The role of glycemic index and glycemic load in cardiovascular disease and its risk factors: A review of the recent literature

Current Atherosclerosis Reports

Volumn 16, Issue 1, 2014, Pages

  Mirrahimi, Arash ^a,b,c   Chiavaroli, Laura ^a,b   Srichaikul, Korbua ^a,b,d   Augustin, Livia S A ^a,b   Sievenpiper, John L ^a,e   Kendall, Cyril W C ^a,b,f   Jenkins, David J A ^a,b,g  

^a ST MICHAEL'S HOSPITAL   (Canada)

^b UNIVERSITY OF TORONTO   (Canada)

^c QUEEN S UNIVERSITY   (Canada)

^d UNIVERSITY OF OTTAWA   (Canada)

^e MCMASTER UNIVERSITY   (Canada)

^f UNIVERSITY OF SASKATCHEWAN   (Canada)

^g ST MICHAEL'S HOSPITAL   (Canada)

Author keywords

Cardiovascular disease risk; Glycemic index; Glycemic load; Review

Indexed keywords

ANIMAL; CARDIOVASCULAR DISEASE; GLUCOSE BLOOD LEVEL; GLYCEMIC INDEX; HUMAN; METABOLISM; PHYSIOLOGY; REVIEW; RISK FACTOR; SEX DIFFERENCE;

ANIMALS; BLOOD GLUCOSE; CARDIOVASCULAR DISEASES; GLYCEMIC INDEX; HUMANS; RISK FACTORS; SEX FACTORS;

EID: 84887898289     PISSN: 15233804     EISSN: 15346242     Source Type: Journal    
DOI: 10.1007/s11883-013-0381-1     Document Type: Review

References (81)

1. Ceriello A, Davidson J, Hanefeld M, et al. Postprandial hyperglycaemia and cardiovascular complications of diabetes: an update. Nut Metab Cardiov Diseas. 2006;16:453-6.
2. Hanefeld M, Pistrosch F, Koehler C, Chiasson JL. Conversion of IGT to type 2 diabetes mellitus is associated with incident cases of hypertension: a post-hoc analysis of the STOP-NIDDM trial. J Hypert. 2012;30:1440-3.
3. Leiter LA, Ceriello A, Davidson JA. Postprandial glucose regulation: new data and new implications. Clin Therap. 2005;27(B):S42-56.
4. Raz I, Ceriello A, Wilson PW, et al. Post hoc subgroup analysis of the HEART2D trial demonstrates lower cardiovascular risk in older patients targeting postprandial versus fasting/premeal glycemia. Diab Care. 2011;34:1511-3.
5. Bhat SL, Abbasi FA, Blasey C, Reaven GM, Kim SH. Beyond fasting plasma glucose: The association between coronary heart disease risk and postprandial glucose, postprandial insulin and insulin resistance in healthy, nondiabetic adults. Metabolism: clinical and experimental 2013.
6. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA. 2003;290:486-94.
7. Monnier L, Mas E, Ginet C, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006;295:1681-7.
8. Okada K, Furusyo N, Murata M, Sawayama Y, Kainuma M, Hayashi J. A hypertriglyceridemic state increases high sensitivity C-reactive protein of Japanese men with normal glucose tolerance. Endocrine. 2012;41:96-102.
9. Ceriello A. Postprandial hyperglycemia and diabetes complications: is it time to treat? Diabetes. 2005;54:1-7.
10. Singer DE, Nathan DM, Anderson KM, Wilson PW, Evans JC. Association of HbA1c with prevalent cardiovascular disease in the original cohort of the Framingham Heart Study. Diabetes. 1992;41:202-8.
11. Brouns F, Bjorck I, Frayn KN, et al. Glycaemic index methodology. Nutr Res Rev. 2005;18:145-71.
12. Standardization IOf. Food products - Determination of the glycaemic index (GI) and recommendation for food classification. ISO 26642:2010 ed, 2010.
13. Dong JY, Zhang YH, Wang P, Qin LQ. Meta-analysis of dietary glycemic load and glycemic index in relation to risk of coronary heart disease. Am J Cardiol. 2012;109:1608-13.
14. Mirrahimi A, de Souza RJ, Chiavaroli L, et al. Associations of glycemic index and load with coronary heart disease events: a systematic review and meta-analysis of prospective cohorts. J Amer Heart Assoc. 2012;1:e000752.
15. •• Fan J, Song Y, Wang Y, Hui R, Zhang W. Dietary glycemic index, glycemic load, and risk of coronary heart disease, stroke, and stroke mortality: a systematic review with meta-analysis. PloS One. 2012;7:e52182. A meta-analysis of 15 observational studies with 438,073 participants assessing the association between dietary GI and GL and CVD risk (CHD and Stroke). GI and GL were significantly associated with risk of CHD in women, but not in men. GI and GL were most significantly associated with CHD in participants with higher BMI. High dietary GL, but not GI, was associated with higher incidence of stroke. A dose-response relationship was found for the association between GL and CHD incidence.
16. Beulens JW, de Bruijne LM, Stolk RP, et al. High dietary glycemic load and glycemic index increase risk of cardiovascular disease among middle-aged women: a population-based follow-up study. J Am Coll Cardiol. 2007;50:14-21.
17. Burger KN, Beulens JW, Boer JM, Spijkerman AM, van der AD. Dietary glycemic load and glycemic index and risk of coronary heart disease and stroke in Dutch men and women: the EPIC-MORGEN study. PloS One. 2011;6:e25955.
18. Grau K, Tetens I, Bjornsbo KS, Heitman BL. Overall glycaemic index and glycaemic load of habitual diet and risk of heart disease. Public Health Nutr. 2011;14:109-18.
19. Halton TL, Willett WC, Liu S, et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355:1991-2002.
20. Levitan EB, Mittleman MA, Hakansson N, Wolk A. Dietary glycemic index, dietary glycemic load, and cardiovascular disease in middle-aged and older Swedish men. Amer J Clin Nut. 2007;85:1521-6.
21. Levitan EB, Mittleman MA, Wolk A. Dietary glycemic index, dietary glycemic load, and incidence of heart failure events: a prospective study of middle-aged and elderly women. J Am Coll Nutr. 2010;29:65-71.
22. Liu S, Willett WC, Stampfer MJ, et al. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Amer J Clin Nut. 2000;71:1455-61.
23. Mursu J, Virtanen JK, Rissanen TH, et al. Glycemic index, glycemic load, and the risk of acute myocardial infarction in Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Nut Metab Cardiov Diseas. 2011;21:144-9.
24. Sieri S, Krogh V, Berrino F, et al. Dietary glycemic load and index and risk of coronary heart disease in a large italian cohort: the EPICOR study. Arch Inter Med. 2010;170:640-7.
25. van Dam RM, Visscher AW, Feskens EJ, Verhoef P, Kromhout D. Dietary glycemic index in relation to metabolic risk factors and incidence of coronary heart disease: the Zutphen Elderly Study. Eur J Clin Nutr. 2000;54:726-31.
26. Oh K, Hu FB, Cho E, et al. Carbohydrate intake, glycemic index, glycemic load, and dietary fiber in relation to risk of stroke in women. Am J Epidemiol. 2005;161:161-9.
27. Kaushik S, Wang JJ, Wong TY, et al. Glycemic index, retinal vascular caliber, and stroke mortality. Stroke; J Cereb Circul. 2009;40:206-12.
28. Hardy DS, Hoelscher DM, Aragaki C, et al. Association of glycemic index and glycemic load with risk of incident coronary heart disease among Whites and African Americans with and without type 2 diabetes: the Atherosclerosis Risk in Communities study. Ann Epidemiol. 2010;20:610-6.
29. Oba S, Nagata C, Nakamura K, et al. Dietary glycemic index, glycemic load, and intake of carbohydrate and rice in relation to risk of mortality from stroke and its subtypes in Japanese men and women. Metab: Clin Experim. 2010;59:1574-82.
30. Pierucci P, Misciagna G, Ventura MT, et al. Diet and myocardial infarction: a nested case-control study in a cohort of elderly subjects in a Mediterranean area of southern Italy. Nut Metab Cardiov Disease. 2012;22:727-33.
31. Jakobsen MU, Dethlefsen C, Joensen AM, et al. Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index. Amer J Clin Nut. 2010;91:1764-8.
32. •• Sieri S, Brighenti F, Agnoli C, et al. Dietary glycemic load and glycemic index and risk of cerebrovascular disease in the EPICOR cohort. PloS One. 2013;8:e62625. A prospective cohort of 44,099 participants (13,646 men and 30,453 women) who completed a dietary questionnaire. In the combined multivariate adjusted analysis of men and women, carbohydrate intake from high-GI foods was associated with an increased risk of stroke, while carbohydrate intake from low-GI foods was not. Increasing GL was associated with significantly increasing risk of stroke.
33. •• Simila ME, Kontto JP, Mannisto S, Valsta LM, Virtamo J. Glycaemic index, carbohydrate substitution for fat and risk of CHD in men. The British journal of nutrition 2013:1-8. A prospective cohort of 21,955 male smokers from a cancer prevention intervention study (the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study), aged 50-69 years, was followed for 19 years with 4,379 CHD cases identified from national registers. Dietary GI was inversely associated with CHD risk in multivariate analysis relative risk, and the replacement of higher-GI carbohydrates with lower-GI carbohydrates was not associated with the risk.
34. Zhang Z, Lanza E, Kris-Etherton PM, et al. A high legume low glycemic index diet improves serum lipid profiles in men. Lipids. 2010;45:765-75.
35. Fleming P, Godwin M. Low-glycaemic index diets in the management of blood lipids: a systematic review and meta-analysis. Family practice 2013.
36. •• Goff LM, Cowland DE, Hooper L, Frost GS. Low glycaemic index diets and blood lipids: a systematic review and meta-analysis of randomised controlled trials. Nut Metab Cardiov Diseas. 2013;23:1-10. A meta-analysis of 28 randomized controlled trials with 1,272 participants comparing low- with high-GI diets over ≥4 weeks. Low-GI diets significantly reduced total and LDL-cholesterol independently of weight loss. Using subgroup analyses, reductions in LDL-C were shown to be greatest in studies with shorter duration and those with greatest GI reductions. There were no effects on HDL-cholesterol or triglycerides.
37. Jenkins DJ, Kendall CW, McKeown-Eyssen G, et al. Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial. JAMA. 2008;300:2742-53.
38. Jenkins DJ, Kendall CW, Augustin LS, et al. Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. 2012;172:1653-60.
39. Wolever TM, Gibbs AL, Mehling C, et al. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Amer J Clin Nut. 2008;87:114-25.
40. Jarvi AE, Karlstrom BE, Granfeldt YE, Bjorck IE, Asp NG, Vessby BO. Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low-glycemic index diet in type 2 diabetic patients. Diab Care. 1999;22:10-8.
41. Kristo AS, Matthan NR, Lichtenstein AH. Effect of diets differing in glycemic index and glycemic load on cardiovascular risk factors: review of randomized controlled-feeding trials. Nutrients. 2013;5:1071-80.
42. •• Schwingshackl L, Hoffmann G. Long-term effects of low glycemic index/load vs. high glycemic index/load diets on parameters of obesity and obesity-associated risks: a systematic review and meta-analysis. Nut Metab Cardiov Diseas. 2013;23:699-706. A meta-analysis of the long-term (≥ 6 months) effects of GI and GL interventions in the management of obesity. Fourteen studies (n=1,734) were included in the primary meta-analysis. Weighted-mean differences in change of C-reactive protein, fasting insulin, and fat-free mass were significantly more pronounced following low GL/GI diets. No significant changes were observed for blood lipids, anthropometric measures, HbA1c and fasting glucose.
43. Livesey G, Taylor R, Hulshof T, Howlett J. Glycemic response and health-a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes. Amer J Clin Nut. 2008;87:258S-68S.
44. Thomas DE, Elliott EJ. The use of low-glycaemic index diets in diabetes control. Brit J Nut. 2010;104:797-802.
45. Brand-Miller J, Hayne S, Petocz P, Colagiuri S. Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diab Care. 2003;26:2261-7.
46. Ajala O, English P, Pinkney J. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Amer J Clin Nut. 2013;97:505-16.
47. •• Livesey G, Taylor R, Livesey H, Liu S. Is there a dose-response relation of dietary glycemic load to risk of type 2 diabetes? Meta-analysis of prospective cohort studies. Amer J Clin Nut. 2013;97:584-96. A meta-analysis of 24 prospective cohort studies with 7.5 million person-years of follow-up, demonstrating a significant dose-response relationship between GL and risk of type-2 diabetes. A meta-analysis model adjusted for sex, dietary instrument validity, follow-up duration, and ethnicity showed a 45 % increase in the risk of developing type-2 diabetes for a 100-g increment in GL.
48. Larsen TM, Dalskov SM, van Baak M, et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med. 2010;363:2102-13.
49. Thomas DE, Elliott EJ, Baur L. Low glycaemic index or low glycaemic load diets for overweight and obesity. The Cochrane database of systematic reviews 2007:CD005105.
50. Mirza NM, Palmer MG, Sinclair KB, et al. Effects of a low glycemic load or a low-fat dietary intervention on body weight in obese Hispanic American children and adolescents: a randomized controlled trial. Amer J Clin Nut. 2013;97:276-85.
51. Rouhani MH, Salehi-Abargouei A, Azadbakht L. Effect of glycemic index and glycemic load on energy intake in children. Nutrition. 2013;29:1100-5.
52. Bazzano LA, Thompson AM, Tees MT, Nguyen CH, Winham DM. Non-soy legume consumption lowers cholesterol levels: a meta-analysis of randomized controlled trials. Nut Metab Cardiov Diseas. 2011;21:94-103.
53. Jayalath VH, de Souza RJ, Sievenpiper JL et al. Effect of Dietary Pulses on Blood Pressure: A Systematic Review and Meta-analysis of Controlled Feeding Trials. American Journal of Hypertension 2013.
54. Sievenpiper JL, Kendall CW, Esfahani A, et al. Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomised controlled experimental trials in people with and without diabetes. Diabetologia. 2009;52:1479-95.
55. Jenkins DJ, Srichaikul K, Kendall CW, et al. The relation of low glycaemic index fruit consumption to glycaemic control and risk factors for coronary heart disease in type 2 diabetes. Diabetologia. 2011;54:271-9.
56. Wolever TM, Gibbs AL, Chiasson JL, et al. Altering source or amount of dietary carbohydrate has acute and chronic effects on postprandial glucose and triglycerides in type 2 diabetes: Canadian trial of Carbohydrates in Diabetes (CCD). Nut Metab Cardiov Diseas. 2013;23:227-34.
57. Afaghi A, Ziaee A, Afaghi M. Effect of low-glycemic load diet on changes in cardiovascular risk factors in poorly controlled diabetic patients. Ind J Endocrinol Metab. 2012;16:991-5.
58. Lin PH, Chen C, Young DR et al. Glycemic index and glycemic load are associated with some cardiovascular risk factors among the PREMIER study participants. Food & nutrition research 2012;56.
59. Jebb SA, Lovegrove JA, Griffin BA, et al. Effect of changing the amount and type of fat and carbohydrate on insulin sensitivity and cardiovascular risk: the RISCK (Reading, Imperial, Surrey, Cambridge, and Kings) trial. Amer J Clin Nut. 2010;92:748-58.
60. Shikany JM, Tinker LF, Neuhouser ML, et al. Association of glycemic load with cardiovascular disease risk factors: the Women's Health Initiative Observational Study. Nutrition. 2010;26:641-7.
61. Hosseinpour-Niazi S, Sohrab G, Asghari G, Mirmiran P, Moslehi N, Azizi F. Dietary glycemic index, glycemic load, and cardiovascular disease risk factors: Tehran Lipid and Glucose Study. Arch Iran Med. 2013;16:401-7.
62. Murakami K, McCaffrey TA, Livingstone MB. Dietary glycaemic index and glycaemic load in relation to food and nutrient intake and indices of body fatness in British children and adolescents. The British Journal of Nutrition 2013:1-12.
63. Murakami K, McCaffrey TA, Livingstone MB. Associations of dietary glycaemic index and glycaemic load with food and nutrient intake and general and central obesity in British adults. The British Journal of Nutrition 2013:1-11.
64. Parillo M, Licenziati MR, Vacca M, De Marco D, Iannuzzi A. Metabolic changes after a hypocaloric, low-glycemic-index diet in obese children. J Endocrinol Investig. 2012;35:629-33.
65. Visek J, Lacigova S, Cechurova D, Rusavy Z. Comparison of a low-glycemic index vs standard diabetic diet. Olomouc: Biomedical papers of the Medical Faculty of the University Palacky; 2012.
66. Shyam S, Arshad F, Abdul Ghani R, et al. Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: a six months randomized trial. Nutr J. 2013;12:68.
67. Barr S, Reeves S, Sharp K, Jeanes YM. An Isocaloric Low Glycemic Index Diet Improves Insulin Sensitivity in Women With Polycystic Ovary Syndrome. Journal of the Academy of Nutrition and Dietetics 2013.
68. Mekary RA, Rimm EB, Giovannucci E, et al. Joint association of glycemic load and alcohol intake with type 2 diabetes incidence in women. Amer J Clin Nut. 2011;94:1525-32.
69. Rossi M, Turati F, Lagiou P et al. Mediterranean diet and glycaemic load in relation to incidence of type 2 diabetes: results from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC). Diabetologia 2013.
70. •• Lennerz BS, Alsop DC, Holsen LM, et al. Effects of dietary glycemic index on brain regions related to reward and craving in men. Amer J Clin Nut. 2013;98:641-7. A randomized, blinded, crossover trial of 12 overweight or obese men (18-35 y) assigned to either a high- and low-GI meals controlled for calories, macronutrients, and palatability on two occasions. Cerebral blood flow was measured using arterial spin-labeling fMRI 4 hours after meals. Reported hunger was greater 4 h after the high- vs. the low-GI meal (P=0.04). At this time, the high-GI meal elicited greater brain activity (P = 0.0006 with adjustment for multiple comparisons) in the areas associated with reward and craving in the late postprandial period, a time with important implications to eating behavior at the next meal.
71. •• Bullo M, Casas R, Portillo MP, et al. Dietary glycemic index/load and peripheral adipokines and inflammatory markers in elderly subjects at high cardiovascular risk. Nut Metab Cardiov Diseas. 2013;23:443-50. A randomized trial of 181 overweight and obese adults (age 30-65), with one or more component of metabolic syndrome, assessing the effect of hypocaloric diets (low-fat vs. low-GI) on inflammatory markers over 3 months. No treatment differences were observed in adipokines, markers of inflammation and clotting factors. With considerable and comparable fat mass loss (4.4 % on low-fat vs. 4.9 % on low-GI) in a short-term study, changes in markers of inflammation may be more difficult to distinguish as significantly different.
72. •• Buscemi S, Cosentino L, Rosafio G, et al. Effects of hypocaloric diets with different glycemic indexes on endothelial function and glycemic variability in overweight and in obese adult patients at increased cardiovascular risk. Clin Nutr. 2013;32:346-52. A clinical trial of 40 obese participants without diabetes randomly assigned to a 3-month treatment of either a low-glycemic index or high-glycemic index hypocaloric diet, otherwise comparable. No significant treatment difference was observed in the 48-h measures of glycemia. Endothelial function was measured as flow-mediated dilatation (FMD) of the brachial artery, and despite comparable weight loss in both groups, dietary GI significantly and beneficially influenced the FMD (P<0.005).
73. •• Buyken AE, Flood V, Empson M. Carbohydrate nutrition and inflammatory disease mortality in older adults. Amer J Clin Nut. 2010;92:634-43. An Australian prospective cohort of 1,490 postmenopausal women and 1,245 men (49 y at baseline; 1992-1994) from who completed a validated food-frequency questionnaire. Over a 13-y period, 84 women and 86 men died of inflammatory diseases. Women in the highest GI tertile had a 2.9-fold increased risk of inflammatory death compared with women in the lowest GI tertile. No associations were observed, however, with cardiovascular mortality.
74. •• Gogebakan O, Kohl A, Osterhoff MA, et al. Effects of weight loss and long-term weight maintenance with diets varying in protein and glycemic index on cardiovascular risk factors: the diet, obesity, and genes (DiOGenes) study: a randomized, controlled trial. Circulation. 2011;124:2829-38. A randomized trial of 932 overweight adults assessing the effect of macronutrient make-up and dietary GI on weight loss maintenance in a factorial design using five arms (four test, one control) over 26 weeks. Participants on low-GI arms had significant decreases in hs-CRP compared to high-GI arms, indicating low-GI carbohydrates may reduce low-grade inflammation.
75. Heggen E, Klemsdal TO, Haugen F, Holme I, Tonstad S. Effect of a low-fat versus a low-gycemic-load diet on inflammatory biomarker and adipokine concentrations. Metabol Synd Relat Disord. 2012;10:437-42.
76. Jones JL, Comperatore M, Barona J, et al. A Mediterranean-style, low-glycemic-load diet decreases atherogenic lipoproteins and reduces lipoprotein (a) and oxidized low-density lipoprotein in women with metabolic syndrome. Metab Clin Experim. 2012;61:366-72.
77. Loh BI, Sathyasuryan DR, Mohamed HJ. Plasma adiponectin concentrations are associated with dietary glycemic index in Malaysian patients with type 2 diabetes. Asia Pac J Clin Nutr. 2013;22:241-8.
78. Mehrabani HH, Salehpour S, Amiri Z, Farahani SJ, Meyer BJ, Tahbaz F. Beneficial effects of a high-protein, low-glycemic-load hypocaloric diet in overweight and obese women with polycystic ovary syndrome: a randomized controlled intervention study. J Am Coll Nutr. 2012;31:117-25.
79. Diez JJ, Iglesias P. The role of the novel adipocyte-derived hormone adiponectin in human disease. Europ J Endocrinol/Europ Federat Endoc Soc. 2003;148:293-300.
80. Steinberg D, Parthasarathy S, Carew TE, Khoo JC, Witztum JL. Beyond cholesterol. Modifications of low-density lipoprotein that increase its atherogenicity. N Engl J Med. 1989;320:915-24.
81. Botero D, Ebbeling CB, Blumberg JB, et al. Acute effects of dietary glycemic index on antioxidant capacity in a nutrient-controlled feeding study. Obesity (Silver Spring). 2009;17:1664-70.