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 journalArticlepeer-review

4 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

Bibliographical note

Funding Information:
EPIC-Asturias was supported by the Regional Government of Asturias. EPIC-Greece was supported by the Hellenic Health Foundation. EPIC-Heidelberg was supported by German Cancer Aid, the German Cancer Research Centre, and the German Federal Ministry of Education and Research. EPIC-Oxford was supported by the UK Medical Research Council (grant MR/M012190/1) and Cancer Research UK (grant 570/A16491). EPIC-Ragusa was supported by the Sicilian Regional Government, the Iblean Charitable Association for Epidemiological Research Ragusa and the Italian Association of Blood Donors Ragusa. EPIC-Turin was supported by the Compagnia di San Paolo and the Human Genetics Foundation Turin. EPIC-NL was supported by the Dutch Ministry of Public Health, Welfare, and Sports; the Netherlands Organisation for Health Research and Development; and the World Cancer Research Fund. EPIC-Umeå was supported by the Swedish Cancer Society, the Swedish Scientific Council, and the Regional Government of Västerbotten.

Funding Information:
EPIC-CVD was supported by the European Union Framework 7 (grant HEALTH-F2-2012-279233), the European Research Council (grant 268834), the UK Medical Research Council (grants G0800270 and MR/L003120/1), the British Heart Foundation (grants SP/09/002, RG/08/014, and RG13/13/30194), and the UK National Institute of Health Research. The establishment of the study subcohort was supported by the EU Sixth Framework Programme (grant LSHM_CT_2006_037197 to the InterAct project) and the Medical Research Council Epidemiology Unit (grants MC_UU_12015/1 and MC_UU_12015/5). NJW and NGF acknowledge support from NIHR Biomedical Research Centre Cambridge: Nutrition, Diet, and Lifestyle Research Theme (grant IS-BRC-1215-20014).

Publisher Copyright:
Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.


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


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