Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes: A Systematic Review and Updated Meta-Analyses of Prospective Cohort Studies

Geoffrey Livesey, Richard Taylor, Helen F. Livesey, Anette E. Buyken, David J. A. Jenkins, Livia Silvia Adriana Augustin, John L. Sievenpiper, Alan W. Barclay, Simin Liu, Thomas M.S. Wolever, Walter C. Willett, Furio Brighenti, Jordi Salas-Salvadó, Inger Björck, Salwa W. Rizkalla, Gabriele Riccardi, Carlo La Vecchia, Antonio Ceriello, Antonia Trichopoulou, Andrea PoliArne Astrup, Cyril W.C. Kendall, Marie-Ann van Ginkel, Sara Baer-Sinnott, Jennie C. Brand-Miller

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Published meta-analyses indicate significant but inconsistent incident type-2 diabetes (T2D)-dietary glycemic index (GI) and glycemic load (GL) risk ratios or risk relations (RR). It is now over a decade ago that a published meta-analysis used a predefined standard to identify valid studies. Considering valid studies only, and using random effects dose–response meta-analysis (DRM) while withdrawing spurious results (p < 0.05), we ascertained whether these relations would support nutrition guidance, specifically for an RR > 1.20 with a lower 95% confidence limit >1.10 across typical intakes (approximately 10th to 90th percentiles of population intakes). The combined T2D–GI RR was 1.27 (1.15–1.40) (p < 0.001, n = 10 studies) per 10 units GI, while that for the T2D–GL RR was 1.26 (1.15–1.37) (p < 0.001, n = 15) per 80 g/d GL in a 2000 kcal (8400 kJ) diet. The corresponding global DRM using restricted cubic splines were 1.87 (1.56–2.25) (p < 0.001, n = 10) and 1.89 (1.66–2.16) (p < 0.001, n = 15) from 47.6 to 76.1 units GI and 73 to 257 g/d GL in a 2000 kcal diet, respectively. In conclusion, among adults initially in good health, diets higher in GI or GL were robustly associated with incident T2D. Together with mechanistic and other data, this supports that consideration should be given to these dietary risk factors in nutrition advice. Concerning the public health relevance at the global level, our evidence indicates that GI and GL are substantial food markers predicting the development of T2D worldwide, for persons of European ancestry and of East Asian ancestry.
Original languageEnglish
Article number 1280
Issue number6
Publication statusPublished - 5 Jun 2019


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