Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
Nutrition Research Center, Department of Community Nutrition, faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran.
Int J Clin Pract. 2021 Oct;75(10):e14295. doi: 10.1111/ijcp.14295. Epub 2021 Jun 25.
Diets with high glycemic index (GI) or high glycemic load (GL) have been linked to important risk factors associated with the development of metabolic syndrome (MetS), such as dyslipidemia, higher blood glucose, and insulin concentrations. However, the role of GI and GL in relation to Mets is still understudied and controversial. This review, therefore, assessed whether high GI or GL contribute to development of Mets.
A systematic search of four bibliographic databases was conducted (MEDLINE/PubMed, EMBASE, Web of Sciences, and Scopus) from inception to January 2020 for observational studies assessing GI/GL in relation to MetS. Risk estimates were pooled using random-effect models for the highest versus lowest intake categories, and assessed for heterogeneity using subgroup analysis. The dose-response nature of the relationship was also investigated. Sensitivity analysis and Egger test were used to check the robustness of findings and the possibility of publication bias, respectively.
Data from 12 publications (one cohort study and eleven cross-sectional studies) with a total sample size of 36,295 subjects are included. The pooled effect sizes from the nine studies indicated high versus low dietary GI was associated with increased risk of MetS (OR = 1.05, 95% CI: 1.01 to 1.09) (I = 58.1, P = .004). This finding was supported by all subgroup analyses except where studies used 24-h recalls for dietary assessment. Additionally, a linear dose-response investigation revealed that each 5-point increment in GI was associated with 2% increase in the risk of MetS (OR = 1.02, 95% CI: 1.01 to 1.02); non-linear pattern was insignificant, however (p-nonlinearity = 0.63). Moreover, pooled effect sizes from ten studies suggested that no association was found between the GL and MetS with results remaining consistent in all subgroup analyses.
A diet with lower GI may protect against MetS. Nutrition policy and clinical practices should encourage a diet with low GI. Future studies should include both GI and GL and different criteria of MetS to provide a better comparison.
高血糖指数（GI）或高血糖负荷（GL）的饮食与代谢综合征（MetS）发展相关的重要危险因素有关，如血脂异常、更高的血糖和胰岛素浓度。然而，GI 和 GL 与 Mets 的关系仍在研究中，存在争议。因此，本综述评估了高 GI 或 GL 是否有助于 Mets 的发展。
从建库到 2020 年 1 月，对 MEDLINE/PubMed、EMBASE、Web of Sciences 和 Scopus 四个文献数据库进行了系统检索，以评估与 MetS 相关的 GI/GL 的观察性研究。使用随机效应模型对最高与最低摄入量类别进行风险估计，并通过亚组分析评估异质性。还研究了这种关系的剂量-反应性质。敏感性分析和 Egger 检验分别用于检查结果的稳健性和发表偏倚的可能性。
纳入了 12 项研究（一项队列研究和 11 项横断面研究），共纳入 36295 名受试者。9 项研究的汇总效应大小表明，高 versus 低饮食 GI 与 MetS 风险增加相关（OR=1.05，95%CI：1.01 至 1.09）（I=58.1，P=0.004）。除了研究使用 24 小时回顾法进行饮食评估的情况外，所有亚组分析均支持这一发现。此外，线性剂量-反应研究表明，GI 每增加 5 个单位，MetS 的风险增加 2%（OR=1.02，95%CI：1.01 至 1.02）；但非线性模式不显著（p-非线性=0.63）。此外，10 项研究的汇总效应大小表明，GL 与 Mets 之间没有关联，所有亚组分析的结果仍然一致。
低 GI 饮食可能有助于预防 Mets。营养政策和临床实践应鼓励低 GI 饮食。未来的研究应同时包括 GI 和 GL 以及不同的 Mets 标准，以提供更好的比较。
