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Cited by 117Food composition and propertiesNutritional Studies and DietDiet, Metabolism, and Disease

Association of glycaemic index and glycaemic load with type 2 diabetes, cardiovascular disease, cancer, and all-cause mortality: a meta-analysis of mega cohorts of more than 100 000 participants

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Jenkins, David J A, Willett, Walter C, Yusuf, Salim, Hu, Frank B, Glenn, Andrea J, Liu, Simin, Mente, Andrew, Miller, Victoria +29 more·2024·The Lancet Diabetes & Endocrinology
DOI 10.1016/s2213-8587(23)00344-3
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Abstract

Background There is debate over whether the glycaemic index of foods relates to chronic disease. We aimed to assess the associations between glycaemic index (GI) and glycaemic load (GL) and type 2 diabetes, cardiovascular disease, diabetes-related cancers, and all-cause mortality.Methods We did a meta-analysis of large cohorts (≥100 000 participants) identified from the Richard Doll Consortium. We searched the Cochrane Library, MEDLINE, PubMed, Embase, Web of Science, and Scopus for cohorts that prospectively examined associations between GI or GL and chronic disease outcomes published from database inception to Aug 4, 2023. Full-article review and extraction of summary estimates data were conducted by three independent reviewers. Primary outcomes were incident type 2 diabetes, total cardiovascular disease (including mortality), diabetes-related cancers (ie, bladder, breast, colorectal, endometrial, hepatic, pancreatic, and non-Hodgkin lymphoma), and all-cause mortality. We assessed comparisons between the lowest and highest quantiles of GI and GL, adjusting for dietary factors, and pooling their most adjusted relative risk (RR) estimates using a fixed-effects model. We also assessed associations between diets high in fibre and whole grains and the four main outcomes. The study protocol is registered with PROSPERO, CRD42023394689.Findings From ten prospective large cohorts (six from the USA, one from Europe, two from Asia, and one international), we identified a total of 48 studies reporting associations between GI or GL and the outcomes of interest: 34 (71%) on various cancers, nine (19%) on cardiovascular disease, five (10%) on type 2 diabetes, and three (6%) on all-cause mortality. Consumption of high GI foods was associated with an increased incidence of type 2 diabetes (RR 1·27 [95% CI 1·21-1·34]; p<0·0001), total cardiovascular disease (1·15 [1·11-1·19]; p<0·0001), diabetes-related cancer (1·05 [1·02-1·08]; p=0·0010), and all-cause mortality (1·08 [1·05-1·12]; p<0·0001). Similar associations were seen between high GL and diabetes (RR 1·15 [95% CI 1·09-1·21]; p<0·0001) and total cardiovascular disease (1·15 [1·10-1·20]; p<0·0001). Associations between diets high in fibre and whole grains and the four main outcomes were similar to those for low GI diets.Interpretation Dietary recommendations to reduce GI and GL could have effects on health outcomes that are similar to outcomes of recommendations to increase intake of fibre and whole grain.Funding Banting and Best and the Karuna Foundation.

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  1. Higgins JPT, Thomas J, Chandler J, et al (eds). Cochrane handbook for systematic reviews of interventions, 2nd edn. Chichester: John Wiley & Sons, 2019.
  2. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-12.

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Authors
Jenkins, D. J. A., Willett, W. C., Yusuf, S., Hu, F. B., Glenn, A. J., Liu, S., Mente, A., Miller, V., Bangdiwala, S. I., Gerstein, H. C., Sieri, S., Ferrari, P., Patel, A. V., McCullough, M. L., Le Marchand, L., Freedman, N. D., Loftfield, E., Sinha, R., Shu, X.-O., Touvier, M., Sawada, N., Tsugane, S., van den Brandt, P. A., Shuval, K., Khan, T. A., Paquette, M., Sahye-Pudaruth, S., Patel, D., Siu, T. F. Y., Srichaikul, K., Kendall, C. W. C., Sievenpiper, J. L., Balachandran, B., Zurbau, A., Wang, X., Liang, F., & Yang, W.
Affiliations
  • St. Michael's Hospital (CA)
  • Harvard University (US)
  • Population Health Research Institute (CA)
  • Brigham and Women's Hospital (US)
  • Brown University (US)
  • Hamilton Health Sciences (CA)
  • Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
  • Centre international de recherche sur le cancer (FR)
  • American Cancer Society (US)
  • National Institutes of Health (US)
  • Vanderbilt University Medical Center (US)
  • Conservatoire National des Arts et Métiers (FR)
  • National Cancer Center Institute for Cancer Control (JP)
  • National Cancer Centre Japan (JP)
  • Cooper Institute (US)
  • University of Toronto (CA)
Corresponding author
Jenkins, David J A
ORCID
Venue
The Lancet Diabetes & Endocrinology
Publisher
Elsevier BV
Published
2024-02
Volume
12
Issue
2
Pages
107-118
ISSN
2213-8587 (ISSN-L)
DOI
10.1016/s2213-8587(23)00344-3
OpenAlex
W4391155287
Cited by
117
References
110
Citations by year
2026: 42 · 2025: 50 · 2024: 25
FWCI
6.87
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Diabetes & Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders
University of Toronto Temerty Faculty of Medicine
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Keywords
glycemic index, glycemic load, type 2 diabetes, cardiovascular disease, all-cause mortality, dietary fiber, whole grains, chronic disease risk, prospective cohort, diet and health outcomes, cardiovascular mortality, diabetes mortality, non-Hodgkin lymphoma, colorectal cancer, pancreatic cancer, breast cancer, bladder cancer
MeSH terms
Glycemic Load, Cardiovascular Diseases, Chronic Disease, Diabetes Mellitus, Type 2, Diet, Dietary Carbohydrates, Humans, Neoplasms, Prospective Studies, Risk Factors, Glycemic Index

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