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.
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Miller Victoria, Jenkins David A, Dehghan Mahshid, Srichaikul Kristie, Rangarajan Sumathy, Mente Andrew, Mohan Viswanathan, Swaminathan Sumathi, Ismail Rosnah, Luz Diaz Maria, Ravindran Rekha M, Zatonska Katarzyna, Bahonar Ahmad, Altuntas Yuksel, Khatib Rasha, Lopez-Jaramillo Patricio, Yusufali Afzalhussein, Yeates Karen, Chifamba Jephat, Iqbal Romaina, Yusuf Rita, Catherina Swart Elizabeth, Bo Hu, Han Guoliang, Li Xiaocong, Alhabib Khalid F, Rosengren Annika, Avezum Alvaro, Lanas Fernando, Yusuf Salim, Prospective Urban and Rural Epidemiology (PURE) study investigators
Аннотация
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.