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Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes: A Systematic Review and Updated Meta-Analyses of Prospective Cohort Studies.

Independent Nutrition Logic Ltd, 21 Bellrope Lane, Wymondham NR180QX, UK. glivesey@inlogic.co.uk. Independent Nutrition Logic Ltd, 21 Bellrope Lane, Wymondham NR180QX, UK. richard.mi.taylor1@gmail.com. Independent Nutrition Logic Ltd, 21 Bellrope Lane, Wymondham NR180QX, UK. helenlivesey@inlogic.co.uk. Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University,33098 Paderborn, Germany. anette.buyken@uni-paderborn.de. Department of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada. david.jenkins@utoronto.ca. Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. david.jenkins@utoronto.ca. Division of Endocrinology & Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. david.jenkins@utoronto.ca. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. david.jenkins@utoronto.ca. Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. livia.augustin@utoronto.ca. Epidemiology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", 80131 Napoli, Italy. livia.augustin@utoronto.ca. Department of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada. john.sievenpiper@alumni.utoronto.ca. Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. john.sievenpiper@alumni.utoronto.ca. Division of Endocrinology & Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. john.sievenpiper@alumni.utoronto.ca. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. john.sievenpiper@alumni.utoronto.ca. Glycemic Index Foundation, 26 Arundel St, Glebe, NSW 2037 Sydney, Australia. alanb@gifoundation.org.au. Department of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA. simin_liu@brown.edu. Department of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada. thomas.wolever@utoronto.ca. Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. thomas.wolever@utoronto.ca. Departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health and Harvard Medical School, Boston, MA 02115, USA. wwillett@hsph.harvard.edu. Department of Food and Drug, University of Parma, 43120 Parma, Italy. furio.brighenti@unipr.it. Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili (IISPV), Rovira i Virgili University, 43201 Reus, Spain. jordi.salas@urv.cat. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 27400 Madrid, Spain. jordi.salas@urv.cat. Retired from Food for Health Science Centre, Antidiabetic Food Centre, Lund University, S-221 00 Lund, Sweden. inger@innovafood.se. Institute of Cardiometabolism and Nutrition, ICAN, Pitié Salpêtrière Hospital, F75013 Paris, France. salwa.rizkalla3@gmail.com. Department of Clinical Medicine and Surgery, Federico II University, 80147 Naples, Italy. riccardi@unina.it. Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 201330 Milan, Italy. carlo.lavecchia@unimi.it. IRCCS MultiMedica, Diabetes Department, 20099 Sesto San Giovanni, Milan, Italy. ACERIELL@clinic.cat. Hellenic Health Foundation, Alexandroupoleos 23, 11527 Athens, Greece. atrichopoulou@hhf-greece.gr. Nutrition Foundation of Italy, Viale Tunisia 38, I-20124 Milan, Italy. poli@nutrition-foundation.it. Department of Nutrition, Exercise and Sports (NEXS) Faculty of Science, University of Copenhagen, 2200 Copenhagen, Denmark. ast@nexs.ku.dk. Department of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada. cyril.kendall@utoronto.ca. Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. cyril.kendall@utoronto.ca. College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5B5, Canada. cyril.kendall@utoronto.ca. Spinney Nutrition, Shirwell, Barnstaple, Devon EX31 4JR, UK. nutrition@thespinney.co.uk. Oldways, Boston, MA 02116, USA. sara@oldwayspt.org. Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney NSW 2006, Australia. jennie.brandmiller@sydney.edu.au.

Nutrients. 2019;(6)
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Abstract

Published meta-analyses indicate significant but inconsistent incident type-2 diabetes(T2D)-dietary glycemic index (GI) and glycemic load (GL) risk ratios or risk relations (RR). It is nowover a decade ago that a published meta-analysis used a predefined standard to identify validstudies. Considering valid studies only, and using random effects dose-response meta-analysis(DRM) while withdrawing spurious results (p < 0.05), we ascertained whether these relationswould support nutrition guidance, specifically for an RR > 1.20 with a lower 95% confidence limit>1.10 across typical intakes (approximately 10th to 90th percentiles of population intakes). Thecombined T2D-GI RR was 1.27 (1.15-1.40) (p < 0.001, n = 10 studies) per 10 units GI, while that forthe T2D-GL RR was 1.26 (1.15-1.37) (p < 0.001, n = 15) per 80 g/d GL in a 2000 kcal (8400 kJ) diet.The corresponding global DRM using restricted cubic splines were 1.87 (1.56-2.25) (p < 0.001, n =10) and 1.89 (1.66-2.16) (p < 0.001, n = 15) from 47.6 to 76.1 units GI and 73 to 257 g/d GL in a 2000kcal diet, respectively. In conclusion, among adults initially in good health, diets higher in GI or GLwere robustly associated with incident T2D. Together with mechanistic and other data, thissupports that consideration should be given to these dietary risk factors in nutrition advice.Concerning the public health relevance at the global level, our evidence indicates that GI and GLare substantial food markers predicting the development of T2D worldwide, for persons ofEuropean ancestry and of East Asian ancestry.

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Publication Type : Meta-Analysis

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