Associations of glycemic index and load with coronary heart disease events: a systematic review and meta-analysis of prospective cohorts

Arash Mirrahimi, Russell J de Souza, Laura Chiavaroli, John L Sievenpiper, Joseph Beyene, Anthony J Hanley, Livia S A Augustin, Cyril W C Kendall, David J A Jenkins, Arash Mirrahimi, Russell J de Souza, Laura Chiavaroli, John L Sievenpiper, Joseph Beyene, Anthony J Hanley, Livia S A Augustin, Cyril W C Kendall, David J A Jenkins

Abstract

Background: Glycemic index (GI) and glycemic load (GL) have been associated with coronary heart disease (CHD) risk in some but not all cohort studies. We therefore assessed the association of GI and GL with CHD risk in prospective cohorts.

Methods and results: We searched MEDLINE, EMBASE, and CINAHL (through April 5, 2012) and identified all prospective cohorts assessing associations of GI and GL with incidence of CHD. Meta-analysis of observational studies in epidemiology (MOOSE) methodologies were used. Relative measures of risk, comparing the group with the highest exposure (mean GI of cohorts=84.4 GI units, range 79.9 to 91; mean GL of cohorts=224.8, range 166 to 270) to the reference group (mean GI=72.3 GI units, range 68.1 to 77; mean GL=135.4, range 83 to 176), were pooled using random-effects models, expressed as relative risk (RR) with heterogeneity assessed by χ(2) and quantified by I(2). Subgroups included sex and duration of follow-up. Ten studies (n=240 936) were eligible. Pooled analyses showed an increase in CHD risk for the highest GI quantile compared with the lowest, with RR=1.11 (95% confidence interval [CI] 0.99 to 1.24) and for GL, RR=1.27 (95% CI 1.09 to 1.49), both with evidence of heterogeneity (I(2)>42%, P<0.07). Subgroup analyses revealed only a significant modification by sex, with the female cohorts showing significance for GI RR=1.26 (95% CI 1.12 to 1.41) and for GL RR=1.55 (95% CI 1.18 to 2.03).

Conclusions: High GI and GL diets were significantly associated with CHD events in women but not in men. Further studies are required to determine the relationship between GI and GL with CHD in men.

Keywords: coronary heart disease; glycemic index and load; meta-analysis; nutrition; prospective cohort.

Figures

Figure 1.
Figure 1.
Literature search and review flow. CHD indicates coronary heart disease; GI, glycemic index.*The Hardy et al study, for which data were unavailable, only reported a rate of change in risk of CHD per 5 and 30 units of GL.
Figure 2.
Figure 2.
Pooled risk estimate of all prospective cohorts investigating the association of highest GI exposure with CHD events (including death and myocardial infarctions) relative to the reference exposure (ΔGI between mean of highest exposure and mean of reference=12.1±1.1 SE). The figure is stratified by sex-specific subgroups with subtotal boxes in 2.1.1 and 2.1.2 summarizing the pooled analysis for women,,,,, and for men,,,,, respectively. The total analysis box represents the overall pooled analysis for both men and women. P values in circles are based on generic inverse variance (IV) methods in random-effects models and represent the significance for association of high-GI diets with CHD. The P value in a rectangle depicts the significance of differences between the subgroups. Interstudy heterogeneity was tested by Cochrane's Q (χ2) at a significance level of P<0.10 and quantified by I2. CHD indicates coronary heart disease; GI, glycemic index.
Figure 3.
Figure 3.
Pooled risk estimate of all prospective cohorts investigating the association of highest GL exposure with CHD events (including death and myocardial infarctions) relative to the reference exposure (ΔGL between mean of highest exposure and mean of reference=89.4±9.5 SE). The figure is stratified by sex-specific subgroups with subtotal boxes in 3.1.1 and 3.1.2 summarizing the pooled analysis for women,,,,, and for men,,,,, respectively. The total analysis box represents the overall pooled analysis for both men and women. P values in circles are based on generic inverse variance (IV) methods in random-effects models and represent the significance for association of high-GL diets with CHD. The P value in a rectangle depicts the significance of differences between the subgroups. Interstudy heterogeneity was tested by Cochrane's Q (χ2) at a significance level of P<0.10 and quantified by I2. CHD indicates coronary heart disease; GI, glycemic index.
Figure 4.
Figure 4.
Test for publication bias in the overall pooled analysis of CHD risk estimates associated with the highest GI quantiles; Grau et al report on men was identified outside the 95% pseudo–confidence limits. Neither Begg's test (P>0.837) nor Egger's test (P=0.621) revealed evidence of publication bias., CHD indicates coronary heart disease; GI, glycemic index.
Figure 5.
Figure 5.
Test for publication bias in the overall pooled analysis of CHD risk estimates associated with highest GL quantiles; Grau et al report on women was identified outside the 95% pseudo–confidence limits. Begg's (P>0.115) and Egger's (P=0.134) tests approached significance for evidence of publication bias., CHD indicates coronary heart disease; GL, glycemic load.

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