J Am Coll Cardiol, 2007; 50:14-21, doi:10.1016/j.jacc.2007.02.068 (Published online 17 June 2007). © 2007 by the American College of Cardiology Foundation

This Article Full Text Full Text (PDF) All Versions of this Article: j.jacc.2007.02.068v1 50/1/14    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Beulens, J. W.J. Articles by van der Schouw, Y. T. Search for Related Content PubMed Articles by Beulens, J. W.J. Articles by van der Schouw, Y. T. Related Collections Related Article

CLINICAL RESEARCH: CARDIOVASCULAR RISK

High Dietary Glycemic Load and Glycemic Index Increase Risk of Cardiovascular Disease Among Middle-Aged Women

A Population-Based Follow-Up Study

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.

Manuscript received November 10, 2006; revised manuscript received February 5, 2007, accepted February 12, 2007.

^_* Reprint requests and correspondence: Dr. Joline W. J. Beulens, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Room STR 6.131, P.O. Box 85500, 3508 GA Utrecht, the Netherlands. (Email: J.Beulens{at}umcutrecht.nl).

Objectives: The goal of this work was to assess whether high dietary glycemic load and glycemic index are associated with an increased risk of cardiovascular disease (CVD).

Background: The associations of dietary glycemic index and glycemic load with risk of CVD are not well established, particularly in populations consuming modest glycemic load diets. Moreover, risk may differ between lean and overweight subjects.

Methods: Associations of glycemic index and glycemic load with incident CVD were examined in a prospective cohort of 15,714 Dutch women age 49 to 70 years without diabetes or CVD. Dietary glycemic index and glycemic load were calculated using the glycemic index, carbohydrate content, and frequency of intake of individual foods.

Results: During 9 ± 2 years of follow-up, 556 cases of coronary heart disease (CHD) and 243 cases of cerebrovascular accident (CVA) occurred. Dietary glycemic load (mean = 100; SD = 17) was associated with increased risk of CVD, adjusted for CVD risk factors and dietary variables, with a hazard ratio (HR) for the highest against lowest quartile of 1.47 (95% confidence interval [CI] 1.04 to 2.09; p_trend = 0.03). Similar results were observed for dietary glycemic index with a corresponding HR of 1.33 (95% CI 1.07 to 1.67; p_trend = 0.02). Glycemic load tended to be associated with both CHD (HR 1.44; 95% CI 0.95 to 2.19; p_trend = 0.14) and CVA (HR 1.55; 95% CI 0.81 to 2.97; p_trend = 0.10), but glycemic index only with CHD (HR 1.44; 95% CI 1.10 to 1.89; p_trend = 0.01). Among overweight women (body mass index >25 kg/m²), glycemic load was associated with CVD (1.78; 95% CI 1.11 to 2.85; p_trend = 0.04), but not among normal weight women (p_interaction = 0.19). Body mass index did not modify the association of glycemic index with CVD.

Conclusions: Among women consuming modest glycemic load diets, high dietary glycemic load and glycemic index increase the risk of CVD, particularly for overweight women.

Abbreviations and Acronyms   BMI = body mass index   CHD = coronary heart disease   CI = confidence interval   CRP = C-reactive protein   CVA = cerebrovascular accidents   CVD = cardiovascular disease   FFQ = food frequency questionnaire   HDL = high-density lipoprotein   HR = hazard ratio   HRT = hormone replacement therapy   ICD-9-CM = International Classification of Diseases-Ninth Revision-Clinical Modification   LDL = low-density lipoprotein   OC = oral contraceptives

Related Article

Diet and Cardiovascular Disease Prevention: The Need for a Paradigm Shift

Frank B. Hu
J. Am. Coll. Cardiol. 2007 50: 22-24. [Full Text] [PDF]

This article has been cited by other articles:

				J. W J Beulens, E. M Monninkhof, M. W M Verschuren, Y. T van der Schouw, J. Smit, M. C Ocke, E. H J M Jansen, S. van Dieren, D. E Grobbee, P. H M Peeters, et al. Cohort Profile: The EPIC-NL study Int. J. Epidemiol., June 17, 2009; (2009) dyp217v2. [Full Text] [PDF]

				K. L. Stanhope and P. J. Havel Fructose Consumption: Considerations for Future Research on Its Effects on Adipose Distribution, Lipid Metabolism, and Insulin Sensitivity in Humans J. Nutr., June 1, 2009; 139(6): 1236S - 1241S. [Abstract] [Full Text] [PDF]

				M. M. E. van Bakel, N. Slimani, E. J. M. Feskens, H. Du, J. W. J. Beulens, Y. T. van der Schouw, F. Brighenti, J. Halkjaer, A. E. Cust, P. Ferrari, et al. Methodological Challenges in the Application of the Glycemic Index in Epidemiological Studies Using Data from the European Prospective Investigation into Cancer and Nutrition J. Nutr., March 1, 2009; 139(3): 568 - 575. [Abstract] [Full Text] [PDF]

				S. M. George, S. T. Mayne, M. F. Leitzmann, Y. Park, A. Schatzkin, A. Flood, A. Hollenbeck, and A. F. Subar Dietary Glycemic Index, Glycemic Load, and Risk of Cancer: A Prospective Cohort Study Am. J. Epidemiol., February 15, 2009; 169(4): 462 - 472. [Abstract] [Full Text] [PDF]

				S. Kaushik, J. J. Wang, T. Y. Wong, V. Flood, A. Barclay, J. Brand-Miller, and P. Mitchell Glycemic Index, Retinal Vascular Caliber, and Stroke Mortality Stroke, January 1, 2009; 40(1): 206 - 212. [Abstract] [Full Text] [PDF]

				D. J. Chess, W. Xu, R. Khairallah, K. M. O'Shea, W. J. Kop, A. M. Azimzadeh, and W. C. Stanley The antioxidant tempol attenuates pressure overload-induced cardiac hypertrophy and contractile dysfunction in mice fed a high-fructose diet Am J Physiol Heart Circ Physiol, December 1, 2008; 295(6): H2223 - H2230. [Abstract] [Full Text] [PDF]

				M. J. Blaha, S. Bansal, R. Rouf, S. H. Golden, R. S. Blumenthal, and A. P. DeFilippis A Practical 'ABCDE' Approach to the Metabolic Syndrome Mayo Clin. Proc., August 1, 2008; 83(8): 932 - 943. [Abstract] [Full Text] [PDF]

				D. J. Chess and W. C. Stanley Role of diet and fuel overabundance in the development and progression of heart failure Cardiovasc Res, July 15, 2008; 79(2): 269 - 278. [Abstract] [Full Text] [PDF]

				S. Dickinson, D. P Hancock, P. Petocz, A. Ceriello, and J. Brand-Miller High-glycemic index carbohydrate increases nuclear factor-{kappa}B activation in mononuclear cells of young, lean healthy subjects Am. J. Clinical Nutrition, May 1, 2008; 87(5): 1188 - 1193. [Abstract] [Full Text] [PDF]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al. Highlights of the year in JACC 2007. J. Am. Coll. Cardiol., January 29, 2008; 51(4): 490 - 512. [Full Text] [PDF]

				J. H. O'Keefe, N. M. Gheewala, and J. O. O'Keefe Dietary Strategies for Improving Post-Prandial Glucose, Lipids, Inflammation, and Cardiovascular Health J. Am. Coll. Cardiol., January 22, 2008; 51(3): 249 - 255. [Abstract] [Full Text] [PDF]

				Carbohydrates Matter Journal Watch Women's Health, August 23, 2007; 2007(823): 3 - 3. [Full Text]

				F. B. Hu Diet and Cardiovascular Disease Prevention: The Need for a Paradigm Shift J. Am. Coll. Cardiol., July 3, 2007; 50(1): 22 - 24. [Full Text] [PDF]