Glycemic index, glycemic load, and risk of coronary heart disease: A pan-European cohort study

Sabina Sieri, Claudia Agnoli*, Sara Grioni, Elisabete Weiderpass, Amalia Mattiello, Ivonne Sluijs, Maria Jose Sanchez, Marianne Uhre Jakobsen, Michael Sweeting, Yvonne T. van der Schouw, Lena Maria Nilsson, Patrik Wennberg, Verena A. Katzke, Tilman Kühn, Kim Overvad, Tammy Y.N. Tong, Moreno Iribas Conchi, José Ramón Quirós, Juan Manuel García-Torrecillas, Olatz MokoroaJesús Humberto Gómez, Anne Tjønneland, Emiliy Sonestedt, Antonia Trichopoulou, Anna Karakatsani, Elissavet Valanou, Jolanda M.A. Boer, W. M. Monique Verschuren, Marie Christine Boutron-Ruault, Guy Fagherazzi, Anne Laure Madika, Manuela M. Bergmann, Matthias B. Schulze, Pietro Ferrari, Heinz Freisling, Hannah Lennon, Carlotta Sacerdote, Giovanna Masala, Rosario Tumino, Elio Riboli, Nicholas J. Wareham, John Danesh, Nita G. Forouhi, Adam S. Butterworth, Vittorio Krogh

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

22 Citations (Scopus)


Background: High carbohydrate intake raises blood triglycerides, glucose, and insulin; reduces HDLs; and may increase risk of coronary heart disease (CHD). Epidemiological studies indicate that high dietary glycemic index (GI) and glycemic load (GL) are associated with increased CHD risk. Objectives: The aim of this study was to determine whether dietary GI, GL, and available carbohydrates are associated with CHD risk in both sexes. Methods: This large prospective study-the European Prospective Investigation into Cancer and Nutrition-consisted of 338,325 participants who completed a dietary questionnaire. HRs with 95% CIs for a CHD event, in relation to intake of GI, GL, and carbohydrates, were estimated using covariate-adjusted Cox proportional hazard models. Results: After 12.8 y (median), 6378 participants had experienced a CHD event. High GL was associated with greater CHD risk [HR 1.16 (95% CI: 1.02, 1.31) highest vs. lowest quintile, p-trend 0.035; HR 1.18 (95% CI: 1.07, 1.29) per 50 g/day of GL intake]. The association between GL and CHD risk was evident in subjects with BMI (in kg/m2) =25 [HR: 1.22 (95% CI: 1.11, 1.35) per 50 g/d] but not in those with BMI <25 [HR: 1.09 (95% CI: 0.98, 1.22) per 50 g/d) (P-interaction = 0.022). The GL-CHD association did not differ between men [HR: 1.19 (95% CI: 1.08, 1.30) per 50 g/d] and women [HR: 1.22 (95% CI: 1.07, 1.40) per 50 g/d] (test for interaction not significant). GI was associated with CHD risk only in the continuous model [HR: 1.04 (95% CI: 1.00, 1.08) per 5 units/d]. High available carbohydrate was associated with greater CHD risk [HR: 1.11 (95% CI: 1.03, 1.18) per 50 g/d]. High sugar intake was associated with greater CHD risk [HR: 1.09 (95% CI: 1.02, 1.17) per 50 g/d]. Conclusions: This large pan-European study provides robust additional support for the hypothesis that a diet that induces a high glucose response is associated with greater CHD risk.

Original languageEnglish
Pages (from-to)631-643
Number of pages13
JournalAmerican Journal of Clinical Nutrition
Issue number3
Publication statusPublished - 1 Aug 2020
Externally publishedYes


  • Cohort study
  • Coronary heart disease
  • EPIC study
  • EPIC-CVD study
  • Glycemic index
  • Glycemic load


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