title: Dietary glycemic index, glycemic load, and digestible carbohydrate intake are not associated with risk of type 2 diabetes in eight European countries.
abstract: The association of glycemic index (GI) and glycemic load (GL) with the risk of type 2 diabetes remains unclear. We investigated associations of dietary GI, GL, and digestible carbohydrate with incident type 2 diabetes. We performed a case-cohort study nested within the European Prospective Investigation into Cancer and Nutrition Study, including a random subcohort (n = 16,835) and incident type 2 diabetes cases (n = 12,403). The median follow-up time was 12 y. Baseline dietary intakes were assessed using country-specific dietary questionnaires. Country-specific HR were calculated and pooled using random effects meta-analysis. Dietary GI, GL, and digestible carbohydrate in the subcohort were (mean ± SD) 56 ± 4, 127 ± 23, and 226 ± 36 g/d, respectively. After adjustment for confounders, GI and GL were not associated with incident diabetes [HR highest vs. lowest quartile (HR(Q4)) for GI: 1.05 (95% CI = 0.96, 1.16); HR(Q4) for GL: 1.07 (95% CI = 0.95, 1.20)]. Digestible carbohydrate intake was not associated with incident diabetes [HR(Q4): 0.98 (95% CI = 0.86, 1.10)]. In additional analyses, we found that discrepancies in the GI value assignment to foods possibly explain differences in GI associations with diabetes within the same study population. In conclusion, an expansion of the GI tables and systematic GI value assignment to foods may be needed to improve the validity of GI values derived in such studies, after which GI associations may need reevaluation. Our study shows that digestible carbohydrate intake is not associated with diabetes risk and suggests that diabetes risk with high-GI and -GL diets may be more modest than initial studies suggested.
authors.affiliation: University Medical Center, Utrecht, The Netherlands. i.sluijs-2@umcutrecht.nl.
authors.forename: Ivonne
authors.initials: I
authors.lastname: Sluijs
authors.forename: Joline W J
authors.initials: JW
authors.lastname: Beulens
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.forename: Daphne L
authors.initials: DL
authors.lastname: van der A
authors.forename: Genevieve
authors.initials: G
authors.lastname: Buckland
authors.forename: Anneleen
authors.initials: A
authors.lastname: Kuijsten
authors.forename: Matthias B
authors.initials: MB
authors.lastname: Schulze
authors.forename: Pilar
authors.initials: P
authors.lastname: Amiano
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.forename: Beverley
authors.initials: B
authors.lastname: Balkau
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Diana
authors.initials: D
authors.lastname: Gavrila
authors.forename: Verena A
authors.initials: VA
authors.lastname: Grote
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Key
authors.forename: Kuanrong
authors.initials: K
authors.lastname: Li
authors.forename: Peter
authors.initials: P
authors.lastname: Nilsson
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.forename: J R
authors.initials: JR
authors.lastname: Quirós
authors.forename: Olov
authors.initials: O
authors.lastname: Rolandsson
authors.forename: Nina
authors.initials: N
authors.lastname: Roswall
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: Sabina
authors.initials: S
authors.lastname: Sieri
authors.forename: Nadia
authors.initials: N
authors.lastname: Slimani
authors.forename: Annemieke M W
authors.initials: AM
authors.lastname: Spijkerman
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Sharp
authors.forename: Claudia
authors.initials: C
authors.lastname: Langenberg
authors.forename: Edith J M
authors.initials: EJ
authors.lastname: Feskens
authors.forename: Nita G
authors.initials: NG
authors.lastname: Forouhi
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism*; D004032:Diet / Q000208:ethnology; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000378:metabolism*; D004063:Digestion; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005502:Food / Q000145:classification; D038321:Glycemic Index; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D004040:Dietary Carbohydrates