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
Authors
Victoria Miller, Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada. Electronic address: victoria.miller@phri.ca.
David A. Jenkins, 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.
Mahshid Dehghan, Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Kristie Srichaikul, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
Sumathy Rangarajan, Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Andrew Mente, Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Viswanathan Mohan, Department of Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialties Centre, Chennai, India.
Sumathi Swaminathan, St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India.
Rosnah Ismail, Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan, Kuala Lumpur, Malaysia.
Maria Luz Diaz, Estudios Clinicos Latino America, Rosario, Argentina.
Rekha M. Ravindran, Department of Health Sciences, Government of Kerala, Kerala, India; Health Action by People, Trivandrum, Kerala, India.
Katarzyna Zatonska, Social Department of Wroclaw Medical University, Wroclaw, Poland.
Ahmad Bahonar, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Yuksel Altuntas, University of Health Sciences Turkey, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Health Training Research Hospital, Clinic of Endocrinology and Metabolism, Sisli/Istabul, Türkiye.
Rasha Khatib, Advocate Health - MidwestFollow
Patricio Lopez-Jaramillo, Masira Research Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia.
Afzalhussein Yusufali, Tamani Foundation, Matemwe, Zanzibar, Tanzania.
Karen Yeates, Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada.
Jephat Chifamba, Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe.
Romaina Iqbal, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Rita Yusuf, Center for Health, Population and Development, Independent University, Dhaka, Bangladesh.
Elizabeth Catherina Swart, Department of Dietetics and Nutrition, University of the Western Cape, Bellville, South Africa.
Hu Bo, Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Guoliang Han, Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Xiaocong Li, Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Khalid F. Alhabib, Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyaadh, Saudi Arabia.
Annika Rosengren, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, and Sahlgrenska University Hospital, Gothenburg, Sweden.
Alvaro Avezum, International Research Center, Hospital Alemão-Oswaldo Cruz & UNISA, São Paulo, SP Brazil.
Fernando Lanas, Universidad de la Frontera, Temuco, Chile.
Salim Yusuf, Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
Recommended Citation
Miller V, Jenkins DA, Dehghan M, et al. 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. Lancet Diabetes Endocrinol. 2024;12(5):330-338. 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.
