title: A high dietary glycemic index increases total mortality in a Mediterranean population at high cardiovascular risk.
abstract: OBJECTIVE
  Different types of carbohydrates have diverse glycemic response, thus glycemic index (GI) and glycemic load (GL) are used to assess this variation. The impact of dietary GI and GL in all-cause mortality is unknown. The objective of this study was to estimate the association between dietary GI and GL and risk of all-cause mortality in the PREDIMED study.
  
  
  METHODS
  The PREDIMED study is a randomized nutritional intervention trial for primary cardiovascular prevention based on community-dwelling men and women at high risk of cardiovascular disease. Dietary information was collected at baseline and yearly using a validated 137-item food frequency questionnaire (FFQ). We assigned GI values of each item by a 5-step methodology, using the International Tables of GI and GL Values. Deaths were ascertained through contact with families and general practitioners, review of medical records and consultation of the National Death Index. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) and their 95% CI for mortality, according to quartiles of energy-adjusted dietary GI/GL. To assess repeated measures of exposure, we updated GI and GL intakes from the yearly FFQs and used Cox models with time-dependent exposures.
  
  
  RESULTS
  We followed 3,583 non-diabetic subjects (4.7 years of follow-up, 123 deaths). As compared to participants in the lowest quartile of baseline dietary GI, those in the highest quartile showed an increased risk of all-cause mortality [HR = 2.15 (95% CI: 1.15-4.04); P for trend  = 0.012]. In the repeated-measures analyses using as exposure the yearly updated information on GI, we observed a similar association. Dietary GL was associated with all-cause mortality only when subjects were younger than 75 years.
  
  
  CONCLUSIONS
  High dietary GI was positively associated with all-cause mortality in elderly population at high cardiovascular risk.
authors.affiliation: Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
authors.forename: Itandehui
authors.initials: I
authors.lastname: Castro-Quezada
authors.affiliation: Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain.
authors.forename: Almudena
authors.initials: A
authors.lastname: Sánchez-Villegas
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Internal Medicine, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Estruch
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Human Nutrition Department, School of Medicine, University Rovira i Virgili, Reus, Tarragona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Salas-Salvadó
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Preventive Medicine, School of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Corella
authors.affiliation: Cardiovascular Risk and Nutrition Research Group, Institut Municipal d'Investigació Medica (IMIM)-Institut de Recerca del Hospital del Mar, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain.
authors.forename: Helmut
authors.initials: H
authors.lastname: Schröder
authors.affiliation: Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Alvarez-Pérez
authors.affiliation: Department of Nutrition and Food Science, School of Pharmacy, University of Granada, Granada, Spain; Institute of Nutrition and Food Technologies, University of Granada. Armilla, Granada, Spain.
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Ruiz-López
authors.affiliation: Department of Nutrition and Food Science, School of Pharmacy, University of Granada, Granada, Spain.
authors.forename: Reyes
authors.initials: R
authors.lastname: Artacho
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Lipid Clinic, Endocrinology and Nutrition Service, Hospital Clinic, l'Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Ros
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Human Nutrition Department, School of Medicine, University Rovira i Virgili, Reus, Tarragona, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Bulló
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Cardiovascular Risk and Nutrition Research Group, Institut Municipal d'Investigació Medica (IMIM)-Institut de Recerca del Hospital del Mar, Barcelona, Spain.
authors.forename: María-Isabel
authors.initials: MI
authors.lastname: Covas
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Group of Nutrition and Lipid Metabolism, Instituto de la Grasa (CSIC), Seville, Spain.
authors.forename: Valentina
authors.initials: V
authors.lastname: Ruiz-Gutiérrez
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine - Clinica Universitaria de Navarra, University of Navarra, Pamplona, Navarra, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruiz-Canela
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine - Clinica Universitaria de Navarra, University of Navarra, Pamplona, Navarra, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Buil-Cosiales
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Preventive Medicine, School of Medicine, University of Malaga, Malaga, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gómez-Gracia
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Family Medicine, Primary Care Division of Sevilla, San Pablo Health Center, Sevilla, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Lapetra
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Internal Medicine Service, Hospital of Bellvitge, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pintó
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Cardiology, Hospital Txagorritxu, Vitoria, Alava, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; University Institute for Health Sciences Investigation, University of Balearic Islands, Palma de Mallorca, Spain; Department of Cardiology, Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Nutrition and Bromatology, School of Pharmacy, University of Barcelona, Barcelona, Spain.
authors.forename: Rosa María
authors.initials: RM
authors.lastname: Lamuela-Raventós
authors.affiliation: Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine - Clinica Universitaria de Navarra, University of Navarra, Pamplona, Navarra, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Martínez-González
authors.affiliation: Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain.
authors.forename: Lluís
authors.initials: L
authors.lastname: Serra-Majem
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications* / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality; D002423:Cause of Death; D004032:Diet / Q000009:adverse effects*; D004040:Dietary Carbohydrates / Q000009:adverse effects; D005247:Feeding Behavior; D005260:Female; D038321:Glycemic Index; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D004040:Dietary Carbohydrates