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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
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Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes: Assessment of Causal Relations

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Independent Nutrition Logic Ltd, 21 Bellrope Lane, Wymondham NR180QX, UK
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Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, 33098 Paderborn, Germany
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Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
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Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
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Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
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Epidemiology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Napoli, Italy
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Glycemic Index Foundation, 26 Arundel St, Glebe, Sydney NSW 2037, Australia
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Department of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
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Departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health and Harvard Medical School, Boston, MA 02115, USA
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Department of Food and Drug, University of Parma, 43120 Parma, Italy
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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
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Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 27400 Madrid, Spain
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Retired from Food for Health Science Centre, Antidiabetic Food Centre, Lund University, S-221 00 Lund, Sweden
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Institute of Cardiometabolism and Nutrition, ICAN, Pitié Salpêtrière Hospital, F75013 Paris, France
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Department of Clinical Medicine and Surgery, Federico II University, 80147 Naples, Italy
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Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 201330 Milan, Italy
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IRCCS MultiMedica, Diabetes Department, Sesto San Giovanni, 20099 Milan, Italy
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Hellenic Health Foundation, Alexandroupoleos 23, 11527 Athens, Greece
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Nutrition Foundation of Italy, Viale Tunisia 38, I-20124 Milan, Italy
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Department of Nutrition, Exercise and Sports (NEXS) Faculty of Science, University of Copenhagen, 2200 Copenhagen, Denmark
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College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5B5, Canada
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Spinney Nutrition, Shirwell, Barnstaple, Devon EX31 4JR, UK
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Oldways, Boston, MA 02116, USA
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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), 1436; https://doi.org/10.3390/nu11061436
Received: 3 May 2019 / Revised: 20 June 2019 / Accepted: 20 June 2019 / Published: 25 June 2019
(This article belongs to the Special Issue The Relationship between Glycemic Index and Human Health)
While dietary factors are important modifiable risk factors for type 2 diabetes (T2D), the causal role of carbohydrate quality in nutrition remains controversial. Dietary glycemic index (GI) and glycemic load (GL) have been examined in relation to the risk of T2D in multiple prospective cohort studies. Previous meta-analyses indicate significant relations but consideration of causality has been minimal. Here, the results of our recent meta-analyses of prospective cohort studies of 4 to 26-y follow-up are interpreted in the context of the nine Bradford-Hill criteria for causality, that is: (1) Strength of Association, (2) Consistency, (3) Specificity, (4) Temporality, (5) Biological Gradient, (6) Plausibility, (7) Experimental evidence, (8) Analogy, and (9) Coherence. These criteria necessitated referral to a body of literature wider than prospective cohort studies alone, especially in criteria 6 to 9. In this analysis, all nine of the Hill’s criteria were met for GI and GL indicating that we can be confident of a role for GI and GL as causal factors contributing to incident T2D. In addition, neither dietary fiber nor cereal fiber nor wholegrain were found to be reliable or effective surrogate measures of GI or GL. Finally, our cost–benefit analysis suggests food and nutrition advice favors lower GI or GL and would produce significant potential cost savings in national healthcare budgets. The high confidence in causal associations for incident T2D is sufficient to consider inclusion of GI and GL in food and nutrient-based recommendations. View Full-Text
Keywords: causation; diabetes; glycemic index; glycemic load; dietary fiber; alcohol; cohort studies; epidemiology; meta-analysis; public health causation; diabetes; glycemic index; glycemic load; dietary fiber; alcohol; cohort studies; epidemiology; meta-analysis; public health
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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: Assessment of Causal Relations. Nutrients 2019, 11, 1436.

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