Glycemic index, glycemic load, and risk of coronary heart disease: A pan-European cohort study

Research output: Contribution to journalJournal articleResearchpeer-review

  • Sabina Sieri
  • Claudia Agnoli
  • Sara Grioni
  • Elisabete Weiderpass
  • Amalia Mattiello
  • Ivonne Sluijs
  • Maria Jose Sanchez
  • Marianne Uhre Jakobsen
  • Michael Sweeting
  • Yvonne T. van der Schouw
  • Lena Maria Nilsson
  • Patrik Wennberg
  • Verena A. Katzke
  • Tilman Kühn
  • Kim Overvad
  • Tammy Y.N. Tong
  • Moreno Iribas Conchi
  • José Ramón Quirós
  • Juan Manuel García-Torrecillas
  • Olatz Mokoroa
  • Jesús Humberto Gómez
  • Emiliy Sonestedt
  • Antonia Trichopoulou
  • Anna Karakatsani
  • Elissavet Valanou
  • Jolanda M.A. Boer
  • W. M. Monique Verschuren
  • Marie Christine Boutron-Ruault
  • Guy Fagherazzi
  • Anne Laure Madika
  • Manuela M. Bergmann
  • Matthias B. Schulze
  • Pietro Ferrari
  • Heinz Freisling
  • Hannah Lennon
  • Carlotta Sacerdote
  • Giovanna Masala
  • Rosario Tumino
  • Elio Riboli
  • Nicholas J. Wareham
  • John Danesh
  • Nita G. Forouhi
  • Adam S. Butterworth
  • Vittorio Krogh

Background: High carbohydrate intake raises blood triglycerides, glucose, and insulin; reduces HDLs; and may increase risk of coronary heart disease (CHD). Epidemiological studies indicate that high dietary glycemic index (GI) and glycemic load (GL) are associated with increased CHD risk. Objectives: The aim of this study was to determine whether dietary GI, GL, and available carbohydrates are associated with CHD risk in both sexes. Methods: This large prospective study-the European Prospective Investigation into Cancer and Nutrition-consisted of 338,325 participants who completed a dietary questionnaire. HRs with 95% CIs for a CHD event, in relation to intake of GI, GL, and carbohydrates, were estimated using covariate-adjusted Cox proportional hazard models. Results: After 12.8 y (median), 6378 participants had experienced a CHD event. High GL was associated with greater CHD risk [HR 1.16 (95% CI: 1.02, 1.31) highest vs. lowest quintile, p-trend 0.035; HR 1.18 (95% CI: 1.07, 1.29) per 50 g/day of GL intake]. The association between GL and CHD risk was evident in subjects with BMI (in kg/m2) =25 [HR: 1.22 (95% CI: 1.11, 1.35) per 50 g/d] but not in those with BMI <25 [HR: 1.09 (95% CI: 0.98, 1.22) per 50 g/d) (P-interaction = 0.022). The GL-CHD association did not differ between men [HR: 1.19 (95% CI: 1.08, 1.30) per 50 g/d] and women [HR: 1.22 (95% CI: 1.07, 1.40) per 50 g/d] (test for interaction not significant). GI was associated with CHD risk only in the continuous model [HR: 1.04 (95% CI: 1.00, 1.08) per 5 units/d]. High available carbohydrate was associated with greater CHD risk [HR: 1.11 (95% CI: 1.03, 1.18) per 50 g/d]. High sugar intake was associated with greater CHD risk [HR: 1.09 (95% CI: 1.02, 1.17) per 50 g/d]. Conclusions: This large pan-European study provides robust additional support for the hypothesis that a diet that induces a high glucose response is associated with greater CHD risk.

Original languageEnglish
JournalAmerican Journal of Clinical Nutrition
Issue number3
Pages (from-to)631-643
Number of pages13
Publication statusPublished - 2020

    Research areas

  • Cohort study, Coronary heart disease, EPIC study, EPIC-CVD study, Glycemic index, Glycemic load

ID: 252716822