Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Nutrition and Health (including climate and ecological aspects)

Dietary glycemic index, glycemic load, and cause-specific mortality: two population-based prospective cohort studies

European Journal of Clinical Nutrition volume 76, pages 1142–1149 (2022)Cite this article

Subjects

Abstract

Background

Epidemiological studies on the relationship between dietary glycemic index (GI), glycemic load (GL) and all-cause and cause-specific mortality yielded conflict results. We aimed to assess these associations in Chinese.

Methods

We conducted this study based on two prospective cohort studies in Shanghai. Dietary information was collected using validated cohort-specific food frequency questionnaires. We used Cox regression model to estimate the hazard ratios (HR) for mortality associated with GI and GL.

Results

After median follow-up periods of 12.8 years for 59,770 men and 18.2 years for 74,735 women, 8,711 deaths in men and 10,501 deaths in women were documented. After we controlled the potential confounders, dietary GI, GL, and carbohydrate intake were associated with a higher risk of cardiovascular disease (CVD) mortality (P values for trend = 0.025, 0.001, and 0.001). Dietary GI was associated with lower risk of total and cause-specific mortality in men in the second quartile (Q) (all-cause mortality: HR Q2 vs. Q1 = 0.89, 95%CI: 0.84, 0.95). Dietary GL was associated with lower risk of cancer mortality but higher risk of CVD mortality in men. In women, dietary GI was associated with mortality due to all-cause (HRMax Q4 vs. Q1 = 1.10, 95%CI: 1.04, 1.06), cancer (HRMax Q4 vs. Q1 = 1.12, 95%CI: 1.02, 1.23), and CVD (HRMax Q4 vs. Q1 = 1.10, 95%CI: 1.00, 1.22).

Conclusions

The present study indicates that diet with higher GI and GL was associated with an increased risk of CVD mortality in Chinese adults. The association may vary for men and women, which need further investigating in other Asian populations.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Seidelmann SB, Claggett B, Cheng S, Henglin M, Shah A, Steffen LM, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health. 2018;3:e419–e428.

    Article  Google Scholar 

  2. Mazidi M, Katsiki N, Mikhailidis DP, Sattar N, Banach M. Lower carbohydrate diets and all-cause and cause-specific mortality: a population-based cohort study and pooling of prospective studies. Eur Heart J. 2019;40:2870–9.

    Article  CAS  Google Scholar 

  3. Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM, et al. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr. 1981;34:362–6.

    Article  CAS  Google Scholar 

  4. Salmeron J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC. Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA. 1997;277:472–7.

    Article  CAS  Google Scholar 

  5. Ludwig DS. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA. 2002;287:2414–23.

    Article  CAS  Google Scholar 

  6. Sieri S, Krogh V, Agnoli C, Ricceri F, Palli D, Masala G, et al. Dietary glycemic index and glycemic load and risk of colorectal cancer: results from the EPIC-Italy study. Int J Cancer. 2015;136:2923–31.

    Article  CAS  Google Scholar 

  7. Amadou A, Degoul J, Hainaut P, Chajes V, Biessy C, Torres Mejia G, et al. Dietary carbohydrate, glycemic index, glycemic load, and breast cancer risk among Mexican women. Epidemiology. 2015;26:917–24.

    Article  Google Scholar 

  8. Xu WH, Xiang YB, Zhang X, Ruan Z, Cai H, Zheng W. et al. Association of dietary glycemic index and glycemic load with endometrial cancer risk among Chinese women. Nutr Cancer. 2015;67:89–97.

    Article  CAS  Google Scholar 

  9. Turati F, Galeone C, Gandini S, Augustin LS, Jenkins DJ, Pelucchi C, et al. High glycemic index and glycemic load are associated with moderately increased cancer risk. Mol Nutr Food Res. 2015;59:1384–94.

    Article  CAS  Google Scholar 

  10. Turati F, Galeone C, Augustin LSA, La Vecchia C. Glycemic index, glycemic load and cancer risk: an updated meta-analysis. Nutrients. 2019;11:2342.

    Article  Google Scholar 

  11. Bhupathiraju SN, Tobias DK, Malik VS, Pan A, Hruby A, Manson JE, et al. Glycemic index, glycemic load, and risk of type 2 diabetes: results from 3 large US cohorts and an updated meta-analysis. Am J Clin Nutr. 2014;100:218–32.

    Article  CAS  Google Scholar 

  12. Livesey G, Taylor R, Livesey HF, Buyken AE, Jenkins DJA, Augustin LSA, et al. Dietary glycemic index and load and the risk of type 2 diabetes: a systematic review and updated meta-analyses of prospective cohort studies. Nutrients. 2019;11:1280.

    Article  Google Scholar 

  13. Mirrahimi A, Chiavaroli L, Srichaikul K, Augustin LS, Sievenpiper JL, Kendall CW, et al. The role of glycemic index and glycemic load in cardiovascular disease and its risk factors: a review of the recent literature. Curr Atheroscler Rep. 2014;16:381.

    Article  Google Scholar 

  14. Yu D, Shu XO, Li H, Xiang YB, Yang G, Gao YT, et al. Dietary carbohydrates, refined grains, glycemic load, and risk of coronary heart disease in Chinese adults. Am J Epidemiol. 2013;178:1542–9.

    Article  Google Scholar 

  15. Jayedi A, Soltani S, Jenkins D, Sievenpiper J, Shab-Bidar S. Dietary glycemic index, glycemic load, and chronic disease: an umbrella review of meta-analyses of prospective cohort studies. Crit Rev Food Sci Nutr. 2020:1–10.

  16. Castro-Quezada I, Sanchez-Villegas A, Estruch R, Salas-Salvado J, Corella D, Schroder H, et al. A high dietary glycemic index increases total mortality in a Mediterranean population at high cardiovascular risk. PLoS One. 2014;9:e107968.

    Article  Google Scholar 

  17. Baer HJ, Glynn RJ, Hu FB, Hankinson SE, Willett WC, Colditz GA, et al. Risk factors for mortality in the Nurses’ Health Study: a competing risks analysis. Am J Epidemiol. 2010;173:319–29.

    Article  Google Scholar 

  18. Levitan EB, Mittleman MA, Hakansson N, Wolk A. Dietary glycemic index, dietary glycemic load, and cardiovascular disease in middle-aged and older Swedish men. Am J Clin Nutr. 2007;85:1521–6.

    Article  CAS  Google Scholar 

  19. Nagata C, Wada K, Tsuji M, Kawachi T, Nakamura K. Dietary glycaemic index and glycaemic load in relation to all-cause and cause-specific mortality in a Japanese community: the Takayama study. Br J Nutr. 2014;112:2010–7.

    Article  CAS  Google Scholar 

  20. Burger KN, Beulens JW, van der Schouw YT, Sluijs I, Spijkerman AM, Sluik D, et al. Dietary fiber, carbohydrate quality and quantity, and mortality risk of individuals with diabetes mellitus. PLoS One. 2012;7:e43127.

    Article  CAS  Google Scholar 

  21. Belle FN, Kampman E, McTiernan A, Bernstein L, Baumgartner K, Baumgartner R, et al. Dietary fiber, carbohydrates, glycemic index, and glycemic load in relation to breast cancer prognosis in the HEAL cohort. Cancer Epidemiol Biomark Prev. 2011;20:890–9.

    Article  CAS  Google Scholar 

  22. Levitan EB, Mittleman MA, Wolk A. Dietary glycemic index, dietary glycemic load and mortality among men with established cardiovascular disease. Eur J Clin Nutr. 2009;63:552–7.

    Article  CAS  Google Scholar 

  23. Shu XO, Li H, Yang G, Gao J, Cai H, Takata Y, et al. Cohort profile: the Shanghai Men’s Health Study. Int J Epidemiol. 2015;44:810–8.

    Article  Google Scholar 

  24. Zheng W, Chow WH, Yang G, Jin F, Rothman N, Blair A, et al. The Shanghai Women’s Health Study: rationale, study design, and baseline characteristics. Am J Epidemiol. 2005;162:1123–31.

    Article  Google Scholar 

  25. Villegas R, Yang G, Liu D, Xiang YB, Cai H, Zheng W, et al. Validity and reproducibility of the food-frequency questionnaire used in the Shanghai men’s health study. Br J Nutr. 2007;97:993–1000.

    Article  CAS  Google Scholar 

  26. Shu XO, Yang G, Jin F, Liu D, Kushi L, Wen W, et al. Validity and reproducibility of the food frequency questionnaire used in the Shanghai Women’s Health Study. Eur J Clin Nutr. 2004;58:17–23.

    Article  CAS  Google Scholar 

  27. Yang YX, Wang GY, Pan XC. China Food Composition Tables 2002, Beijing University Medical Press: Beijing, China, 2002.

  28. Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr. 2002;76:5–56.

    Article  CAS  Google Scholar 

  29. Miller JB, Pang E, Broomhead L. The glycaemic index of foods containing sugars: comparison of foods with naturally-occurring v. added sugars. Br J Nutr. 1995;73:613–23.

    Article  CAS  Google Scholar 

  30. Wolever TM, Jenkins DJ, Jenkins AL, Josse RG. The glycemic index: methodology and clinical implications. Am J Clin Nutr. 1991;54:846–54.

    Article  CAS  Google Scholar 

  31. World Health Organization. International Classification of Diseases: Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. Ninth Revision., World Health Organization: Geneva, Switzerland, 1977.

  32. Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr. 1997;65:1220S–8S.

    Article  CAS  Google Scholar 

  33. Schoenfeld D. Partial residuals for the proportional hazards regression model. Biometrika. 1982;69:239–41.

    Article  Google Scholar 

  34. Desquilbet L, Mariotti F. Dose-response analyses using restricted cubic spline functions in public health research. Stat Med. 2010;29:1037–57.

    PubMed  Google Scholar 

  35. Mekary RA, Rimm EB, Giovannucci E, Stampfer MJ, Willett WC, Ludwig DS, et al. Joint association of glycemic load and alcohol intake with type 2 diabetes incidence in women. Am J Clin Nutr. 2011;94:1525–32.

    Article  CAS  Google Scholar 

  36. Oba S, Nagata C, Nakamura K, Fujii K, Kawachi T, Takatsuka N, et al. Dietary glycemic index, glycemic load, and intake of carbohydrate and rice in relation to risk of mortality from stroke and its subtypes in Japanese men and women. Metabolism. 2010;59:1574–82.

    Article  CAS  Google Scholar 

  37. Jenkins DJA, Dehghan M, Mente A, Bangdiwala SI, Rangarajan S, Srichaikul K, et al. Glycemic index, glycemic load, and cardiovascular disease and mortality. N Engl J Med. 2021;384:1312–22.

    Article  CAS  Google Scholar 

  38. Coleman HG, Kitahara CM, Murray LJ, Dodd KW, Black A, Stolzenberg-Solomon RZ, et al. Dietary carbohydrate intake, glycemic index, and glycemic load and endometrial cancer risk: a prospective cohort study. Am J Epidemiol. 2014;179:75–84.

    Article  Google Scholar 

  39. Li H, Liu H, Chen J, Li L, Wang H, Li J, et al. Relationship between glycemic load and blood lipid level in hospitalized adult Chinese. Iran J Public Health. 2015;44:318–24.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Sluijs I, Beulens JW, van der Schouw YT, van der AD, Buckland G, Kuijsten A, et al. Dietary glycemic index, glycemic load, and digestible carbohydrate intake are not associated with risk of type 2 diabetes in eight European countries. J Nutr. 2013;143:93–9.

    Article  CAS  Google Scholar 

  41. Sacks FM, Carey VJ, Anderson CAM, Miller ER, Copeland T, Charleston J, et al. Effects of high vs low glycemic index of dietary carbohydrate on cardiovascular disease risk factors and insulin sensitivity. JAMA. 2014;312:2531–41.

    Article  Google Scholar 

  42. Vogtmann E, Li HL, Shu XO, Chow WH, Ji BT, Cai H, et al. Dietary glycemic load, glycemic index, and carbohydrates on the risk of primary liver cancer among Chinese women and men. Ann Oncol. 2013;24:238–44.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to thank the participants and the staff from the Shanghai Women’s and Men’s Health Studies for their contribution to this research.

Funding

This work was supported by the fund of National Key Project of Research and Development Program of China [2021YFC2500404, 2016YFC1302503], and parent cohorts were supported by the grants from US National Institutes of Health [UM1 CA182910, UM1 CA173640].

Author information

Author notes

  1. These authors contributed equally: Long-Gang Zhao, Hong-Lan Li.

Authors and Affiliations

  1. State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Long-Gang Zhao, Hong-Lan Li, Da-Ke Liu, Jie Fang, Jing Wang, Yu-Ting Tan & Yong-Bing Xiang

Authors
  1. Long-Gang Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hong-Lan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Da-Ke Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jie Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yu-Ting Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yong-Bing Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Y-BX designed the study; H-LL, D-KL, JF, JW, Y-TT and Y-BX collected the data; L-GZ and H-LL analyzed data; L-GZ, H-LL, and Y-BX interpreted the data; L-GZ drafted first manuscript; Y-BX had the primary responsibility for the final content of the manuscript; all authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Yong-Bing Xiang.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhao, LG., Li, HL., Liu, DK. et al. Dietary glycemic index, glycemic load, and cause-specific mortality: two population-based prospective cohort studies. Eur J Clin Nutr 76, 1142–1149 (2022). https://doi.org/10.1038/s41430-022-01083-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-022-01083-9

Search

Advanced search

Quick links