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Cited by 278Nutritional Studies and DietDiet, Metabolism, and DiseaseFood composition and properties

High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative

Open access
Gangwisch, James E, Hale, Lauren, Garcia, Lorena, Malaspina, Dolores, Opler, Mark G, Payne, Martha E, Rossom, Rebecca C, Lane, Dorothy·2015·The American Journal of Clinical Nutrition
DOI 10.3945/ajcn.114.103846PMC PMC4515860
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Abstract

Background The consumption of sweetened beverages, refined foods, and pastries has been shown to be associated with an increased risk of depression in longitudinal studies. However, any influence that refined carbohydrates has on mood could be commensurate with their proportion in the overall diet; studies are therefore needed that measure overall intakes of carbohydrate and sugar, glycemic index (GI), and glycemic load.Objective We hypothesized that higher dietary GI and glycemic load would be associated with greater odds of the prevalence and incidence of depression.Design This was a prospective cohort study to investigate the relations between dietary GI, glycemic load, and other carbohydrate measures (added sugars, total sugars, glucose, sucrose, lactose, fructose, starch, carbohydrate) and depression in postmenopausal women who participated in the Women's Health Initiative Observational Study at baseline between 1994 and 1998 (n = 87,618) and at the 3-y follow-up (n = 69,954).Results We found a progressively higher dietary GI to be associated with increasing odds of incident depression in fully adjusted models (OR for the fifth compared with first quintile: 1.22; 95% CI: 1.09, 1.37), with the trend being statistically significant (P = 0.0032). Progressively higher consumption of dietary added sugars was also associated with increasing odds of incident depression (OR for the fifth compared with first quintile: 1.23; 95% CI: 1.07, 1.41; P-trend = 0.0029). Higher consumption of lactose, fiber, nonjuice fruit, and vegetables was significantly associated with lower odds of incident depression, and nonwhole/refined grain consumption was associated with increased odds of depression.Conclusions The results from this study suggest that high-GI diets could be a risk factor for depression in postmenopausal women. Randomized trials should be undertaken to examine the question of whether diets rich in low-GI foods could serve as treatments and primary preventive measures for depression in postmenopausal women.

AI snapshot

Written from the paper’s full text.

TL;DR

In a large prospective cohort of postmenopausal women, higher dietary glycemic index and added-sugar intake were associated with greater odds of incident depression 3 years later. The authors conclude that high-GI diets could be a risk factor for depression and call for randomized trials of low-GI diets.

Key findings

  • Higher dietary GI was associated with increasing odds of incident depression in fully adjusted models: OR for fifth vs first quintile = 1.22 (95% CI: 1.09, 1.37), P-trend = 0.0032.
  • Higher added-sugar consumption was also associated with incident depression: OR for fifth vs first quintile = 1.23 (95% CI: 1.07, 1.41), P-trend = 0.0029.
  • Higher lactose, fiber, nonjuice fruit, and vegetable consumption was significantly associated with lower odds of incident depression; nonwhole/refined grain consumption was associated with increased odds.
  • No association was found between dietary glycemic load and depression incidence.

Methods

  • Prospective cohort study using Women’s Health Initiative Observational Study data: 87,618 postmenopausal women at baseline (1994–1998) for cross-sectional analyses and 69,954 at 3-year follow-up for longitudinal analyses after excluding baseline depression.
  • Dietary exposures were estimated from a 145-item WHI food-frequency questionnaire, including GI, glycemic load, added sugars, total sugars, glucose, sucrose, lactose, fructose, starch, and total carbohydrate.
  • Depression was assessed with the Burnam 8-item scale for depressive disorders at baseline and 3 years; multivariable logistic regression calculated ORs with sequential adjustment models and tests for linear trend.

Limitations

  • The paper states dietary exposures and covariates were measured by FFQ rather than biomarkers or food records, and depression was assessed by self-reported symptoms rather than psychiatric interviews.
  • The paper notes potential residual confounding from unmeasured confounders and that the sample was entirely postmenopausal women, limiting generalizability.
  • Evident from the text: the observational design cannot establish causality, and the authors explicitly state that randomized trials should be undertaken.

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

Integrity signals

Registry

Crossref · 10.3945/ajcn.114.103846

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 22 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    After full adjustment, dietary glycemic load was not significantly associated with prevalent depression at baseline (P-trend=0.3951).

    “P-trend | | | 0.7789 | 0.0598 | 0.3951”
    Quote in the paperSubstantial claim
  • Findingown data

    Higher consumption of nonwhole/refined grains is associated with increased odds of incident depression.

    “A higher consumption of nonwhole/refined grains was associated with higher incidence of depression, with participants in the fifth quintile being significantly more likely to have depression incidence.”
    Quote in the paperSubstantial claim
  • Findingown data

    Higher consumption of vegetables is significantly associated with lower odds of incident depression in fully adjusted models.

    “Participants in the third, fourth, and fifth quintiles for nonjuice fruit and for vegetables were significantly less likely to have depression incidence in fully adjusted models.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Higher consumption of lactose is significantly associated with lower odds of incident depression.

    “The odds of the incidence of depression decreased with higher amounts of dietary lactose consumption, and the trends were significant.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The fifth quintiles for fiber, non-whole grains, fruit, and vegetables remained significant after controlling false discovery rate at 0.15 using the Benjamini-Hochberg procedure.

    “The fifth quintiles for fiber, non-whole grains, fruit, and vegetables continued to be significant after the false discovery rate of 0.15 was controlled for by using the Benjamini-Hochberg procedure.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 13
  • The quote only partly states this claim. 3
  • Classified as probably not a substantial claim. 7

  • May combine two claims.

    Findingown data

    Progressively increasing consumption of whole grains was associated with lower depression incidence, but these relations became nonsignificant in the fully adjusted model.

    “Progressively increasing consumption of whole grains was associated with lower depression incidence, but these relations became nonsignificant in the fully adjusted model.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the Women's Health Initiative cohort, higher dietary glycemic index was associated with higher odds of incident depression 3 years later after full adjustment (model 3), with a significant trend (P=0.0032) and fifth versus first quintile OR 1.22 (95% CI 1.09, 1.37).

    “Fifth quintile | 56.3 | 1123 | 1.42 (1.29, 1.55) 1.24 (1.12, 1.37) 1.22 (1.09, 1.37)”
    • Also stated in: § DISCUSSION · plain
      “P-trend | | | ,0.0001 | ,0.0001 | 0.0032”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The relation between depression and glycemic load was U-shaped in energy-adjusted model 1, with the second, third, and fourth quintiles significantly less likely to have depression than the first.

    “The relation between depression and glycemic load was U-shaped in energy-adjusted results (model 1), with participants whose dietary glycemic loads were in the second, third, and fourth quintiles being significantly less likely to have depression than participants in the first quintile.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    As consumption of fruit and vegetables increased, the odds of depression incidence 3 years later decreased, with significant trends.

    “As consumption of fruit and vegetables increased, the odds of depression incidence 3 y later decreased, with the trends being significant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Tests for trend were significant for GI in cross-sectional models 1 and 2 but not model 3 or any glycemic load models.

    “Tests for trend were significant for models 1 and 2 for GI but not for model 3 or any of the glycemic load models.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The cross-sectional association between dietary GI and depression was attenuated after adjustment for model 2 covariates, with only the fifth quintile remaining significant, and further attenuated in model 3 so the fifth quintile was no longer significant.

    “The inclusion of the variables in model 2 attenuated the associations, with the result that only the fifth quintile for both GI and glycemic load was significantly associated with depression.The inclusion of the covariates that directly affect average GI in model 3 further attenuated the results, with the fifth quintile no longer being significant.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Higher whole grain intake was associated with lower odds of incident depression 3 years later after model 2 adjustment (P-trend=0.0166).

    “P-trend | | | ,0.0001 | 0.0166”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Higher nonjuice fruit intake was associated with lower odds of incident depression 3 years later after model 2 adjustment (P-trend=0.0247; fifth versus first quintile OR 0.88, 95% CI 0.79, 0.99).

    “Fifth quintile | 2.338 | 775 | 0.63 (0.58, 0.70) | 0.88 (0.79, 0.99)”
    • Also stated in: § DISCUSSION · plain
      “P-trend | | | ,0.0001 | 0.0247”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Findingown data

    Nuts/seeds intake was not significantly associated with incident depression 3 years later after model 2 adjustment (P-trend=0.1530).

    “P-trend | | | 0.0097 | 0.1530”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Foods such as potatoes, bread, and rice can have enough protein to blunt or prevent increases in tryptophan concentrations.

    “foods such as potatoes, bread, and rice can have enough protein to blunt or prevent increases in tryptophan concentrations.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Of the 7 most commonly consumed fruits in the United States, 4 have low GIs, 2 have intermediate GIs, and only one has a high GI.

    “Although the GIs of fruit vary, of the 7 most commonly consumed fruit in the United States, 4 have low GIs (apples, strawberries, oranges, and peaches), 2 have intermediate GIs (ripe bananas and grapes), and only one has a high GI (watermelon) (24).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] USDA; Economic Research Service. Food availability per capita data system [updated 20 Aug 2012]. [cited 2015 Jun 5]. Available from: http://www.ers.usda.gov/data-products/chart-gallery/detail.aspx?chartId=30486

      Not checked in the free run.

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

    Premisecitation

    Carbohydrate intake has been theorized to facilitate the synthesis of serotonin in the brain.

    “Carbohydrate intake has also been theorized to facilitate the synthesis of serotonin in the brain (27).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Wurtman, 1995, Brain serotonin, carbohydrate-craving, obesity and depression, Obes Res source

      Not checked in the free run.

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

    Study design and conductown data

    The study controlled for a false discovery rate of 0.15 using the Benjamini-Hochberg procedure in post hoc analyses.

    “We controlled for a false discovery rate of 0.15 using the Benjamini-Hochberg procedure in post hoc analyses where we examined the association between the consumption of dietary fiber and specific foods (whole grains, nonwhole/refined grains, nonjuice fruit, vegetables, nuts/seeds, and legumes) and depression incidence (23).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Benjamini, 1995, Controlling the false discovery rate: a practical and powerful approach to multiple testing, J R Stat Soc Series B source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    Any misclassification of exposure or outcome would have been random, resulting in nondifferential misclassification and bias toward the null.

    “However, we would expect that any misclassification of exposure or outcome would have been random, resulting in nondifferential misclassification, which usually leads to bias toward the null hypothesis (42).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Rothman, 1998

      Not checked in the free run.

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

    Interpretationreasoning

    A relatively low GI could be one of the attributes of fruit that contributes toward their association with lower odds for depression.

    “A relatively low GI could be one of the attributes of fruit that contributes toward their association with lower odds for depression.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Experimental studies found random assignment to diets with higher glycemic load and carbohydrate content to have negative effects on mood, but these studies had small sample sizes.

    “A number of experimental studies found random assignment to diets with a higher glycemic load and carbohydrate content to have negative effects on mood (9)(10)(11), but a limitation of these studies is their small sample sizes.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [9] Micha, 2011, Glycaemic index and glycaemic load of breakfast predict cognitive function and mood in school children: a randomized controlled trial, Br J Nutr source

      Not checked in the free run.

    • cites [10] Cheatham, 2009, Long-term effects of providing low and high glycemic load energy diets on mood and cognition, Physiol Behav source

      Not checked in the free run.

    • cites [11] Nabb, 2006, The effect of the interaction between glucose tolerance and breakfasts varying in carbohydrate and fibre on mood and cognition, Nutr Neurosci source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The high consumption of refined starches and sugars is a risk factor for inflammation and cardiovascular disease, and these conditions have been implicated in the pathogenesis of depression.

    “The high consumption of refined starches and sugars is a risk factor for inflammation and cardiovascular disease (31), and these conditions have been implicated in the pathogenesis of depression (32).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [31] Lopez-Garcia, 2004, Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction, Am J Clin Nutr source

      Not checked in the free run.

    • cites [32] Rumsfeld, 2005, Depression and cardiovascular disease: a call for recognition, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Counterregulatory hormone responses can cause anxiety, irritability, and hunger, and neuroglycopenia can cause cognitive impairment, mood and behavioral changes, and fatigue.

    “Counterregulatory hormone responses can cause symptoms such as anxiety, irritability, and hunger, whereas manifestations of neuroglycopenia can include cognitive impairment, mood and behavioral changes, and fatigue (39).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Alsahli, 2013, Hypoglycemia, Endocrinol Metab Clin North Am source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The consumption of high-GI diets could lead to insulin resistance, which has been associated with volumetric and neurocognitive deficits similar to those in major depression.

    “The consumption of high-GI diets could also lead to insulin resistance (33), which has been associated with a pattern of volumetric and neurocognitive deficits that are highly similar to those reported in individuals suffering from major depression (34).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [33] McKeown, 2004, Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort, Diabetes Care source

      Not checked in the free run.

    • cites [34] McIntyre, 2010, Brain volume abnormalities and neurocognitive deficits in diabetes mellitus: points of pathophysiological commonality with mood disorders?, Adv Ther source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Depressive symptoms were measured with the Burnam 8-item scale using a standard threshold of 0.06 to identify women with symptoms consistent with depressive disorders such as major depression and dysthymia.

    “A standard threshold of 0.06 was used to identify women who experienced symptoms consistent with depressive disorders such as major depression and dysthymia (21).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Burnam, 1988, Development of a brief screening instrument for detecting depressive disorders, Med Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    For carbohydrate intake to increase tryptophan, the meal must be entirely carbohydrate and consumed without protein in the gut; as little as 2.5% protein blunts the increase and 5% protein prevents tryptophan increase.

    “However, for this process to occur, the meal must be made up entirely of carbohydrate and consumed without any protein remaining in the gut.If the meal contains as little as 2.5% protein, the increase in tryptophan will be blunted; and if the meal contains as little as 5% protein, then tryptophan concentrations will not increase (30).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Yokogoshi, 1986, Meal composition and plasma amino acid ratio: effect of various proteins or carbohydrates and of various protein concentrations, Metabolism source

      Not checked in the free run.

21 of 21

  • The paper relies on this without support.

    The relation between depression and carbohydrate consumption is likely bidirectional.

    “However, the relation between depression and carbohydrate consumption is likely to be bidirectional, so associations in cross-sectional studies do not provide evidence of causality.”

  • The paper relies on this without support.

    Any influence that refined carbohydrates has on mood is likely commensurate with the proportion they constitute in the overall diet.

    “However, any influence that refined carbohydrates has on mood is likely commensurate with the proportion they constitute in the overall diet, so a limitation of these studies is that they examined only specific types of refined foods, as opposed to dietary GI and glycemic load in the overall diet.”

  • The paper relies on this without support.

    Longitudinal epidemiologic studies have larger sample sizes that allow control of more factors.

    “Longitudinal epidemiologic studies have larger sample sizes that allow control of more factors.”

  • The paper relies on this without support.

    The food source of sugar influences the GI, with higher fiber content slowing the metabolism of carbohydrate and lowering the GI.

    “The food source of sugar influences the GI, with higher fiber content slowing the metabolism of carbohydrate and lowering the GI.”

  • The paper relies on this without support.

    Starches are complex carbohydrates, but some sources have high GI, whereas others rich in fiber have low GI.

    “Starches are complex carbohydrates, but some sources, such as refined white bread and boiled potatoes, have a high GI, whereas others that are rich in fiber, such as legumes, nuts/seeds, and yams, have a low GI.”
5 of 5

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?

  • Data from longitudinal research show an association between progressively higher dietary glycaemic index and the incidence of depressive symptoms.

    “data from longitudinal research show an association between progressively higher dietary glycaemic index and the incidence of depressive symptoms.6”

    From Food and mood: How do diet and nutrition affect mental wellbeing? (2020) · cites this paper as [6]

  • Diets with a high glycaemic index and load may have a detrimental effect on psychological wellbeing.

    “As well as the physical health risks, diets with a high glycaemic index and load (eg, diets containing high amounts of refined carbohydrates and sugars) may also have a detrimental effect on psychological wellbeing”

    From Food and mood: How do diet and nutrition affect mental wellbeing? (2020) · cites this paper as [6]

The citation lists haven’t been fetched yet

References 38 · Cited by 278

Authors
Gangwisch, J. E., Hale, L., Garcia, L., Malaspina, D., Opler, M. G., Payne, M. E., Rossom, R. C., & Lane, D.
Affiliations
  • Columbia University (US)
  • Stony Brook Medicine (US)
  • NYU Langone Health (US)
  • Duke University (US)
  • University of Minnesota (US)
Corresponding author
Gangwisch, James E
ORCID
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2015-08
Volume
102
Issue
2
Pages
454-463
ISSN
0002-9165 (ISSN-L)
DOI
10.3945/ajcn.114.103846
PMC
PMC4515860
OpenAlex
W2147938755
Cited by
278
References
38
Citations by year
2026: 16 · 2025: 37 · 2024: 42 · 2023: 28 · 2022: 31 · 2021: 26 · 2020: 26 · 2019: 19 · 2018: 30 · 2017: 9 · 2016: 11 · 2015: 3
FWCI
18.95
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Clinical Nutrition (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Heart, Lung, and Blood Institute (N01WH22110, 24152, 32100-2, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, 44221)
  • NIH (N01WH22110, 24152, 32100-2, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, 44221)
  • US Department of Health and Human Services (N01WH22110, 24152, 32100-2, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, 44221)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
  • Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
Keywords
glycemic index, glycemic load, depression, postmenopausal women, added sugars, dietary carbohydrates, refined grains, dietary fiber intake, fruit and vegetable intake, Women's Health Initiative
MeSH terms
Aged, Aging, Cross-Sectional Studies, Depression, Diet, Dietary Carbohydrates, Female, Humans, Longitudinal Studies, Middle Aged, Psychiatric Status Rating Scales, Surveys and Questionnaires, Risk Factors, United States, Cohort Studies, Incidence, Prevalence, Postmenopause, Glycemic Index, Nutritive Sweeteners

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