title: Dietary glycemic index, glycemic load, and refined carbohydrates are associated with risk of stroke: a prospective cohort study in urban Chinese women.
abstract: Epidemiologic evidence on dietary carbohydrates and stroke risk remains controversial. Very few prospective cohort studies have been conducted in Asian populations, who usually consume a high-carbohydrate diet and have a high burden of stroke.
  
  
  
  We examined dietary glycemic index (GI), glycemic load (GL), and intakes of refined and total carbohydrates in relation to risks of total, ischemic, and hemorrhagic stroke and stroke mortality.
  
  
  
  This study included 64,328 Chinese women, aged 40-70 y, with no history of cardiovascular disease, diabetes, or cancer. A validated, interviewer-administered food-frequency questionnaire was used to assess usual dietary intakes at baseline and during follow-up. Incident stroke cases and deaths were identified via follow-up interviews and death registries and were confirmed by review of medical records and death certificates.
  
  
  
  During mean follow-ups of 10 y for stroke incidence and 12 y for stroke mortality, we ascertained 2991 stroke cases (2750 ischemic and 241 hemorrhagic) and 609 stroke deaths. After potential confounders were controlled for, we observed significant positive associations of dietary GI and GL with total stroke risk; multivariable-adjusted HRs (95% CIs) for high compared with low levels (90th compared with 10th percentile) were 1.19 (1.04, 1.36) for GI and 1.27 (1.04, 1.54) for GL (both P-linearity < 0.05 and P-overall significance < 0.05). Similar linear associations were found for ischemic stroke, but the associations with hemorrhagic stroke appeared to be J-shaped. Similar trends of positive associations with stroke risks were suggested for refined carbohydrates but not for total carbohydrates. No significant associations were found for stroke mortality after multivariable adjustment.
  
  
  
  Our results suggest that high dietary GI and GL, primarily due to high intakes of refined grains, are associated with increased risks of total, ischemic, and hemorrhagic stroke in middle-aged and older urban Chinese women.
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Danxia
authors.initials: D
authors.lastname: Yu
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.|Tennessee Department of Health, Nashville, TN.
authors.forename: Xianglan
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Xiao-Ou
authors.initials: XO
authors.lastname: Shu
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Hui
authors.initials: H
authors.lastname: Cai
authors.affiliation: Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; and.
authors.forename: Honglan
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Ding
authors.initials: D
authors.lastname: Ding
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Hong
authors.affiliation: Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; and.
authors.forename: Yong-Bing
authors.initials: YB
authors.lastname: Xiang
authors.affiliation: Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; and.
authors.forename: Yu-Tang
authors.initials: YT
authors.lastname: Gao
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Wei
authors.initials: W
authors.lastname: Zheng
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; gong.yang@vanderbilt.edu.
authors.forename: Gong
authors.initials: G
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D002681:China; D004032:Diet; D004040:Dietary Carbohydrates / Q000009:adverse effects* / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D038321:Glycemic Index; D000067940:Glycemic Load; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014505:Urban Population
chemical_list: D004040:Dietary Carbohydrates
keywords: dietary carbohydrates; glycemic index; glycemic load; prospective cohort; stroke