Background

There is debate over whether the glycaemic index of foods relates to chronic disease. We aimed to assess the associations between glycaemic index (GI) and glycaemic load (GL) and type 2 diabetes, cardiovascular disease, diabetes-related cancers, and all-cause mortality.

Methods

We did a meta-analysis of large cohorts (≥100 000 participants) identified from the Richard Doll Consortium. We searched the Cochrane Library, MEDLINE, PubMed, Embase, Web of Science, and Scopus for cohorts that prospectively examined associations between GI or GL and chronic disease outcomes published from database inception to Aug 4, 2023. Full-article review and extraction of summary estimates data were conducted by three independent reviewers. Primary outcomes were incident type 2 diabetes, total cardiovascular disease (including mortality), diabetes-related cancers (ie, bladder, breast, colorectal, endometrial, hepatic, pancreatic, and non-Hodgkin lymphoma), and all-cause mortality. We assessed comparisons between the lowest and highest quantiles of GI and GL, adjusting for dietary factors, and pooling their most adjusted relative risk (RR) estimates using a fixed-effects model. We also assessed associations between diets high in fibre and whole grains and the four main outcomes. The study protocol is registered with PROSPERO, CRD42023394689.

Findings

From ten prospective large cohorts (six from the USA, one from Europe, two from Asia, and one international), we identified a total of 48 studies reporting associations between GI or GL and the outcomes of interest: 34 (71%) on various cancers, nine (19%) on cardiovascular disease, five (10%) on type 2 diabetes, and three (6%) on all-cause mortality. Consumption of high GI foods was associated with an increased incidence of type 2 diabetes (RR 1·27 [95% CI 1·21–1·34]; p<0·0001), total cardiovascular disease (1·15 [1·11–1·19]; p<0·0001), diabetes-related cancer (1·05 [1·02–1·08]; p=0·0010), and all-cause mortality (1·08 [1·05–1·12]; p<0·0001). Similar associations were seen between high GL and diabetes (RR 1·15 [95% CI 1·09–1·21]; p<0·0001) and total cardiovascular disease (1·15 [1·10–1·20]; p<0·0001). Associations between diets high in fibre and whole grains and the four main outcomes were similar to those for low GI diets.

Interpretation

Dietary recommendations to reduce GI and GL could have effects on health outcomes that are similar to outcomes of recommendations to increase intake of fibre and whole grain.

Funding

Banting and Best and the Karuna Foundation.

中文翻译：

---

血糖指数和血糖负荷与 2 型糖尿病、心血管疾病、癌症和全因死亡率的关联：对超过 100 000 名参与者的大型队列的荟萃分析

背景

关于食物的血糖指数是否与慢性疾病有关存在争议。我们的目的是评估血糖指数 (GI) 和血糖负荷 (GL) 与 2 型糖尿病、心血管疾病、糖尿病相关癌症和全因死亡率之间的关联。

方法

我们对 Richard Doll 联盟确定的大型队列（≥100 000 名参与者）进行了荟萃分析。我们检索了 Cochrane Library、MEDLINE、PubMed、 Embase 、Web of Science 和 Scopus，寻找从数据库建立到 2023 年 8 月 4 日发布的前瞻性研究 GI 或 GL 与慢性病结果之间关联的队列。 全文回顾和摘要摘录估计数据由三名独立评审员进行。主要结局是2型糖尿病、总心血管疾病（包括死亡率）、糖尿病相关癌症（即膀胱癌、乳腺癌、结直肠癌、子宫内膜癌、肝癌、胰腺癌和非霍奇金淋巴瘤）以及全因死亡率。我们评估了 GI 和 GL 最低和最高分位数之间的比较，调整饮食因素，并使用固定效应模型汇总其最调整的相对风险 (RR) 估计值。我们还评估了高纤维和全谷物饮食与四个主要结果之间的关联。该研究方案已在 PROSPERO 注册，CRD42023394689。

发现

从 10 个前瞻性大型队列（6 个来自美国，1 个来自欧洲，2 个来自亚洲，1 个国际）中，我们总共确定了 48 项报告 GI 或 GL 与感兴趣结果之间关联的研究：34 项 (71%) 涉及不同的研究领域。癌症、9 例（19%）心血管疾病、5 例（10%）2 型糖尿病、3 例（6%）全因死亡率。食用高 GI 食物与 2 型糖尿病 (RR 1·27 [95% CI 1·21–1·34]；p<0·0001)、总体心血管疾病 (1·15 [1· 11–1·19]；p<0·0001）、糖尿病相关癌症（1·05 [1·02–1·08]；p=0·0010）和全因死亡率（1·08 [1 ·05–1·12]；p<0·0001)。高 GL 与糖尿病 (RR 1·15 [95% CI 1·09–1·21]；p<0·0001) 和总体心血管疾病 (1·15 [1·10–1·20]) 之间也存在类似的关联。 ；p<0·0001)。高纤维和全谷物饮食与四个主要结果之间的关联与低 GI 饮食相似。

解释

降低 GI 和 GL 的饮食建议可能对健康结果产生影响，这与增加纤维和全谷物摄入量的建议的结果类似。

资金

班廷、贝斯特和卡鲁纳基金会。