title: Dietary glycemic load and glycemic index and risk of cerebrovascular disease in the EPICOR cohort.
abstract: BACKGROUND
  Studies on the association of stroke risk to dietary glycemic index (GI) and glycemic load (GL) have produced contrasting results.
  
  
  OBJECTIVE
  To investigate the relation of dietary GI and GL to stroke risk in the large EPIC-Italy cohort (EPICOR) recruited from widely dispersed geographic areas of Italy.
  
  
  METHODS
  We studied 44099 participants (13,646 men and 30,453 women) who completed a dietary questionnaire. Multivariable Cox modeling estimated adjusted hazard ratios (HRs) of stroke with 95% confidence intervals (95%CI). Over 11 years of follow-up, 355 stroke cases (195 ischemic and 83 hemorrhagic) were identified.
  
  
  RESULTS
  Increasing carbohydrate intake was associated with increasing stroke risk (HR = 2.01, 95%CI = 1.04-3.86 highest vs. lowest quintile; p for trend 0.025). Increasing carbohydrate intake from high-GI foods was also significantly associated with increasing stroke risk (HR 1.87, 95%CI = 1.16-3.02 highest vs. lowest, p trend 0.008), while increasing carbohydrate intake from low-GI foods was not. Increasing GL was associated with significantly increasing stroke risk (HR 2.21, 95%CI = 1.16-4.20, highest vs. lowest; p trend 0.015). Dietary carbohydrate from high GI foods was associated with increased both ischemic stroke risk (highest vs. lowest HR 1.92, 95%CI = 1.01-3.66) and hemorrhagic stroke risk (highest vs. lowest HR 3.14, 95%CI = 1.09-9.04). GL was associated with increased both ischemic and hemorrhagic stroke risk (HR 1.44, 95%CI = 1.09-1.92 and HR 1.56, 95%CI = 1.01-2.41 respectively, continuous variable).
  
  
  CONCLUSIONS
  In this Italian cohort, high dietary GL and carbohydrate from high GI foods consumption increase overall risk of stroke.
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. sabina.sieri@istitutotumori.mi.it
authors.forename: Sabina
authors.initials: S
authors.lastname: Sieri
authors.forename: Furio
authors.initials: F
authors.lastname: Brighenti
authors.forename: Claudia
authors.initials: C
authors.lastname: Agnoli
authors.forename: Sara
authors.initials: S
authors.lastname: Grioni
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bendinelli
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.forename: Fulvio
authors.initials: F
authors.lastname: Ricceri
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Giurdanella
authors.forename: Valeria
authors.initials: V
authors.lastname: Pala
authors.forename: Franco
authors.initials: F
authors.lastname: Berrino
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000209:etiology* / Q000401:mortality; D015331:Cohort Studies; D004032:Diet; D004040:Dietary Carbohydrates / Q000009:adverse effects*; D005260:Female; D038321:Glycemic Index; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D004040:Dietary Carbohydrates