TY - JOUR

T1 - Dietary glycemic index and load and the risk of type 2 diabetes: Assessment of causal relations

AU - Livesey, Geoffrey

AU - Taylor, Richard

AU - Livesey, Helen F

AU - Buyken, Anette E

AU - Jenkins, David J A

AU - Augustin, Livia S A

AU - Sievenpiper, John L

AU - Barclay, Alan W

AU - Liu, Simin

AU - Wolever, Thomas M S

AU - Willett, Walter C

AU - Brighenti, Furio

AU - Salas-Salvadó, Jordi

AU - Björck, Inger

AU - Rizkalla, Salwa W

AU - Riccardi, Gabriele

AU - La Vecchia, Carlo

AU - Ceriello, Antonio

AU - Trichopoulou, Antonia

AU - Poli, Andrea

AU - Astrup, Arne

AU - Kendall, Cyril W C

AU - Ha, Marie-Ann

AU - Baer-Sinnott, Sara

AU - Brand-Miller, Jennie

N1 - CURIS 2019 NEXS 222

PY - 2019

Y1 - 2019

N2 - While dietary factors are important modifiable risk factors for type 2 diabetes (T2D), the causal role of carbohydrate quality in nutrition remains controversial. Dietary glycemic index (GI) and glycemic load (GL) have been examined in relation to the risk of T2D in multiple prospective cohort studies. Previous meta-analyses indicate significant relations but consideration of causality has been minimal. Here, the results of our recent meta-analyses of prospective cohort studies of 4 to 26-y follow-up are interpreted in the context of the nine Bradford-Hill criteria for causality, that is: (1) Strength of Association, (2) Consistency, (3) Specificity, (4) Temporality, (5) Biological Gradient, (6) Plausibility, (7) Experimental evidence, (8) Analogy, and (9) Coherence. These criteria necessitated referral to a body of literature wider than prospective cohort studies alone, especially in criteria 6 to 9. In this analysis, all nine of the Hill’s criteria were met for GI and GL indicating that we can be confident of a role for GI and GL as causal factors contributing to incident T2D. In addition, neitherdietary fiber nor cereal fiber nor wholegrain were found to be reliable or eective surrogate measures of GI or GL. Finally, our cost–benefit analysis suggests food and nutrition advice favors lower GI or GL and would produce significant potential cost savings in national healthcare budgets. The high confidence in causal associations for incident T2D is sucient to consider inclusion of GI and GL in food and nutrient-based recommendations.

AB - While dietary factors are important modifiable risk factors for type 2 diabetes (T2D), the causal role of carbohydrate quality in nutrition remains controversial. Dietary glycemic index (GI) and glycemic load (GL) have been examined in relation to the risk of T2D in multiple prospective cohort studies. Previous meta-analyses indicate significant relations but consideration of causality has been minimal. Here, the results of our recent meta-analyses of prospective cohort studies of 4 to 26-y follow-up are interpreted in the context of the nine Bradford-Hill criteria for causality, that is: (1) Strength of Association, (2) Consistency, (3) Specificity, (4) Temporality, (5) Biological Gradient, (6) Plausibility, (7) Experimental evidence, (8) Analogy, and (9) Coherence. These criteria necessitated referral to a body of literature wider than prospective cohort studies alone, especially in criteria 6 to 9. In this analysis, all nine of the Hill’s criteria were met for GI and GL indicating that we can be confident of a role for GI and GL as causal factors contributing to incident T2D. In addition, neitherdietary fiber nor cereal fiber nor wholegrain were found to be reliable or eective surrogate measures of GI or GL. Finally, our cost–benefit analysis suggests food and nutrition advice favors lower GI or GL and would produce significant potential cost savings in national healthcare budgets. The high confidence in causal associations for incident T2D is sucient to consider inclusion of GI and GL in food and nutrient-based recommendations.

KW - Faculty of Science

KW - Causation

KW - Diabetes

KW - Glycemic index

KW - Glycemic load

KW - Dietary fiber

KW - Alcohol

KW - Cohort studies

KW - Epidemiology

KW - Meta-analysis

KW - Public health

U2 - 10.3390/nu11061436

DO - 10.3390/nu11061436

M3 - Review

C2 - 31242690

VL - 11

JO - Nutrients

JF - Nutrients

SN - 2072-6643

IS - 6

M1 - 1436

ER -