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Associations of the Glycaemic Index and the Glycaemic Load With Risk of Type 2 Diabetes in 127 594 People From 20 Countries (Pure): A Prospective Cohort Study Publisher Pubmed



Miller V1, 2 ; Jenkins DA3, 4, 5, 6, 7 ; Dehghan M1 ; Srichaikul K4 ; Rangarajan S1 ; Mente A1, 8 ; Mohan V9 ; Swaminathan S10 ; Ismail R11 ; Luz Diaz M12 ; Ravindran RM13, 14 ; Zatonska K15 ; Bahonar A16 ; Altuntas Y17 Show All Authors
Authors
  1. Miller V1, 2
  2. Jenkins DA3, 4, 5, 6, 7
  3. Dehghan M1
  4. Srichaikul K4
  5. Rangarajan S1
  6. Mente A1, 8
  7. Mohan V9
  8. Swaminathan S10
  9. Ismail R11
  10. Luz Diaz M12
  11. Ravindran RM13, 14
  12. Zatonska K15
  13. Bahonar A16
  14. Altuntas Y17
  15. Khatib R18, 19
  16. Lopezjaramillo P20
  17. Yusufali A21
  18. Yeates K22
  19. Chifamba J23
  20. Iqbal R24
  21. Yusuf R25
  22. Catherina Swart E26
  23. Bo H27
  24. Han G27
  25. Li X27
  26. Alhabib KF28
  27. Rosengren A29
  28. Avezum A30
  29. Lanas F31
  30. Yusuf S1, 2
Show Affiliations
Authors Affiliations
  1. 1. Population Health Research Institute, McMaster University, Hamilton, ON, Canada
  2. 2. Department of Medicine, McMaster University, Hamilton, ON, Canada
  3. 3. Department of Nutritional Sciences and Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
  4. 4. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
  5. 5. Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
  6. 6. Clinical Nutrition Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
  7. 7. Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, ON, Canada
  8. 8. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
  9. 9. Department of Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialties Centre, Chennai, India
  10. 10. St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India
  11. 11. Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan, Kuala Lumpur, Malaysia
  12. 12. Estudios Clinicos Latino America, Rosario, Argentina
  13. 13. Department of Health Sciences, Government of Kerala, Kerala, India
  14. 14. Health Action by People, Trivandrum, Kerala, India
  15. 15. Social Department of Wroclaw Medical University, Wroclaw, Poland
  16. 16. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  17. 17. University of Health Sciences Turkey, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Health Training Research Hospital, Clinic of Endocrinology and Metabolism, Sisli/Istabul, Turkiye
  18. 18. Advocate Aurora Research Institute, Milwaukee, WI, United States
  19. 19. Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
  20. 20. Masira Research Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia
  21. 21. Tamani Foundation, Matemwe, Zanzibar, Tanzania
  22. 22. Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
  23. 23. Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
  24. 24. Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
  25. 25. Center for Health, Population and Development, Independent University, Dhaka, Bangladesh
  26. 26. Department of Dietetics and Nutrition, University of the Western Cape, Bellville, South Africa
  27. 27. Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
  28. 28. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyaadh, Saudi Arabia
  29. 29. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden
  30. 30. International Research Center, Hospital Alemao-Oswaldo Cruz & UNISA, SP, Sao Paulo, Brazil
  31. 31. Universidad de la Frontera, Temuco, Chile

Source: The Lancet Diabetes and Endocrinology Published:2024


Abstract

Background: The association between the glycaemic index and the glycaemic load with type 2 diabetes incidence is controversial. We aimed to evaluate this association in an international cohort with diverse glycaemic index and glycaemic load diets. Methods: The PURE study is a prospective cohort study of 127 594 adults aged 35–70 years from 20 high-income, middle-income, and low-income countries. Diet was assessed at baseline using country-specific validated food frequency questionnaires. The glycaemic index and the glycaemic load were estimated on the basis of the intake of seven categories of carbohydrate-containing foods. Participants were categorised into quintiles of glycaemic index and glycaemic load. The primary outcome was incident type 2 diabetes. Multivariable Cox Frailty models with random intercepts for study centre were used to calculate hazard ratios (HRs). Findings: During a median follow-up of 11·8 years (IQR 9·0–13·0), 7326 (5·7%) incident cases of type 2 diabetes occurred. In multivariable adjusted analyses, a diet with a higher glycaemic index was significantly associated with a higher risk of diabetes (quintile 5 vs quintile 1; HR 1·15 [95% CI 1·03–1·29]). Participants in the highest quintile of the glycaemic load had a higher risk of incident type 2 diabetes compared with those in the lowest quintile (HR 1·21, 95% CI 1·06–1·37). The glycaemic index was more strongly associated with diabetes among individuals with a higher BMI (quintile 5 vs quintile 1; HR 1·23 [95% CI 1·08–1·41]) than those with a lower BMI (quintile 5 vs quintile 1; 1·10 [0·87–1·39]; p interaction=0·030). Interpretation: Diets with a high glycaemic index and a high glycaemic load were associated with a higher risk of incident type 2 diabetes in a multinational cohort spanning five continents. Our findings suggest that consuming low glycaemic index and low glycaemic load diets might prevent the development of type 2 diabetes. Funding: Full funding sources are listed at the end of the Article. © 2024 Elsevier Ltd
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