TY - JOUR
T1 - Carbohydrate quality, glycemic index, glycemic load and cardiometabolic risks in the US, Europe and Asia
T2 - A dose–response meta-analysis
AU - Hardy, Dale Sharon
AU - Garvin, Barbara Jane Threatt
AU - Xu, Hongyan
N1 - Funding Information:
This work was supported by a K01 grant by the National Heart, Lung, and Blood Institute , grant no. K01 HL127278 .
Publisher Copyright:
© 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University
PY - 2020/6/9
Y1 - 2020/6/9
N2 - Background and aims: Despite the proven evidence of high glycemic index (GI) and glycemic load (GL) diets to increase cardiometabolic risks, knowledge about the meta-evidence for carbohydrate quality within world geographic regions is limited. We conducted a meta-analysis to synthesize the evidence of GI/GL studies and carbohydrate quality, gathering additional exposures for carbohydrate, high glycemic carbohydrate, total dietary fiber, and cereal fiber and risks for type 2 diabetes (T2DM), coronary heart disease (CHD), stroke, and mortality, grouped into the US, Europe, and Asia. Secondary aims examined cardiometabolic risks in overweight/obese individuals, by sex, and dose–response dietary variable trends. Methods and results: 40-prospective observational studies from 4-Medline bibliographical databases (Ovid, PubMed, EBSCOhost, CINAHL) were search up to November 2019. Random-effects hazard ratios (HR) and 95% confidence intervals (CI) for highest vs. lowest categories and continuous form combined were reported. Heterogeneity (I2>50%) was frequent in US GI/GL studies due to differing study characteristics. Increased risks ((HRGI,T2DM,US=1.14;CI:1.06,1.21), HRGL,T2DM,US=1.02 (1.01, 1.03)), HRGI,T2DM,Asia=1.25;1.02,1.53), and HRGL,T2DM,Asia=1.37 (1.17, 1.60)) were associated with cardiometabolic diseases. GI/GL in overweight/obese females had the strongest magnitude of risks in US-and Asian studies. Total dietary fiber (HRT2DM,US = 0.92;0.88,0.96) and cereal fiber (HRT2DM,US = 0.83;0.77,0.90) decreased risk of developing T2DM. Among females, we found protective dose–response risks for total dietary fiber (HR5g-total-dietary-fiber,T2DM,US = 0.94;0.92,0.97), but cereal fiber showed better ability to lower T2DM risk (HR5g-cereal-fiber,T2DM,US = 0.67;0.60,0.74). Total dietary-and cereal fibers' dose–response effects were nullified by GL, but not so for cereal fiber with GI. Conclusions: Overweight/obese females could shift their carbohydrate intake for higher cereal fiber to decrease T2DM risk, but higher GL may cancel-out this effect.
AB - Background and aims: Despite the proven evidence of high glycemic index (GI) and glycemic load (GL) diets to increase cardiometabolic risks, knowledge about the meta-evidence for carbohydrate quality within world geographic regions is limited. We conducted a meta-analysis to synthesize the evidence of GI/GL studies and carbohydrate quality, gathering additional exposures for carbohydrate, high glycemic carbohydrate, total dietary fiber, and cereal fiber and risks for type 2 diabetes (T2DM), coronary heart disease (CHD), stroke, and mortality, grouped into the US, Europe, and Asia. Secondary aims examined cardiometabolic risks in overweight/obese individuals, by sex, and dose–response dietary variable trends. Methods and results: 40-prospective observational studies from 4-Medline bibliographical databases (Ovid, PubMed, EBSCOhost, CINAHL) were search up to November 2019. Random-effects hazard ratios (HR) and 95% confidence intervals (CI) for highest vs. lowest categories and continuous form combined were reported. Heterogeneity (I2>50%) was frequent in US GI/GL studies due to differing study characteristics. Increased risks ((HRGI,T2DM,US=1.14;CI:1.06,1.21), HRGL,T2DM,US=1.02 (1.01, 1.03)), HRGI,T2DM,Asia=1.25;1.02,1.53), and HRGL,T2DM,Asia=1.37 (1.17, 1.60)) were associated with cardiometabolic diseases. GI/GL in overweight/obese females had the strongest magnitude of risks in US-and Asian studies. Total dietary fiber (HRT2DM,US = 0.92;0.88,0.96) and cereal fiber (HRT2DM,US = 0.83;0.77,0.90) decreased risk of developing T2DM. Among females, we found protective dose–response risks for total dietary fiber (HR5g-total-dietary-fiber,T2DM,US = 0.94;0.92,0.97), but cereal fiber showed better ability to lower T2DM risk (HR5g-cereal-fiber,T2DM,US = 0.67;0.60,0.74). Total dietary-and cereal fibers' dose–response effects were nullified by GL, but not so for cereal fiber with GI. Conclusions: Overweight/obese females could shift their carbohydrate intake for higher cereal fiber to decrease T2DM risk, but higher GL may cancel-out this effect.
KW - Cardiometabolic risks
KW - Cereal fiber
KW - Dose–response
KW - Geographic regions
KW - Glycemic index and glycemic load
KW - Total dietary fiber
KW - Type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85083011137&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85083011137&partnerID=8YFLogxK
U2 - 10.1016/j.numecd.2019.12.050
DO - 10.1016/j.numecd.2019.12.050
M3 - Article
C2 - 32278608
AN - SCOPUS:85083011137
VL - 30
SP - 853
EP - 871
JO - Nutrition, Metabolism and Cardiovascular Diseases
JF - Nutrition, Metabolism and Cardiovascular Diseases
SN - 0939-4753
IS - 6
ER -