Abstract
BackgroundStudies on the association of stroke risk to dietary glycemic index (GI) and glycemic load (GL) have produced contrasting results.ObjectiveTo investigate the relation of dietary GI and GL to stroke risk in the large EPIC-Italy cohort (EPICOR) recruited from widely dispersed geographic areas of Italy.DesignWe studied 44099 participants (13,646 men and 30,453 women) who completed a dietary questionnaire. Multivariable Cox modeling estimated adjusted hazard ratios (HRs) of stroke with 95% confidence intervals (95%CI). Over 11 years of follow-up, 355 stroke cases (195 ischemic and 83 hemorrhagic) were identified.ResultsIncreasing carbohydrate intake was associated with increasing stroke risk (HR = 2.01, 95%CI = 1.04–3.86 highest vs. lowest quintile; p for trend 0.025). Increasing carbohydrate intake from high-GI foods was also significantly associated with increasing stroke risk (HR 1.87, 95%CI = 1.16–3.02 highest vs. lowest, p trend 0.008), while increasing carbohydrate intake from low-GI foods was not. Increasing GL was associated with significantly increasing stroke risk (HR 2.21, 95%CI = 1.16–4.20, highest vs. lowest; p trend 0.015). Dietary carbohydrate from high GI foods was associated with increased both ischemic stroke risk (highest vs. lowest HR 1.92, 95%CI = 1.01–3.66) and hemorrhagic stroke risk (highest vs. lowest HR 3.14, 95%CI = 1.09–9.04). GL was associated with increased both ischemic and hemorrhagic stroke risk (HR 1.44, 95%CI = 1.09–1.92 and HR 1.56, 95%CI = 1.01–2.41 respectively, continuous variable).ConclusionsIn this Italian cohort, high dietary GL and carbohydrate from high GI foods consumption increase overall risk of stroke.
Highlights
Hyperglycemia, insulin resistance and associated disorders of lipid metabolism are known to increase the risk of cardiovascular disease (CVD) and are known to be caused, at least in part, by diet [1]
Increasing carbohydrate intake from high-glycemic index (GI) foods was significantly associated with increasing stroke risk (HR 1.87, 95% confidence intervals (95%CI) = 1.16–3.02 highest vs. lowest, p trend 0.008), while increasing carbohydrate intake from low-GI foods was not
We have previously investigated the association of glycemic load (GL) and GI with risk of coronary heart disease (CHD) in the Italian European Prospective Investigation into Cancer and Nutrition (EPIC)-Italy cohort (EPICOR) cohort – a large cohort recruited from widely dispersed geographic areas of Italy
Summary
Hyperglycemia, insulin resistance and associated disorders of lipid metabolism (dyslipidemias) are known to increase the risk of cardiovascular disease (CVD) and are known to be caused, at least in part, by diet [1]. Carbohydrates vary markedly in physical form, chemical structure, particle size, and fiber content, and in their ability to increase postprandial blood glucose levels. The glycemic index (GI) of a food is a commonly used marker of postprandial blood glucose response [4]. Given that the amount of carbohydrate in a food (or overall diet) can vary and have a variable influence on the postprandial glycemic response, the glycemic load (GL) (product of the GI of a food item and its available carbohydrate content) is used as an estimator of the overall glycemic effect of the diet. Studies on the association of stroke risk to dietary glycemic index (GI) and glycemic load (GL) have produced contrasting results
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