Associations of Glycemic Index and Load With Coronary Heart Disease Events: A Systematic Review and Meta‐Analysis of Prospective Cohorts
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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.
