Dietary glycemic index, glycemic load, and refined carbohydrates are associated with risk of stroke: a prospective cohort study in urban Chinese women.

BACKGROUND Epidemiologic evidence on dietary carbohydrates and stroke risk remains controversial. Very few prospective cohort studies have been conducted in Asian populations, who usually consume a high-carbohydrate diet and have a high burden of stroke. OBJECTIVE We examined dietary glycemic index (GI), glycemic load (GL), and intakes of refined and total carbohydrates in relation to risks of total, ischemic, and hemorrhagic stroke and stroke mortality. DESIGN This study included 64,328 Chinese women, aged 40-70 y, with no history of cardiovascular disease, diabetes, or cancer. A validated, interviewer-administered food-frequency questionnaire was used to assess usual dietary intakes at baseline and during follow-up. Incident stroke cases and deaths were identified via follow-up interviews and death registries and were confirmed by review of medical records and death certificates. RESULTS During mean follow-ups of 10 y for stroke incidence and 12 y for stroke mortality, we ascertained 2991 stroke cases (2750 ischemic and 241 hemorrhagic) and 609 stroke deaths. After potential confounders were controlled for, we observed significant positive associations of dietary GI and GL with total stroke risk; multivariable-adjusted HRs (95% CIs) for high compared with low levels (90th compared with 10th percentile) were 1.19 (1.04, 1.36) for GI and 1.27 (1.04, 1.54) for GL (both P-linearity < 0.05 and P-overall significance < 0.05). Similar linear associations were found for ischemic stroke, but the associations with hemorrhagic stroke appeared to be J-shaped. Similar trends of positive associations with stroke risks were suggested for refined carbohydrates but not for total carbohydrates. No significant associations were found for stroke mortality after multivariable adjustment. CONCLUSION Our results suggest that high dietary GI and GL, primarily due to high intakes of refined grains, are associated with increased risks of total, ischemic, and hemorrhagic stroke in middle-aged and older urban Chinese women.

[1]  V. Mcgivney,et al.  The National Survey , 2018, European Dimensions and the Secondary School Curriculum.

[2]  E. Vidoni,et al.  A high-glycemic diet is associated with cerebral amyloid burden in cognitively normal older adults. , 2017, The American journal of clinical nutrition.

[3]  C. la Vecchia,et al.  Relation of dietary glycemic load with ischemic and hemorrhagic stroke: a cohort study in Greece and a meta-analysis , 2015, European Journal of Nutrition.

[4]  Peiying Liu,et al.  Acute effect of glucose on cerebral blood flow, blood oxygenation, and oxidative metabolism , 2015, Human brain mapping.

[5]  X. Shu,et al.  Adherence to dietary guidelines and mortality: a report from prospective cohort studies of 134,000 Chinese adults in urban Shanghai. , 2014, The American journal of clinical nutrition.

[6]  J. Manson,et al.  Glycemic index , glycemic load , and risk of type 2 diabetes : results from 3 large US cohorts and an updated meta-analysis 1 – 3 , 2014 .

[7]  X. Shu,et al.  Dietary carbohydrates, refined grains, glycemic load, and risk of coronary heart disease in Chinese adults. , 2013, American journal of epidemiology.

[8]  D. Greenwood,et al.  Glycemic Index, Glycemic Load, Carbohydrates, and Type 2 Diabetes , 2013, Diabetes Care.

[9]  F. Berrino,et al.  Dietary Glycemic Load and Glycemic Index and Risk of Cerebrovascular Disease in the EPICOR Cohort , 2013, PLoS ONE.

[10]  Weili Zhang,et al.  Dietary Glycemic Index, Glycemic Load, and Risk of Coronary Heart Disease, Stroke, and Stroke Mortality: A Systematic Review with Meta-Analysis , 2012, PloS one.

[11]  J. Beyene,et al.  Associations of Glycemic Index and Load With Coronary Heart Disease Events: A Systematic Review and Meta-Analysis of Prospective Cohorts , 2012, Journal of the American Heart Association.

[12]  L. Qin,et al.  Meta-analysis of dietary glycemic load and glycemic index in relation to risk of coronary heart disease. , 2012, The American journal of cardiology.

[13]  J. Boer,et al.  Dietary Glycemic Load and Glycemic Index and Risk of Coronary Heart Disease and Stroke in Dutch Men and Women: The EPIC-MORGEN Study , 2011, PloS one.

[14]  C. Nagata,et al.  Dietary glycemic index, glycemic load, and intake of carbohydrate and rice in relation to risk of mortality from stroke and its subtypes in Japanese men and women. , 2010, Metabolism: clinical and experimental.

[15]  S Claiborne Johnston,et al.  Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling , 2009, The Lancet Neurology.

[16]  P. Mitchell,et al.  Glycemic Index, Retinal Vascular Caliber, and Stroke Mortality , 2009, Stroke.

[17]  Kaye Foster-Powell,et al.  International Tables of Glycemic Index and Glycemic Load Values: 2008 , 2008, Diabetes Care.

[18]  X. Shu,et al.  Prospective study of dietary carbohydrates, glycemic index, glycemic load, and incidence of type 2 diabetes mellitus in middle-aged Chinese women. , 2007, Archives of internal medicine.

[19]  A. Wolk,et al.  Dietary glycemic index, dietary glycemic load, and cardiovascular disease in middle-aged and older Swedish men. , 2007, The American journal of clinical nutrition.

[20]  D. Grobbee,et al.  High dietary glycemic load and glycemic index increase risk of cardiovascular disease among middle-aged women: a population-based follow-up study. , 2007, Journal of the American College of Cardiology.

[21]  Yue-xin Yang,et al.  Glycemic index of cereals and tubers produced in China. , 2006, World journal of gastroenterology.

[22]  N. Rothman,et al.  The Shanghai Women's Health Study: rationale, study design, and baseline characteristics. , 2005, American journal of epidemiology.

[23]  J. Brand-Miller,et al.  Glycemic index, postprandial glycemia and cardiovascular disease , 2005, Current opinion in lipidology.

[24]  J. Manson,et al.  Carbohydrate intake, glycemic index, glycemic load, and dietary fiber in relation to risk of stroke in women. , 2005, American journal of epidemiology.

[25]  D. Ludwig,et al.  The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. , 2002, JAMA.

[26]  D Spiegelman,et al.  Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. , 1999, American journal of epidemiology.

[27]  W C Willett,et al.  Adjustment for total energy intake in epidemiologic studies. , 1997, The American journal of clinical nutrition.

[28]  G A Colditz,et al.  Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. , 1997, JAMA.

[29]  A. Ershow,et al.  Chinese Food Composition Tables: An annotated translation of the 1981 edition published by the Institute of Nutrition and Food Hygiene, Chinese Academy of Preventive Medicine, Beijing , 1990 .

[30]  T. Wolever,et al.  Glycemic index of foods: a physiological basis for carbohydrate exchange. , 1981, The American journal of clinical nutrition.

[31]  F. D. Weinfeld,et al.  The National Survey of Stroke. Clinical findings. , 1981, Stroke.

[32]  M. Posada de la Paz,et al.  CLINICAL FINDINGS , 1978, WHO regional publications. European series.

[33]  X. Shu,et al.  Validity and reproducibility of the food frequency questionnaire used in the Shanghai Women's Health Study , 2004, European Journal of Clinical Nutrition.