title: Glycemic load and coronary heart disease in a Mediterranean population: the EPIC Greek cohort study.
abstract: OBJECTIVE
  High glycemic load (GL) has been associated with increased coronary heart disease (CHD) risk. We evaluated whether preference of low-GL foods conveys incremental benefits with respect to CHD, especially to people adhering to the traditional Mediterranean diet (MD).
  
  
  RESULTS
  We analyzed data from the Greek European Prospective Investigation into Cancer and Nutrition, including 20,275 participants free of cardiovascular diseases, cancer, or diabetes at baseline and without incident diabetes. Subjects completed a validated, semi-quantitative food frequency questionnaire at enrollment. We calculated a 10-point MD adherence score and the dietary GL, and estimated hazard ratios (HRs) for CHD incidence and mortality through Cox proportional hazard regression. After a median follow-up of 10.4 years, 417 participants developed CHD, and 162 died from the disease. A significant positive association of GL with CHD incidence emerged (HR for the highest versus the lowest tertile = 1.41, 95% confidence interval, CI: 1.05-1.90). HRs for CHD mortality exceeded unity but were not statistically significant. The association with GL was stronger among subjects with higher body mass index. High adherence to MD with low/moderate GL was associated with lower risk of CHD incidence (HR = 0.61, CI: 0.39-0.95) and mortality (HR = 0.47, 95% CI: 0.23-96).
  
  
  CONCLUSIONS
  High dietary GL increases the risk of CHD. Compared to a high GL diet with suboptimal adherence to the traditional Mediterranean pattern, a low/moderate GL diet that also conforms to the traditional MD principles could lead to a 40% reduced risk for CHD, and over 50% reduced risk for death from CHD.
authors: Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors: F
authors: F
authors: Turati
authors: Hellenic Health Foundation, Athens, Greece.
authors: V
authors: V
authors: Dilis
authors: Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors: M
authors: M
authors: Rossi
authors: Hellenic Health Foundation, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece; Department of Epidemiology, Harvard School of Public Health, Boston, USA; Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
authors: P
authors: P
authors: Lagiou
authors: Hellenic Health Foundation, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece.
authors: V
authors: V
authors: Benetou
authors: Hellenic Health Foundation, Athens, Greece.
authors: M
authors: M
authors: Katsoulis
authors: Hellenic Health Foundation, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece.
authors: A
authors: A
authors: Naska
authors: Hellenic Health Foundation, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece; Department of Epidemiology, Harvard School of Public Health, Boston, USA; Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
authors: D
authors: D
authors: Trichopoulos
authors: Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Vanzetti 5, 20133 Milan, Italy. Electronic address: lavecchia@unimi.it.
authors: C
authors: C
authors: La Vecchia
authors: Hellenic Health Foundation, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece; Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
authors: A
authors: A
authors: Trichopoulou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000178:diet therapy* / Q000401:mortality*; D038441:Diet, Mediterranean; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D000067940:Glycemic Load; D006115:Greece; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D044465:White People; D055815:Young Adult
keywords: Cohort study; Coronary heart diseases; Diet; Glycemic load; Mediterranean diet