Abstract
BackgroundThe relationship between dietary glycemic index, glycemic load and risk of coronary heart disease (CHD), stroke, and stroke-related mortality is inconsistent.MethodsWe 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.ResultsFifteen 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.ConclusionHigh 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.
Highlights
High carbohydrate intake has adverse effects on lipid and glucose metabolism [1,2,3], thereby creating potential worries to increase the risk of cardiovascular diseases [4]
In addition to exclusion of participants with known preexisting coronary heart disease (CHD) and stroke, all studies excluded those with diabetes at baseline except for the study by Mursu [13]
Our results showed that gender significantly modified the effects of dietary glycemic load (GL) and glycemic index (GI) on CHD risk, and high dietary GL and GI are positively associated with increased CHD risk in women but not in men
Summary
High carbohydrate intake has adverse effects on lipid and glucose metabolism [1,2,3], thereby creating potential worries to increase the risk of cardiovascular diseases [4]. In a study of Chinese Americans, participants who consumed a high-carbohydrate and low-fat diet had lower high density lipoprotein and total cholesterol concentrations compared with elderly Whites [8]. These characteristics were similar to those of urban populations in China, where hemorrhagic stroke is the major cause of cardiovascular disease [9]. The relationship between dietary glycemic index, glycemic load and risk of coronary heart disease (CHD), stroke, and stroke-related mortality is inconsistent
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