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

Miller V 1 , Jenkins DA 2 , Dehghan M 3 , Srichaikul K 4 , Rangarajan S 3 , Mente A 5 Show all authors , Mohan V 6 , Swaminathan S 7 , Ismail R 8 , Luz Diaz M 9 , Ravindran RM 10 , Zatonska K 11 , Bahonar A 12 , Altuntas Y 13 , Khatib R 14 , Lopez-Jaramillo P 15 , Yusufali A 16 , Yeates K 17 , Chifamba J 18 , Iqbal R 19 , Yusuf R 20 , Catherina Swart E 21 , Bo H 22 , Han G 22 , Li X 22 , Alhabib KF 23 , Rosengren A 24 , Avezum A 25 , Lanas F 26 , Yusuf S 27 , Prospective Urban and Rural Epidemiology (PURE) study investigators

Affiliations 

  • 1 Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada. Electronic address: victoria.miller@phri.ca
  • 2 Department of Nutritional Sciences and Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada; Clinical Nutrition Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, ON, Canada
  • 3 Population Health Research Institute, McMaster University, Hamilton, ON, Canada
  • 4 Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
  • 5 Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
  • 6 Department of Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialties Centre, Chennai, India
  • 7 St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India
  • 8 Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan, Kuala Lumpur, Malaysia
  • 9 Estudios Clinicos Latino America, Rosario, Argentina
  • 10 Department of Health Sciences, Government of Kerala, Kerala, India; Health Action by People, Trivandrum, Kerala, India
  • 11 Social Department of Wroclaw Medical University, Wroclaw, Poland
  • 12 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  • 13 University of Health Sciences Turkey, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Health Training Research Hospital, Clinic of Endocrinology and Metabolism, Sisli/Istabul, Türkiye
  • 14 Advocate Aurora Research Institute, Milwaukee, WI, USA; Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
  • 15 Masira Research Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia
  • 16 Tamani Foundation, Matemwe, Zanzibar, Tanzania
  • 17 Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
  • 18 Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
  • 19 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
  • 20 Center for Health, Population and Development, Independent University, Dhaka, Bangladesh
  • 21 Department of Dietetics and Nutrition, University of the Western Cape, Bellville, South Africa
  • 22 Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
  • 23 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyaadh, Saudi Arabia
  • 24 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, and Sahlgrenska University Hospital, Gothenburg, Sweden
  • 25 International Research Center, Hospital Alemão-Oswaldo Cruz & UNISA, São Paulo, SP Brazil
  • 26 Universidad de la Frontera, Temuco, Chile
  • 27 Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
Lancet Diabetes Endocrinol, 2024 May;12(5):330-338.
PMID: 38588684 DOI: 10.1016/S2213-8587(24)00069-X

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications