Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
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.
Lancet Diabetes Endocrinol. 2024 May;12(5):330-338. doi: 10.1016/S2213-8587(24)00069-X. Epub 2024 Apr 5.
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.
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).
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).
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.
Full funding sources are listed at the end of the Article.
血糖指数和血糖负荷与 2 型糖尿病发病之间的关系存在争议。我们旨在评估在具有不同血糖指数和血糖负荷饮食的国际队列中这种关联。
PURE 研究是一项前瞻性队列研究，共纳入来自 20 个高收入、中等收入和低收入国家的 127594 名 35-70 岁成年人。在基线时使用国家特异性验证后的食物频率问卷评估饮食。根据七类含碳水化合物食物的摄入量来估计血糖指数和血糖负荷。参与者被分为血糖指数和血糖负荷五分位数组。主要结局是 2 型糖尿病的发病情况。采用具有研究中心随机截距的多变量 Cox 脆弱性模型来计算风险比（HR）。
在中位随访 11.8 年（IQR 9.0-13.0）期间，发生了 7326 例（5.7%）2 型糖尿病发病事件。在多变量调整分析中，血糖指数较高的饮食与糖尿病风险增加显著相关（五分位数 5 与五分位数 1 相比；HR 1.15[95%CI 1.03-1.29]）。与最低五分位数组相比，血糖负荷最高五分位数组的人发生 2 型糖尿病的风险更高（HR 1.21，95%CI 1.06-1.37）。在 BMI 较高的个体中，血糖指数与糖尿病的相关性更强（五分位数 5 与五分位数 1 相比；HR 1.23[95%CI 1.08-1.41]），而在 BMI 较低的个体中（五分位数 5 与五分位数 1 相比；1.10[0.87-1.39]；p 交互=0.030）。
在一个跨越五大洲的多国队列中，高血糖指数和高血糖负荷的饮食与 2 型糖尿病发病风险增加相关。我们的研究结果表明，摄入低血糖指数和低血糖负荷的饮食可能有助于预防 2 型糖尿病的发生。
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