Glycemic load and cardiovascular health -
By definition, the consumption of high-GI foods results in higher and more rapid increases in blood glucose concentrations than the consumption of low-GI foods. Rapid increases in blood glucose resulting in hyperglycemia are potent signals to the β-cells of the pancreas to increase insulin secretion 7.
Over the next few hours, the increase in blood insulin concentration hyperinsulinemia induced by the consumption of high-GI foods may cause a sharp decrease in the concentration of glucose in blood resulting in hypoglycemia.
In contrast, the consumption of low-GI foods results in lower but more sustained increases in blood glucose and lower insulin demands on pancreatic β-cells 8. Many observational studies have examined the association between GI and risk of chronic disease , relying on published GI values of individual foods and using the following formula to calculate meal or diet GI 9 :.
Yet, the use of published GI values of individual foods to estimate the average GI value of a meal or diet may be inappropriate because factors such as food variety, ripeness, processing, and cooking are known to modify GI values.
In a study by Dodd et al. Besides the GI of individual foods, various food factors are known to influence the postprandial glucose and insulin responses to a carbohydrate-containing mixed diet. A recent cross-over , randomized trial in 14 subjects with type 2 diabetes mellitus examined the acute effects of four types of breakfasts with high- or low-GI and high- or low- fiber content on postprandial glucose concentrations.
Plasma glucose was found to be significantly higher following consumption of a high-GI and low-fiber breakfast than following a low-GI and high-fiber breakfast. However, there was no significant difference in postprandial glycemic responses between high-GI and low-GI breakfasts of similar fiber content In this study, meal GI values derived from published data failed to correctly predict postprandial glucose response, which appeared to be essentially influenced by the fiber content of meals.
Since the amounts and types of carbohydrate, fat, protein , and other dietary factors in a mixed meal modify the glycemic impact of carbohydrate GI values, the GI of a mixed meal calculated using the above-mentioned formula is unlikely to accurately predict the postprandial glucose response to this meal 3.
Using direct measures of meal GIs in future trials — rather than estimates derived from GI tables — would increase the accuracy and predictive value of the GI method 2 , 6. In addition, in a recent meta-analysis of 28 studies examining the effect of low- versus high-GI diets on serum lipids , Goff et al.
indicated that the mean GI of low-GI diets varied from 21 to 57 across studies, while the mean GI of high-GI diets ranged from 51 to 75 Therefore, a stricter use of GI cutoff values may also be warranted to provide more reliable information about carbohydrate-containing foods.
The glycemic index GI compares the potential of foods containing the same amount of carbohydrate to raise blood glucose. However, the amount of carbohydrate contained in a food serving also affects blood glucose concentrations and insulin responses.
For example, the mean GI of watermelon is 76, which is as high as the GI of a doughnut see Table 1. Yet, one serving of watermelon provides 11 g of available carbohydrate, while a medium doughnut provides 23 g of available carbohydrate. The concept of glycemic load GL was developed by scientists to simultaneously describe the quality GI and quantity of carbohydrate in a food serving, meal, or diet.
The GL of a single food is calculated by multiplying the GI by the amount of carbohydrate in grams g provided by a food serving and then dividing the total by 4 :. Using the above-mentioned example, despite similar GIs, one serving of watermelon has a GL of 8, while a medium-sized doughnut has a GL of Dietary GL is the sum of the GLs for all foods consumed in the diet.
It should be noted that while healthy food choices generally include low-GI foods, this is not always the case.
For example, intermediate-to-high-GI foods like parsnip, watermelon, banana, and pineapple, have low-to-intermediate GLs see Table 1. The consumption of high-GI and -GL diets for several years might result in higher postprandial blood glucose concentration and excessive insulin secretion.
This might contribute to the loss of the insulin-secreting function of pancreatic β-cells and lead to irreversible type 2 diabetes mellitus A US ecologic study of national data from to found that the increased consumption of refined carbohydrates in the form of corn syrup, coupled with the declining intake of dietary fiber , has paralleled the increased prevalence of type 2 diabetes In addition, high-GI and -GL diets have been associated with an increased risk of type 2 diabetes in several large prospective cohort studies.
Moreover, obese participants who consumed foods with high-GI or -GL values had a risk of developing type 2 diabetes that was more than fold greater than lean subjects consuming low-GI or -GL diets However, a number of prospective cohort studies have reported a lack of association between GI or GL and type 2 diabetes The use of GI food classification tables based predominantly on Australian and American food products might be a source of GI value misassignment and partly explain null associations reported in many prospective studies of European and Asian cohorts.
Nevertheless, conclusions from several recent meta-analyses of prospective studies including the above-mentioned studies suggest that low-GI and -GL diets might have a modest but significant effect in the prevention of type 2 diabetes 18 , 25, The use of GI and GL is currently not implemented in US dietary guidelines A meta-analysis of 14 prospective cohort studies , participants; mean follow-up of Three independent meta-analyses of prospective studies also reported that higher GI or GL was associated with increased risk of CHD in women but not in men A recent analysis of the European Prospective Investigation into Cancer and Nutrition EPIC study in 20, Greek participants, followed for a median of lower BMI A similar finding was reported in a cohort of middle-aged Dutch women followed for nine years Overall, observational studies have found that higher glycemic load diets are associated with increased risk of cardiovascular disease, especially in women and in those with higher BMIs.
A meta-analysis of 27 randomized controlled trials published between and examining the effect of low-GI diets on serum lipid profile reported a significant reduction in total and LDL - cholesterol independent of weight loss Yet, further analysis suggested significant reductions in serum lipids only with the consumption of low-GI diets with high fiber content.
In a three-month, randomized controlled study, an increase in the values of flow-mediated dilation FMD of the brachial artery, a surrogate marker of vascular health, was observed following the consumption of a low- versus high-GI hypocaloric diet in obese subjects High dietary GLs have been associated with increased concentrations of markers of systemic inflammation , such as C-reactive protein CRP , interleukin-6, and tumor necrosis factor-α TNF-α 40, In a small week dietary intervention study, the consumption of a Mediterranean-style, low-GL diet without caloric restriction significantly reduced waist circumference, insulin resistance , systolic blood pressure , as well as plasma fasting insulin , triglycerides , LDL-cholesterol, and TNF-α in women with metabolic syndrome.
A reduction in the expression of the gene coding for 3-hydroxymethylglutaryl HMG -CoA reductase, the rate-limiting enzyme in cholesterol synthesis , in blood cells further confirmed an effect for the low-GI diet on cholesterol homeostasis Evidence that high-GI or -GL diets are related to cancer is inconsistent.
A recent meta-analysis of 32 case-control studies and 20 prospective cohort studies found modest and nonsignificant increased risks of hormone -related cancers breast, prostate , ovarian, and endometrial cancers and digestive tract cancers esophageal , gastric , pancreas , and liver cancers with high versus low dietary GI and GL A significant positive association was found only between a high dietary GI and colorectal cancer Yet, earlier meta-analyses of prospective cohort studies failed to find a link between high-GI or -GL diets and colorectal cancer Another recent meta-analysis of prospective studies suggested a borderline increase in breast cancer risk with high dietary GI and GL.
Adjustment for confounding factors across studies found no modification of menopausal status or BMI on the association Further investigations are needed to verify whether GI and GL are associated with various cancers.
Whether low-GI foods could improve overall blood glucose control in people with type 1 or type 2 diabetes mellitus has been investigated in a number of intervention studies.
A meta-analysis of 19 randomized controlled trials that included diabetic patients with type 1 diabetes and with type 2 diabetes found that consumption of low-GI foods improved short-term and long-term control of blood glucose concentrations, reflected by significant decreases in fructosamine and glycated hemoglobin HbA1c levels However, these results need to be cautiously interpreted because of significant heterogeneity among the included studies.
The American Diabetes Association has rated poorly the current evidence supporting the substitution of low-GL foods for high-GL foods to improve glycemic control in adults with type 1 or type 2 diabetes 51, A randomized controlled study in 92 pregnant women weeks diagnosed with gestational diabetes found no significant effects of a low-GI diet on maternal metabolic profile e.
The low-GI diet consumed during the pregnancy also failed to improve maternal glucose tolerance , insulin sensitivity , and other cardiovascular risk factors, or maternal and infant anthropometric data in a three-month postpartum follow-up study of 55 of the mother-infant pairs At present, there is no evidence that a low-GI diet provides benefits beyond those of a healthy, moderate-GI diet in women at high risk or affected by gestational diabetes.
Obesity is often associated with metabolic disorders, such as hyperglycemia , insulin resistance , dyslipidemia , and hypertension , which place individuals at increased risk for type 2 diabetes mellitus , cardiovascular disease , and early death 56, Lowering the GI of conventional energy-restricted, low-fat diets was proven to be more effective to reduce postpartum body weight and waist and hip circumferences and prevent type 2 diabetes mellitus in women with prior gestational diabetes mellitus Yet, the consumption of a low-GL diet increased HDL - cholesterol and decreased triglyceride concentrations significantly more than the low-fat diet, but LDL -cholesterol concentration was significantly more reduced with the low-fat than low-GI diet Weight loss with each diet was equivalent ~4 kg.
Both interventions similarly reduced triglycerides, C-reactive protein CRP , and fasting insulin , and increased HDL-cholesterol. Yet, the reduction in waist and hip circumferences was greater with the low-fat diet, while blood pressure was significantly more reduced with the low-GL diet Additionally, the low-GI diet improved fasting insulin concentration, β-cell function, and insulin resistance better than the low-fat diet.
None of the diets modulated hunger or satiety or affected biomarkers of endothelial function or inflammation. Finally, no significant differences were observed in low- compared to high-GL diets regarding weight loss and insulin metabolism It has been suggested that the consumption of low-GI foods delayed the return of hunger, decreased subsequent food intake, and increased satiety when compared to high-GI foods The effect of isocaloric low- and high-GI test meals on the activity of brain regions controlling appetite and eating behavior was evaluated in a small randomized , blinded, cross-over study in 12 overweight or obese men During the postprandial period, blood glucose and insulin rose higher after the high-GI meal than after the low-GI meal.
In addition, in response to the excess insulin secretion, blood glucose dropped below fasting concentrations three to five hours after high-GI meal consumption.
Cerebral blood flow was significantly higher four hours after ingestion of the high-GI meal compared to a low-GI meal in a specific region of the striatum right nucleus accumbens associated with food intake reward and craving.
If the data suggested that consuming low- rather than high-GI foods may help restrain overeating and protect against weight gain, this has not yet been confirmed in long-term randomized controlled trials.
However, the dietary interventions only achieved a modest difference in GI ~5 units between high- and low-GI diets such that the effect of GI in weight maintenance remained unknown.
Table 1 includes GI and GL values of selected foods relative to pure glucose Originally written in by: Jane Higdon, Ph. Linus Pauling Institute Oregon State University.
Updated in December by: Jane Higdon, Ph. Updated in February by: Victoria J. Drake, Ph. Updated in March by: Barbara Delage, Ph.
Reviewed in March by: Simin Liu, M. Professor of Epidemiology, Professor of Medicine Brown University. Liu S, Willett WC. Dietary glycemic load and atherothrombotic risk.
Curr Atheroscler Rep. Brouns F, Bjorck I, Frayn KN, et al. Glycaemic index methodology. Nutr Res Rev. Augustin LS, Kendall CW, Jenkins DJ, et al. Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium ICQC.
Nutr Metab Cardiovasc Dis. Monro JA, Shaw M. Glycemic impact, glycemic glucose equivalents, glycemic index, and glycemic load: definitions, distinctions, and implications.
Misclassification of dietary exposure is a valid concern in studies that rely on self-report. Moreover, the FFQ was not specifically designed to measure dietary GL and GI.
However, the Dutch EPIC FFQ has been validated showing good agreement with h recalls for most food groups as well as for dietary GL and GI [24] — [26]. A previous study showed that underreporting influenced associations of dietary GI and GL with risk of diabetes [46].
Although, a broad exclusion of potential energy-underreporters did augment the effects of GL and GI on CVD risk in men, it did not result in a positive association of GL or GI with CVD risk in women. There has recently been some criticism with respect to the reliability and individual variability of GI [47].
Overall, GI appears to be a valid predictor of the glycemic response, also to mixed meals [48] , [49]. Even though not every food with a low GI may be equally beneficial, GI represents a useful functional property that can help guide dietary choices that should also take total available and unavailable carbohydrate consumption into account [50].
To our knowledge, this is the first study to show that, also among men, dietary GL and GI may be associated with an increased CVD risk, but these findings need to be further replicated. Dietary GL, and carbohydrate and starch intake were associated with increased CHD risk, while dietary GI was associated with increased stroke risk in men.
No associations were observed for women. Also considering earlier studies carried out in more aged study populations, dietary GL and GI emerge as potentially important determinants of CVD risk for both men and women.
Notably, increments of 1 SD in dietary GL, GI, and carbohydrate were shown to be achievable in practice [51]. Therefore, reducing dietary GL and GI should be part of the nutritional advice for a healthy lifestyle. The authors are grateful to the epidemiologists and field workers of the Municipal Health Services in Amsterdam, Doetichem, and Maastricht for their important contribution to the data collection.
We thank GBA, Statistics Netherlands and the institute PHARMO for providing data on vital status, cause of death and occurrence of cardiovascular diseases.
Conceived and designed the experiments: KB JWJB DvdA. Performed the experiments: KB JWJB DvdA. Analyzed the data: KB JWJB DvdA. Wrote the paper: KB JWJB DvdA. Browse Subject Areas?
Click through the PLOS taxonomy to find articles in your field. Article Authors Metrics Comments Media Coverage Reader Comments Figures. Abstract Background The associations of glycemic load GL and glycemic index GI with the risk of cardiovascular diseases CVD are not well-established, particularly in men, and may be modified by gender.
Objective To assess whether high dietary GL and GI increase the risk of CVD in men and women. Methods A large prospective cohort study EPIC-MORGEN was conducted within the general Dutch population among 8, men and 10, women, aged 21—64 years at baseline — and free of diabetes and CVD.
Results During a mean follow-up of Conclusion Among men, high GL and GI, and high carbohydrate and starch intake, were associated with increased risk of CVD. Introduction Cardiovascular diseases CVD are a major cause of death worldwide.
Methods Ethics Statement The study complied with the Declaration of Helsinki and was approved by the Medical Ethical Committee of TNO Nutrition and Food Research. Population The EPIC-MORGEN cohort consists of 22, men and women aged 20—65 years selected from random samples of the Dutch population in 3 towns Amsterdam, Doetinchem, and Maastricht in the Netherlands between and [21] , [22].
Baseline Measurements The general questionnaire contained questions on demographics, presence of and risk factors for chronic diseases. Dietary Information Daily nutritional intake was obtained at baseline from a FFQ containing questions on the usual frequency of consumption of 79 main food groups during the year preceding enrollment.
Morbidity and Mortality Follow-up Data on morbidity were obtained from the Dutch Centre for Health Care Information, which holds a register of hospital discharge diagnoses from all general and university hospitals in the Netherlands starting from Statistical Analysis GL, GI, and intakes of nutrients were adjusted for total energy intake by means of the regression residual method [32].
Results Daily mean ± SD energy-adjusted dietary GL was lower in men Download: PPT. Table 1. Table 2. Table 3. Discussion Our main finding is that in this Dutch cohort consuming a modest GL diet, a high dietary GL and GI, and high total carbohydrate and starch intake, were associated with an increased CVD risk in men.
Acknowledgments The authors are grateful to the epidemiologists and field workers of the Municipal Health Services in Amsterdam, Doetichem, and Maastricht for their important contribution to the data collection.
Author Contributions Conceived and designed the experiments: KB JWJB DvdA. References 1. Rayner M, Allender S, Scarborough P, British Heart Foundation Health Promotion Research Group Cardiovascular disease in europe.
Eur J Cardiovasc Prev Rehabil Suppl 2S43—S View Article Google Scholar 2. Hoekstra T, Beulens JW, van der Schouw YT Cardiovascular disease prevention in women: Impact of dietary interventions.
Maturitas 20— View Article Google Scholar 3. Levitan EB, Cook NR, Stampfer MJ, Ridker PM, Rexrode KM, et al. Metabolism — View Article Google Scholar 4.
Frost G, Leeds AA, Dore CJ, Madeiros S, Brading S, et al. Lancet — View Article Google Scholar 5. Liu S, Manson JE, Stampfer MJ, Holmes MD, Hu FB, et al. Am J Clin Nutr — View Article Google Scholar 6. McKeown NM, Meigs JB, Liu S, Rogers G, Yoshida M, et al.
J Am Coll Nutr — View Article Google Scholar 7. Gerich JE Clinical significance, pathogenesis, and management of postprandial hyperglycemia. Arch Intern Med — View Article Google Scholar 8. Aryangat AV, Gerich JE Type 2 diabetes: Postprandial hyperglycemia and increased cardiovascular risk. Vasc Health Risk Manag 6: — View Article Google Scholar 9.
Aston LM Glycaemic index and metabolic disease risk. Proc Nutr Soc — View Article Google Scholar Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, et al. Liu S, Willett WC, Stampfer MJ, Hu FB, Franz M, et al. Oh K, Hu FB, Cho E, Rexrode KM, Stampfer MJ, et al.
Am J Epidemiol — Beulens JW, de Bruijne LM, Stolk RP, Peeters PH, Bots ML, et al. J Am Coll Cardiol 14— Levitan EB, Mittleman MA, Hakansson N, Wolk A Dietary glycemic index, dietary glycemic load, and cardiovascular disease in middle-aged and older swedish men.
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 — Tavani A, Bosetti C, Negri E, Augustin LS, Jenkins DJ, et al. Heart — Lopez-Miranda J, Williams C, Lairon D Dietary, physiological, genetic and pathological influences on postprandial lipid metabolism.
Br J Nutr — Knopp RH, Paramsothy P, Retzlaff BM, Fish B, Walden C, et al. Curr Cardiol Rep 8: — Sieri S, Krogh V, Berrino F, Evangelista A, Agnoli C, et al. Oba S, Nagata C, Nakamura K, Fujii K, Kawachi T, et al.
Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, et al. Public Health Nutr 5: — Verschuren WM, Blokstra A, Picavet HS, Smit HA Cohort profile: The doetinchem cohort study. Advanced Search. Home About FAQ My Account Accessibility Statement.
Privacy Copyright. Skip to main content. Home About FAQ My Account. Authors David J A Jenkins Mahshid Dehghan Follow Andrew Mente Shrikant I Bangdiwala Follow Sumathy Rangarajan Kristie Srichaikul Viswanathan Mohan Alvaro Avezum Follow Rafael Díaz Annika Rosengren Fernando Lanas Patricio Lopez-Jaramillo Wei Li Aytekin Oguz Rasha Khatib , Advocate Aurora Health Follow Paul Poirier Noushin Mohammadifard Andrea Pepe Khalid F Alhabib Follow Jephat Chifamba Follow Afzal Hussein Yusufali Romaina Iqbal Karen Yeates Khalid Yusoff Noorhassim Ismail Koon Teo Sumathi Swaminathan Xiaoyun Liu Katarzyna Zatońska Rita Yusuf Salim Yusuf.
Recommended Citation Jenkins DJA, Dehghan M, Mente A, et al. Affiliations Advocate Research Institute, Advocate Health Care. Document Type Article. Teammate Access.
Heaoth Glycemic load and cardiovascular health. Diet has a significant Nutrient-rich meals with Glycemci risk of coronary heart disease CHD. Oral health tips the effect of diet on CHD was measured with carviovascular biomarker for low-density lipoprotein LDL cholesterol. However, LDL is not the only or even the most important biomarker for CHD risk. A suitably integrated view of the mechanism by which diet influences the detailed CHD pathogenetic pathways is therefore needed in order to better understand CHD risk factors and help with better holistic CHD prevention and treatment decisions. A systematic review of the existing literature was conducted.:max_bytes(150000):strip_icc()/VWH-Michela-Buttignol-Glycemic-Index-vs-Glycemic-Load-Recirc-ec63f3707d4c46dfa98d55aa83bc0578.jpg "Glycemic load and cardiovascular health")
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