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November 2002, Volume 56, Number 11, Pages 1049-1071
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Glycemic index in chronic disease: a review
L S Augustin1,2,a,b, S Franceschi1,4,b, D J A Jenkins2,3,b, C W C Kendall2,3,b and C La Vecchia5,6,b

1Servizio di Epidemiologia, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Italy

2Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Canada

3Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, Canada

4Field and Intervention Studies Unit, International Agency for Research on Cancer, Lyon, France

5Istituto di Ricerche Farmacologiche 'Mario Negri', Milano, Italy

6Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, Milano, Italy

Correspondence to: L S Augustin, 150 College St no. 340, Toronto, Ontario, M5S 3E2 Canada. E-mail:

aGuarantor: L Augustin.

bContributors: SF and LA were responsible for the concept of writing a comprehensive review on the topic of the glycemic index in chronic disease. LA was responsible for writing the review. DJ and CK contributed with their expertise on glycemic index, coronary heart disease and diabetes. CLV and SF contributed with their expertise on cancer and epidemiology. All authors read the report and made suggestions.


Aim: The intent of this review is to critically analyze the scientific evidence on the role of the glycemic index in chronic Western disease and to discuss the utility of the glycemic index in the prevention and management of these disease states.

Background: The glycemic index ranks foods based on their postprandial blood glucose response. Hyperinsulinemia and insulin resistance, as well as their determinants (eg high energy intake, obesity, lack of physical activity) have been implicated in the etiology of diabetes, coronary heart disease and cancer. Recently, among dietary factors, carbohydrates have attracted much attention as a significant culprit, however, different types of carbohydrate produce varying glycemic and insulinemic responses. Low glycemic index foods, characterized by slowly absorbed carbohydrates, have been shown in some studies to produce beneficial effects on glucose control, hyperinsulinemia, insulin resistance, blood lipids and satiety.

Method: Studies on the short and long-term metabolic effects of diets with different glycemic indices will be presented and discussed. The review will focus primarily on clinical and epidemiological data, and will briefly discuss in vitro and animal studies related to possible mechanisms by which the glycemic index may influence chronic disease.

European Journal of Clinical Nutrition (2002) 56, 1049-1071. doi:10.1038/sj.ejcn.1601454


glycemic index; glycemic load; diabetes; coronary heart disease; obesity; cancer

Received 13 March 2002
November 2002, Volume 56, Number 11, Pages 1049-1071
Table of contents    Previous  Abstract  Next   Full text  PDF