title: High dietary glycemic load and glycemic index increase risk of cardiovascular disease among middle-aged women: a population-based follow-up study.
abstract: OBJECTIVE
  The goal of this work was to assess whether high dietary glycemic load and glycemic index are associated with an increased risk of cardiovascular disease (CVD).
  
  
  BACKGROUND
  The associations of dietary glycemic index and glycemic load with risk of CVD are not well established, particularly in populations consuming modest glycemic load diets. Moreover, risk may differ between lean and overweight subjects.
  
  
  METHODS
  Associations of glycemic index and glycemic load with incident CVD were examined in a prospective cohort of 15,714 Dutch women age 49 to 70 years without diabetes or CVD. Dietary glycemic index and glycemic load were calculated using the glycemic index, carbohydrate content, and frequency of intake of individual foods.
  
  
  RESULTS
  During 9 +/- 2 years of follow-up, 556 cases of coronary heart disease (CHD) and 243 cases of cerebrovascular accident (CVA) occurred. Dietary glycemic load (mean = 100; SD = 17) was associated with increased risk of CVD, adjusted for CVD risk factors and dietary variables, with a hazard ratio (HR) for the highest against lowest quartile of 1.47 (95% confidence interval [CI] 1.04 to 2.09; p(trend) = 0.03). Similar results were observed for dietary glycemic index with a corresponding HR of 1.33 (95% CI 1.07 to 1.67; p(trend) = 0.02). Glycemic load tended to be associated with both CHD (HR 1.44; 95% CI 0.95 to 2.19; p(trend) = 0.14) and CVA (HR 1.55; 95% CI 0.81 to 2.97; p(trend) = 0.10), but glycemic index only with CHD (HR 1.44; 95% CI 1.10 to 1.89; p(trend) = 0.01). Among overweight women (body mass index >25 kg/m2), glycemic load was associated with CVD (1.78; 95% CI 1.11 to 2.85; p(trend) = 0.04), but not among normal weight women (p(interaction) = 0.19). Body mass index did not modify the association of glycemic index with CVD.
  
  
  CONCLUSIONS
  Among women consuming modest glycemic load diets, high dietary glycemic load and glycemic index increase the risk of CVD, particularly for overweight women.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. J.Beulens@umcutrecht.nl
authors.forename: Joline W J
authors.initials: JW
authors.lastname: Beulens
authors.forename: Leonie M
authors.initials: LM
authors.lastname: de Bruijne
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Stolk
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
mesh_terms: D017677:Age Distribution; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D015331:Cohort Studies; D016001:Confidence Intervals; D004040:Dietary Carbohydrates / Q000009:adverse effects*; D004734:Energy Metabolism; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D038321:Glycemic Index; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015596:Nutrition Assessment; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates