title: Glycaemic index, carbohydrate substitution for fat and risk of CHD in men.
abstract: We have examined the associations between dietary glycaemic index (GI), substitutions of total, low-, medium- and high-GI carbohydrates for fat and the risk of CHD. The study consisted of 21 955 male smokers, aged 50-69 years, within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. The diet was assessed at baseline using a validated FFQ. During a 19-year follow-up, 4379 CHD cases (2377 non-fatal myocardial infarctions and 2002 CHD deaths) were identified from national registers. Relative risks (RR) and CI for CHD were analysed using Cox proportional hazards modelling, and multivariate nutrient density models were applied to examine the associations between the substitutions of macronutrients and the risk of CHD. Dietary GI was inversely associated with CHD risk: multivariate RR in the highest v. lowest quintile was 0·89 (95 % CI 0·81, 0·99). Replacement of higher-GI carbohydrates with lower-GI carbohydrates did not associate with the risk. Replacing saturated and trans-fatty acids with carbohydrates was associated with decreased CHD risk: RR for substitution of 2 % of energy intake was 0·97 (95 % CI 0·94, 0·99). On the contrary, replacing MUFA with carbohydrates was associated with an increased risk: RR for substitution of 2 % of energy intake was 1·08 (95 % CI 1·01, 1·16). We conclude that in the present study population, contrary to the hypothesis, a lower GI does not associate with a decreased risk of CHD. The associations of carbohydrates with CHD risk depend on the fatty acid composition of the diet.
authors.affiliation: Division of Welfare and Health Promotion, National Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland.
authors.forename: Minna E
authors.initials: ME
authors.lastname: Similä
authors.forename: Jukka P
authors.initials: JP
authors.lastname: Kontto
authors.forename: Satu
authors.initials: S
authors.lastname: Männistö
authors.forename: Liisa M
authors.initials: LM
authors.lastname: Valsta
authors.forename: Jarmo
authors.initials: J
authors.lastname: Virtamo
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D004032:Diet; D004034:Diet Surveys; D004040:Dietary Carbohydrates / Q000009:adverse effects / Q000378:metabolism / Q000494:pharmacology; D004041:Dietary Fats / Q000009:adverse effects / Q000494:pharmacology; D002149:Energy Intake; D005227:Fatty Acids / Q000009:adverse effects / Q000494:pharmacology; D005229:Fatty Acids, Monounsaturated / Q000494:pharmacology; D005500:Follow-Up Studies; D038321:Glycemic Index; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires; D044242:Trans Fatty Acids / Q000009:adverse effects
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D005227:Fatty Acids; D005229:Fatty Acids, Monounsaturated; D044242:Trans Fatty Acids