 6 authors...
AbstractMultiple factors may affect the metabolic fate of carbohydrates. Today, well-standardised and accepted methods may allow for the definitions of the changes in the glucose and insulin curves...