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Cited by 162Nutritional Studies and DietFood composition and propertiesDiet, Metabolism, and Disease

Associations of Glycemic Index and Load With Coronary Heart Disease Events: A Systematic Review and Meta‐Analysis of Prospective Cohorts

Open access
Mirrahimi, Arash, de Souza, Russell J., Chiavaroli, Laura, Sievenpiper, John L., Beyene, Joseph, Hanley, Anthony J., Augustin, Livia S. A., Kendall, Cyril W. C. +1 more·2012·Journal of the American Heart Association
DOI 10.1161/jaha.112.000752PMC PMC3541617
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Abstract

Background: Glycemic index ( GI ) and glycemic load ( GL ) have been associated with coronary heart disease ( CHD ) risk in some but not all cohort studies. We therefore assessed the association of GI and GL with CHD risk in prospective cohorts. Methods and Results: We searched MEDLINE , EMBASE , and CINAHL (through April 5, 2012) and identified all prospective cohorts assessing associations of GI and GL with incidence of CHD . Meta‐analysis of observational studies in epidemiology ( MOOSE ) methodologies were used. Relative measures of risk, comparing the group with the highest exposure (mean GI of cohorts=84.4 GI units, range 79.9 to 91; mean GL of cohorts=224.8, range 166 to 270) to the reference group (mean GI =72.3 GI units, range 68.1 to 77; mean GL =135.4, range 83 to 176), were pooled using random‐effects models, expressed as relative risk ( RR ) with heterogeneity assessed by χ 2 and quantified by I 2 . Subgroups included sex and duration of follow‐up. Ten studies (n=240 936) were eligible. Pooled analyses showed an increase in CHD risk for the highest GI quantile compared with the lowest, with RR =1.11 (95% confidence interval [ CI ] 0.99 to 1.24) and for GL , RR =1.27 (95% CI 1.09 to 1.49), both with evidence of heterogeneity (I 2 >42%, P <0.07). Subgroup analyses revealed only a significant modification by sex, with the female cohorts showing significance for GI RR =1.26 (95% CI 1.12 to 1.41) and for GL RR =1.55 (95% CI 1.18 to 2.03). Conclusions: High GI and GL diets were significantly associated with CHD events in women but not in men. Further studies are required to determine the relationship between GI and GL with CHD in men.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis of 10 prospective cohorts found that high glycemic load was significantly associated with increased coronary heart disease risk, while high glycemic index was not significant overall. The associations were significant in women but not in men.

Key findings

  • Across 10 studies (n=240,936 for GL; n=233,655 for GI), 6 to 25 years of follow-up yielded 6,940 coronary events.
  • Highest versus lowest GI exposure: RR=1.11 (95% CI 0.99 to 1.24), P=0.09, with heterogeneity I²=45%, P=0.05; removing the Grau et al. report on men gave RR=1.14 (95% CI 1.02 to 1.26), P=0.02, I²=30%.
  • Highest versus lowest GL exposure: RR=1.27 (95% CI 1.09 to 1.49), P=0.002, with heterogeneity I²=43%, P=0.06.
  • Sex significantly modified associations: women had GI RR=1.26 (95% CI 1.12 to 1.41) and GL RR=1.55 (95% CI 1.18 to 2.03); men had GI RR=0.96 (95% CI 0.84 to 1.11) and GL RR=1.08 (95% CI 0.93 to 1.26). Duration of follow-up was not a significant modifier.

Methods

  • Systematic review and meta-analysis of prospective cohorts in healthy adults, following MOOSE guidelines; MEDLINE, EMBASE, and CINAHL were searched through April 5, 2012, for studies assessing GI or GL and incident CHD, MI, or CHD death.
  • Eligible studies included 10 cohorts with 12 GI reports and 12 GL reports; all used Cox proportional hazards models except one study using restricted cubic spline models.
  • Natural log-transformed relative risks comparing highest versus reference exposure were pooled using random-effects generic inverse variance models; heterogeneity was assessed by Cochrane’s Q and I², with a priori subgroups for sex and follow-up duration and publication bias tested by Begg’s and Egger’s tests.

Limitations

  • The paper states limitations including the limited number of studies, inability to include potentially relevant studies because of missing data, heterogeneity in overall analyses, likely underpowered analyses in men, potential residual confounding or overadjustment, combining dietary data from multiple instruments, and a predominantly white population limiting racial diversity.
  • The text makes evident that observational design cannot establish causality, and the sex-specific findings may be influenced by the larger female sample and underpowered male cohorts.
  • One included study used restricted cubic splines and was identified as an outlier and contributor to heterogeneity, which the authors note may affect pooled estimates.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1161/jaha.112.000752

Cites

65 of 65 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 66 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    During 6 to 25 years of follow-up, 6940 coronary events were recorded.

    “During 6 to 25 years of follow-up, 6940 coronary events were recorded.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Pooled analysis showed an increase in CHD risk for the highest GI quantile compared with the lowest, with RR=1.11 (95% CI 0.99 to 1.24).

    “Pooled analyses showed an increase in CHD risk for the highest GI quantile compared with the lowest, with RR=1.11 (95% confidence interval [CI] 0.99 to 1.24)”
    • Also stated in: § Glycemic Index and Coronary Heart Disease · plain
      “The CHD incidence rate was increased at the highest level of GI exposure (mean GI of 84.4 GI units, range 79.9 to 91) relative to the lowest (mean GI of 72.3 GI units, range 68.1 to 77), RR=1.11, 95% CI 0.99 to 1.24, and approached significance (P=0.09)”
    Quote in the paperSubstantial claim
  • Findingown data

    There was significant heterogeneity in the overall GL analysis (I2=43%, P=0.06).

    “The pooled risk estimation showed a significant increase in CHD risk (RR=1.27 [95% CI 1.09 to 1.49], P=0.002), with significant heterogeneity (I2=43%, P=0.06), for the highest level of GL exposure (mean GL of 224.8 GL units, range 166 to 270) relative to the lowest (mean GL of 135.4 GL units, range 83 to 176).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Removal of the Grau et al43 report somewhat reduced the estimate of the association of GL with CHD (RR=1.21, 95% CI 1.05 to 1.38, P=0.007; I2=23%, P=0.23).

    “The removal of Grau et al43 somewhat reduced the estimate of the association of GL with CHD (RR=1.21 [95% CI 1.05 to 1.38], P=0.007; I2=23%, P=0.23)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Grau et al43

      Not checked in the free run.

  • Findingown data

    Sensitivity analyses identified the Grau et al report on men as the largest contributor to heterogeneity.

    “Sensitivity analyses identified the Grau et al43 report on men as the largest contributor to heterogeneity.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 27
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 22

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In female cohorts, the association between GL and CHD was statistically significant (RR=1.55, 95% CI 1.18 to 2.03; ΔGL=88.4±17.6 SE).

    “The effect was seen only in women with 26% increased relative risk of CHD for GI and 55% for GL.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Two reports on the Nurses' Health Study provided data on GL exposure; only the report with larger subject numbers and longer follow-up was included in GL analyses.

    “Two reports28,34 on the Nurses' Health Study provided data on the GL exposure; only the report with the larger subject numbers and longer follow-up was included in the GL analyses.34,44”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The most common confounders adjusted for included age, BMI, and cigarette smoking.

    “The most common confounders adjusted for included age, BMI, and cigarette smoking, with full multivariate analyses outlined in Table 1.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Removal of the Grau et al report changed the risk estimate for GI with CHD to RR=1.14 (95% CI 1.02 to 1.26, P=0.02) and eliminated much of the heterogeneity (I2=30%, P=0.16).

    “The removal of this study changed the risk estimate for the association of GI with CHD (RR=1.14 [95% CI 1.02 to 1.26], P=0.02) and also improved the precision of the estimate and eliminated much of the heterogeneity (I2=30%, P=0.16).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    All studies used Cox proportional hazard models for CHD risk estimation, except one that used restricted cubic spline models.

    “All studies used Cox proportional hazard models for CHD risk estimation analyses, except for 1 study43 which used restricted cubic spline models.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In visual inspection of the GI funnel plot, the Grau et al43 report on men appears to be an outlier.

    “in the visual inspection of the GI funnel plot, the Grau et al43 report on men appears to be an outlier”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Grau et al43

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The dietary patterns across GL quantiles were similar between studies, with a trend of increasing carbohydrate and decreasing protein and fat content at higher GL quantiles.

    “The dietary patterns across the different quantiles of GL were similar between studies, with a trend of increasing carbohydrate and decreasing protein and fat content at higher GL quantiles (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of the 10 studies, 12 GI and 12 GL reports were included, with 233,655 and 240,936 subjects respectively.

    “Of the 10 studies identified, 12 GI and 12 GL reports with CHD risk estimation were included in our analyses, with a total of 233 65528–31,33,35,36,42,43 and 240 93628–31,33,34,35,36,42,43 subjects, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Study 43 differed from other studies of men: the proportion of smokers was 54%, almost twice that of other studies, and BMI was lower (25.3 versus 26.1 kg/m2).

    “This study differed from the other studies of men in several respects. The proportion (54%) of smokers was almost twice that of the other studies, and BMI was somewhat lower (25.3 versus 26.1 kg/m2)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] Grau K Tetens I Bjornsbo KS Heitman BL Overall glycaemic index and glycaemic load of habitual diet and risk of heart disease. Public Health Nutr. 2011; 14: 109- 118. 20576198 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The majority of studies (7 of 10) used SFFQ or FFQ, while 3 used 4- or 7-day diet records or diet history interviews.

    “The majority of the studies (7 of 10) used either a semiquantitative or quantitative Food Frequency Questionnaire (SFFQ or FFQ),28,30,31,33,34,36,42 but 3 used 4- or 7-day diet records or diet history interviews for food consumption patterns.29,35,43”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    All analyses were stratified by sex.

    “All analyses were stratified by sex.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All cohorts excluded those with documented CHD or major CHD risk factor at enrollment, except one that included a population 5% of whom had diabetes but adjusted for diabetes status.

    “All cohorts excluded those with documented CHD or major CHD risk factor at time of enrollment, with the exception of 1 that included a population 5% of whom had diabetes35 but adjusted for diabetes status.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was significant evidence of heterogeneity in the female subset but not in the male subset.

    “There was significant evidence of heterogeneity in the female subset but not in the male subset.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In all, 473 eligible studies were identified by the search.

    “In all, 473 eligible studies were identified by the search.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    A total of 10 studies with 12 GI reports and 12 GL reports were selected for analyses.

    “A total of 10 studies with 12 GI reports28–31,33,35,36,42,43 and 12 GL reports28–31,33–36,42,43 were selected for analyses.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    All studies used the International Tables of Glycemic Index for assessing GI; 3 used the 1995 iteration, 6 used the 2002 iteration, and 1 used the 2008 iteration.

    “All studies used the International Tables of Glycemic Index for assessing the GI of different foods; 328,29,34 used the 1995 iteration,45 630,31,33,36,42,43 used the 2002 iteration,46 and 135 used the 2008 iteration.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In male cohorts, the pooled RR for GI was 0.96 (95% CI 0.84 to 1.11), showing no association.

    “whereas the male cohorts29,30,33,35,36,43 showed no association (ΔGI between mean of highest exposure and mean of reference=12.2±1.7 SE, RR=0.96 [95% CI 0.84 to 1.11])”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The glycemic index and glycemic load data were in agreement, although the magnitude of CHD risk was greater based on the difference between extreme quantiles of glycemic load.

    “In general, the glycemic index and glycemic load data were in agreement, although the magnitude of the CHD risk was greater based on the difference between the extreme quantiles of glycemic load.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study followed MOOSE guidelines for this report.

    “We followed the meta-analysis of observational studies in epidemiology (MOOSE) guidelines for this report.32”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Stroup DF Berlin JA Morton SC Olkin I Williamson GD Rennie D Moher D Becker BJ Sipe TA Thacker SB Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000; 283: 2008- 2012. 10789670 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Electronic databases were searched by 2 individuals independently, supplemented by manual searches.

    “Electronic databases (MEDLINE 1946-March, Week 4, 2012; EMBASE 1980–2012, Week 13; CINAHL 1982–December 2011) were searched by 2 individuals independently; searches were supplemented by manual searches through the reference lists of original publications and review articles.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Two reviewers independently reviewed and extracted relevant data using a standardized pro forma sheet.

    “Two reviewers (A.M., L.C.) independently reviewed and extracted relevant data employing a standardized pro forma sheet with the first author and year of publication used as study identifiers for convenience.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Potential publication bias was assessed visually by funnel plots and formally tested using Begg's and Egger's tests.

    “Potential publication bias was assessed visually by inspecting funnel plots of effect size against the standard error and formally tested using Begg's and Egger's tests in STATA.39,40”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [39] Begg CB Mazumdar M Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994; 50: 1088- 1101. 7786990 source

      Not checked in the free run.

    • cites [40] Egger M Davey Smith G Schneider M Minder C Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997; 315: 629- 634. 9310563 PMC2127453 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Sensitivity analyses were performed to identify sources of heterogeneity regardless of P value.

    “Regardless of P value, sensitivity analyses were performed to identify sources of heterogeneity.38”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Higgins J Green S Cochrane handbook for systematic reviews of interventions version 5.0.0 [updated February 2008] 2008 The Cochrane Collaboration source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    A priori stratified analyses included sex and duration of follow-up, analyzed using meta-regression.

    “Our a priori stratified analyses included sex and duration of follow-up, that is, whether studies were more or less than 10 years, consistent with the 10-year Framingham Risk Score41 approach, and analyzed using meta-regression in STATA.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Anderson KM Odell PM Wilson PW Kannel WB Cardiovascular disease risk profiles. Am Heart J. 1991; 121: 293- 298. 1985385 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Titles and abstracts were reviewed by 2 independent reviewers, with disagreements resolved by discussion with 2 additional adjudicators.

    “Titles and abstracts were initially reviewed to identify relevant reports by 2 independent reviewers (A.M., L.C., both investigators); reviewers conducted a subsequent full-text assessment of all studies in which there was uncertainty about the assessment of relevance. Disagreements regarding eligibility were resolved through discussion with 2 additional adjudicators (D.J.A.J/R.J.D.).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    SFAs per se no longer appeared to be associated with CHD, emphasizing the potentially deleterious effects of refined, rapidly absorbed carbohydrates.

    “As a result, SFAs per se no longer appeared to be associated with CHD, emphasizing the potentially deleterious effects of refined, rapidly absorbed carbohydrates.4,5”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [4] Jakobsen MU O'Reilly EJ Heitmann BL Pereira MA Balter K Fraser GE Goldbourt U Hallmans G Knekt P Liu S Pietinen P Spiegelman D Stevens J Virtamo J Willett WC Ascherio A Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr. 2009; 89: 1425- 1432. 19211817 PMC2676998 source

      Not checked in the free run.

    • cites [5] Siri-Tarino PW Sun Q Hu FB Krauss RM Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010; 91: 535- 546. 20071648 PMC2824152 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Two studies could not be included because results were expressed as substitution of low GI carbohydrates for SFAs or as incremental association per 5 GI units rather than quantile presentation.

    “However, we were unable to include 2 studies in this analysis because of the expression of results as either the substitution of low GI carbohydrates for SFAs, rather than dietary GI analysis, or the incremental association of dietary GI with CHD rather than quantile presentation (ie, CHD risk per 5 GI unit increments).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Higher glycemic index diets tend to reduce circulating HDL-C concentrations and thus disproportionately increase CHD risk in women, especially when postmenopausal.

    “Higher glycemic index diets tend to reduce circulating HDL-C concentrations and thus disproportionately increase CHD risk in women, especially when postmenopausal.51”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] Matthews KA Meilahn E Kuller LH Kelsey SF Caggiula AW Wing RR Menopause and risk factors for coronary heart disease. N Engl J Med. 1989; 321: 641- 646. 2488072 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    High GI and GL diets were not significantly associated with CHD events in men.

    “High GI and GL diets were significantly associated with CHD events in women but not in men.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Neither Begg's nor Egger's tests revealed significant evidence of publication bias in the overall analyses of GI and GL (P>0.115 for all).

    “Neither Begg's nor Egger's tests revealed significant evidence of publication bias in the overall analyses of GI and GL (P>0.115 for all).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [39] Begg CB Mazumdar M Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994; 50: 1088- 1101. 7786990 source

      Not checked in the free run.

    • cites [40] Egger M Davey Smith G Schneider M Minder C Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997; 315: 629- 634. 9310563 PMC2127453 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    High GI and GL diets were significantly associated with CHD events in women.

    “High GI and GL diets were significantly associated with CHD events in women but not in men.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Blood pressure and CRP may be raised by high-GI diets and may contribute to increased CHD risk.

    “Other factors that in general may contribute to the increased CHD risk with high-GI diets are blood pressure and CRP, both of which may be raised by high-GI diets.52,55”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [52] Levitan EB Cook NR Stampfer MJ Ridker PM Rexrode KM Buring JE Manson JE Liu S Dietary glycemic index, dietary glycemic load, blood lipids, and C-reactive protein. Metabolism. 2008; 57: 437- 443. 18249220 PMC2262400 source

      Not checked in the free run.

    • cites [55] Liu S Manson JE Buring JE Stampfer MJ Willett WC Ridker PM Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 2002; 75: 492- 498. 11864854 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Because no studies have a time frame shorter than 6 years, it is not possible to determine whether the effect is early or later.

    “Because no studies have a time frame shorter than 6 years, it is not possible to determine whether the effect is early, possibly from alterations in clotting factors,60 or later due to reduction in the rate of atheroma formation secondary to oxidative damage.61”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [60] Jarvi AE Karlstrom BE Granfeldt YE Bjorck IE Asp NG Vessby BO Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low-glycemic index diet in type 2 diabetic patients. Diabetes Care. 1999; 22: 10- 18. 10333897 source

      Not checked in the free run.

    • cites [61] Hu Y Block G Norkus EP Morrow JD Dietrich M Hudes M Relations of glycemic index and glycemic load with plasma oxidative stress markers. Am J Clin Nutr. 2006; 84: 70- 76 quiz 266-267 16825683 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The GI and GL data were compiled from various data sources.

    “because of the time frame of published reports, the GI and GL data were still compiled from various data sources.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    The weaknesses of the present study include the limited number of studies, the inability to include potentially relevant studies because of lack of necessary data, and the heterogeneity in the overall analyses, especially in the likely underpowered analyses of men.

    “The weaknesses of the present study include the limited number of studies, the inability to include potentially relevant studies44,47 because of lack of necessary data, and the heterogeneity in the overall analyses, especially in the likely underpowered analyses of men.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [44] Hardy DS Hoelscher DM Aragaki C Stevens J Steffen LM Pankow JS Boerwinkle E Association of glycemic index and glycemic load with risk of incident coronary heart disease among whites and African Americans with and without type 2 diabetes: the Atherosclerosis Risk in Communities study. Ann Epidemiol. 2010; 20: 610- 616. 20609341 PMC3085981 source

      Not checked in the free run.

    • cites [47] Jakobsen MU Dethlefsen C Joensen AM Stegger J Tjonneland A Schmidt EB Overvad K Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index. Am J Clin Nutr. 2010; 91: 1764- 1768. 20375186 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The systematic review was strengthened by efforts to acquire as much data as possible by contacting all study authors to include all relevant studies.

    “We further believe that our systematic review was strengthened by our efforts to acquire as much data as possible by contacting all study authors to include all relevant studies in our analyses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Acarbose has been shown to prevent hypertension and CHD events in the STOP NIDDM trial.

    “Conversely, acarbose, the α-glucosidase inhibitor that converts dietary carbohydrate to a low glycemic index form, has been shown to prevent hypertension and CHD events in the STOP NIDDM trial.56”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Chiasson JL Josse RG Gomis R Hanefeld M Karasik A Laakso M STOP-NIDDM Trial Research Group. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA. 2003; 290: 486- 494. 12876091 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    An earlier meta-analysis concluded that low-GI diets were protective for diabetes, CHD, and colon and breast cancers.

    “An earlier meta-analysis that assessed the effect of dietary GI on several health outcomes including diabetes, CHD, and cancer also concluded that low-GI diets were protective for diabetes, CHD, and colon and breast cancers.62”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] Barclay AW Petocz P McMillan-Price J Flood VM Prvan T Mitchell P Brand-Miller JC Glycemic index, glycemic load, and chronic disease risk – a meta-analysis of observational studies. Am J Clin Nutr. 2008; 87: 627- 637. 18326601 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The use of random-effects models allowed assessment of heterogeneity to guide the sensitivity analyses.

    “The strength of our study included the use of random-effects models to allow assessment of heterogeneity to guide the sensitivity analyses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Meta-analyses of low-GI RCTs have shown beneficial effects on body weight and lipid profiles in obese and overweight subjects and on glycemic control in type 2 diabetic subjects.

    “In addition, meta-analyses of low-GI RCTs have shown beneficial effects on body weight and lipid profiles in obese and overweight subjects21 as well as on glycemic control in type 2 diabetic subjects.59”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [21] Thomas D Elliott E Baur L Low glycaemic index or low glycaemic load diets for overweight and obesity. Cochrane Database Syst Rev. 2007 CD005105 17636786 PMC9022192

      Not checked in the free run.

    • cites [59] Thomas D Elliott EJ Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database Syst Rev. 2009 CD006296 19160276 PMC6486008

      Not checked in the free run.

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  • The paper relies on this without support.

    Carbohydrates with differing physical form, particle size, chemical structure, and fiber content alter the rate of starch digestion and their physiological response.

    “Carbohydrates with differing physical form, particle size, chemical structure, and fiber content alter the rate of starch digestion and their physiological response.”

  • The paper relies on this without support.

    The observed associations between GI/GL and CHD in women reflect causal effects that would be modified by reducing GI/GL.

    “We conclude that a reduction in the glycemic index and glycemic load may favorably affect CHD outcomes in women.”
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Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • GL figure caption omits the Burger et al male cohort

    Minor

    The results text includes Burger et al (reference 36) among the male cohorts in the GL analysis, but Figure 3's list of studies contributing to the male subtotal omits it.

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Cites

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2 of the 67 references couldn’t be matched to a known paper.

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Authors
Mirrahimi, A., de Souza, R. J., Chiavaroli, L., Sievenpiper, J. L., Beyene, J., Hanley, A. J., Augustin, L. S. A., Kendall, C. W. C., & Jenkins, D. J. A.
Affiliations
  • St. Michael's Hospital (CA)
  • Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
  • University of Toronto (CA)
ORCID
Venue
Journal of the American Heart Association
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2012-09-26
Volume
1
Issue
5
Pages
e000752-e000752
ISSN
2047-9980 (ISSN-L)
DOI
10.1161/jaha.112.000752
PMC
PMC3541617
OpenAlex
W2170277419
Semantic Scholar
47eb7760657e667e37984e210aefe8411be10287
Cited by
161
References
67
Citations by year
2026: 3 · 2025: 4 · 2024: 10 · 2023: 8 · 2022: 13 · 2021: 10 · 2020: 13 · 2019: 11 · 2018: 12 · 2017: 16 · 2016: 17 · 2015: 11 · 2014: 25 · 2013: 7
FWCI
2.14
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Journal of the American Heart Association (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Keywords
glycemic index, glycemic load, coronary artery disease, cardiovascular risk, sex differences, prospective cohort
MeSH terms
Coronary Disease, Humans, Risk Factors, Incidence, Glycemic Index

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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