作者
Victoria Miller,David Jenkins,Mahshid Dehghan,Kristie Srichaikul,Sumathy Rangarajan,Andrew Mente,Viswanathan Mohan,Sumathi Swaminathan,Rosnah Ismail,Marı́a Luz Dı́az,Rekha Ravindran,Katarzyna Zatońska,Ahmad Bahonar,Yüksel Altuntaş,Rasha Khatib,Patricio López‐Jaramillo,Afzalhussein Yusufali,Karen Yeates,Jephat Chifamba,Romaina Iqbal,Rita Yusuf,Rina Swart,Bo Hu,Guoliang Han,Xiaocong Li,Khalid F. AlHabib,A Rosengren,Álvaro Avezum,Fernando Lanas,Salim Yusuf
摘要
Summary
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.