Dietary Glycemic Index, Glycemic Load, and Risk of Coronary Heart Disease, Stroke, and Stroke Mortality: A Systematic Review with Meta-Analysis
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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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Harms of poor quality carbohydrates appear to be larger in women and others predisposed to insulin resistance and atherogenic dyslipidemia, and smaller in men and in younger, lean individuals with high physical activity.
“Harms appear to be larger in women89, 167 and others predisposed to insulin resistance and atherogenic dyslipidemia, and smaller in men and in younger, lean individuals with high physical activity.”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [167]
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- Authors
- Fan, J., Song, Y., Wang, Y., Hui, R., & Zhang, W.
- Affiliations
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Brigham and Women's Hospital (US)
- Corresponding author
- Zhang, Weili
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-12-20
- Volume
- 7
- Issue
- 12
- Pages
- e52182
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3527433
- OpenAlex
- W2048021590
- Cited by
- 148
- References
- 48
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 9 · 2023: 6 · 2022: 11 · 2021: 10 · 2020: 13 · 2019: 14 · 2018: 14 · 2017: 11 · 2016: 18 · 2015: 15 · 2014: 17 · 2013: 6
- FWCI
- 1.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- 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
- dietary glycemic index, glycemic load, coronary artery disease, stroke, stroke mortality, cardiovascular risk, sex differences, body mass index, obesity, overweight, dose-response relationship, dietary carbohydrates, glycemic control, glycemic variability
- MeSH terms
- Body Weight, Coronary Disease, Dietary Carbohydrates, Humans, Risk Factors, Sex Factors, Stroke, Glycemic Index
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