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Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes: A Systematic Review and Updated Meta-Analyses of Prospective Cohort Studies

Independent Nutrition Logic Ltd, 21 Bellrope Lane, Wymondham NR180QX, UK
Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, 33098 Paderborn, Germany
Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
Division of Endocrinology & Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
Epidemiology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Napoli, Italy
Glycemic Index Foundation, 26 Arundel St, Glebe, NSW 2037 Sydney, Australia
Department of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
Departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health and Harvard Medical School, Boston, MA 02115, USA
Department of Food and Drug, University of Parma, 43120 Parma, Italy
Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Institut d’Investigació Sanitària Pere Virgili (IISPV), Rovira i Virgili University, 43201 Reus, Spain
Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 27400 Madrid, Spain
Retired from Food for Health Science Centre, Antidiabetic Food Centre, Lund University, S-221 00 Lund, Sweden
Institute of Cardiometabolism and Nutrition, ICAN, Pitié Salpêtrière Hospital, F75013 Paris, France
Department of Clinical Medicine and Surgery, Federico II University, 80147 Naples, Italy
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 201330 Milan, Italy
IRCCS MultiMedica, Diabetes Department, Sesto San Giovanni, 20099 Milan, Italy
Hellenic Health Foundation, Alexandroupoleos 23, 11527 Athens, Greece
Nutrition Foundation of Italy, Viale Tunisia 38, I-20124 Milan, Italy
Department of Nutrition, Exercise and Sports (NEXS) Faculty of Science, University of Copenhagen, 2200 Copenhagen, Denmark
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5B5, Canada
Spinney Nutrition, Shirwell, Barnstaple, Devon EX31 4JR, UK
Oldways, Boston, MA 02116, USA
Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney NSW 2006, Australia
Author to whom correspondence should be addressed.
Nutrients 2019, 11(6), 1280;
Received: 2 May 2019 / Revised: 28 May 2019 / Accepted: 30 May 2019 / Published: 5 June 2019
(This article belongs to the Special Issue The Relationship between Glycemic Index and Human Health)
Published meta-analyses indicate significant but inconsistent incident type-2 diabetes (T2D)-dietary glycemic index (GI) and glycemic load (GL) risk ratios or risk relations (RR). It is now over a decade ago that a published meta-analysis used a predefined standard to identify valid studies. Considering valid studies only, and using random effects dose–response meta-analysis (DRM) while withdrawing spurious results (p < 0.05), we ascertained whether these relations would support nutrition guidance, specifically for an RR > 1.20 with a lower 95% confidence limit >1.10 across typical intakes (approximately 10th to 90th percentiles of population intakes). The combined T2D–GI RR was 1.27 (1.15–1.40) (p < 0.001, n = 10 studies) per 10 units GI, while that for the T2D–GL RR was 1.26 (1.15–1.37) (p < 0.001, n = 15) per 80 g/d GL in a 2000 kcal (8400 kJ) diet. The corresponding global DRM using restricted cubic splines were 1.87 (1.56–2.25) (p < 0.001, n = 10) and 1.89 (1.66–2.16) (p < 0.001, n = 15) from 47.6 to 76.1 units GI and 73 to 257 g/d GL in a 2000 kcal diet, respectively. In conclusion, among adults initially in good health, diets higher in GI or GL were robustly associated with incident T2D. Together with mechanistic and other data, this supports that consideration should be given to these dietary risk factors in nutrition advice. Concerning the public health relevance at the global level, our evidence indicates that GI and GL are substantial food markers predicting the development of T2D worldwide, for persons of European ancestry and of East Asian ancestry. View Full-Text
Keywords: glycemic index; glycemic load; dietary fiber; protein; alcohol; type 2 diabetes; cohort studies; epidemiology; meta-analysis glycemic index; glycemic load; dietary fiber; protein; alcohol; type 2 diabetes; cohort studies; epidemiology; meta-analysis
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Livesey, G.; Taylor, R.; Livesey, H.F.; Buyken, A.E.; Jenkins, D.J.A.; Augustin, L.S.A.; Sievenpiper, J.L.; Barclay, A.W.; Liu, S.; Wolever, T.M.S.; Willett, W.C.; Brighenti, F.; Salas-Salvadó, J.; Björck, I.; Rizkalla, S.W.; Riccardi, G.; Vecchia, C.L.; Ceriello, A.; Trichopoulou, A.; Poli, A.; Astrup, A.; Kendall, C.W.C.; Ha, M.-A.; Baer-Sinnott, S.; Brand-Miller, J.C. 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.

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