Dietary glycemic load and glycemic index and risk of coronary heart disease and stroke in Dutch men and women: the EPIC-MORGEN study.

Koert N J Burger,Daphne L Van Der A,Joline W J Beulens,Annemieke M W Spijkerman,Jolanda M A Boer,Andreas Schäfer

doi:10.1371/journal.pone.0025955

Koert N J Burger, Daphne L Van Der A + Show 4 more

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https://doi.org/10.1371/journal.pone.0025955

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Abstract

BackgroundThe associations of glycemic load (GL) and glycemic index (GI) with the risk of cardiovascular diseases (CVD) are not well-established, particularly in men, and may be modified by gender.ObjectiveTo assess whether high dietary GL and GI increase the risk of CVD in men and women.MethodsA large prospective cohort study (EPIC-MORGEN) was conducted within the general Dutch population among 8,855 men and 10,753 women, aged 21–64 years at baseline (1993–1997) and free of diabetes and CVD. Dietary intake was assessed with a validated food-frequency questionnaire and GI and GL were calculated using Foster-Powell's international table of GI. Information on morbidity and mortality was obtained through linkage with national registries. Cox proportional hazards analysis was performed to estimate hazard ratios (HRs) for incident coronary heart disease (CHD) and stroke, while adjusting for age, CVD risk factors, and dietary factors.ResultsDuring a mean follow-up of 11.9 years, 581 CHD cases and 120 stroke cases occurred among men, and 300 CHD cases and 109 stroke cases occurred among women. In men, GL was associated with an increased CHD risk (adjusted HR per SD increase, 1.17 [95% CI, 1.02–1.35]), while no significant association was found in women (1.09 [0.89–1.33]). GI was not associated with CHD risk in both genders, while it was associated with increased stroke risk in men (1.27 [1.02–1.58]) but not in women (0.96 [0.75–1.22]). Similarly, total carbohydrate intake and starch intake were associated with a higher CHD risk in men (1.23 [1.04–1.46]; and 1.24 [1.07–1.45]), but not in women.ConclusionAmong men, high GL and GI, and high carbohydrate and starch intake, were associated with increased risk of CVD.

Highlights

Cardiovascular diseases (CVD) are a major cause of death worldwide
Participants underwent a medical examination and filled in a general and food frequency questionnaire (FFQ). After exclusion of those who gave no consent to linkage with disease registries (n = 2097), who had a history of type 2 diabetes (n = 194) or cardiovascular diseases (CVD) (n = 526), had missing nutritional data (n = 62), and/or were ranked in the top or bottom 0.5% of the ratio of reported energy intake over estimated basal metabolic rate (BMR; n = 210), a total of 19,608 participants were eligible for analysis
glycemic index (GI) was associated with an increased stroke risk, while glycemic load (GL), carbohydrate and starch intake were associated with an increased coronary heart disease (CHD) risk

Summary

Introduction

Cardiovascular diseases (CVD) are a major cause of death worldwide. In Europe 54% of women and 43% of men die of CVD [1]. Hyperglycemia, insulin resistance, and associated disorders of lipid metabolism (hyperlipidemia) are key determinants of CVD, and these determinants are in turn influenced by diet [2,3]. High carbohydrate diets may promote hyperglycemia, and can raise fasting triacylglycerol and reduce HDL levels [4,5,6], which may eventually increase the risk of CVD. High carbohydrate diets may increase the risk of CVD. The associations of glycemic load (GL) and glycemic index (GI) with the risk of cardiovascular diseases (CVD) are not well-established, in men, and may be modified by gender

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