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升糖指数、血糖负荷、心血管疾病和死亡率的关系
Glycemic Index, Glycemic Load, and Cardiovascular Disease and Mortality


David J.A. Jenkins ... 心脑血管疾病 糖尿病 • 2021.04.08
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NEJM发表的这项饮食与死亡风险研究,方法学上可靠吗

 

宗耕

中国科学院上海营养与健康研究所

 

升糖指数(glycemic index,GI)是一个反映特定食物引起血糖升高速度的参数,一般是将目标食物的升血糖效应与含等量碳水化合物的葡萄糖、白面包等进行比较来表述。举例来说,217克香蕉(测定食物)和100克白面包(对照食物)均含有50克碳水化合物;对受试者进食这两个食物后的血糖进行连续监测,并绘制血糖-时间曲线,可得到两者血糖增加曲线下面积(incremental area under the glucose curve,iAUC),则(iAUC香蕉/iAUC面包)×100就是香蕉的GI。将特定食物的GI与该食物的摄入量相乘,即可得到升糖负荷(glycemic load,GL)。

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摘要


背景

升糖指数与心血管疾病之间的关联数据大多来自高收入的西方人群,而来自西方以外低收入和中等收入国家的信息很少。为了填补这一空白,我们需要涵盖不同地区的大规模人群的数据。

 

方法

此项分析纳入了五大洲137,851例35~70岁参与者,中位随访时间为9.5年。我们应用各国的食物频率问卷确定了饮食摄入量,并根据7类碳水化合物类食物摄入量估算了升糖指数和血糖负荷。我们应用多变量Cox脆弱性模型计算了风险比。主要结局是由主要心血管事件(心血管原因死亡、非致死性心肌梗死、卒中和心力衰竭)或全因死亡构成的复合结局。

 

结果

在研究人群中,随访期间发生了8,780例死亡和8,252起主要心血管事件。对升糖指数最低和最高五分位数间的比较进行广泛校正后,我们发现,在之前有心血管疾病(风险比,1.51;95%可信区间[CI],1.25~1.82)和无心血管疾病的参与者中(风险比,1.21;95% CI,1.11~1.34),高升糖指数饮食均与主要心血管事件或死亡风险增加相关。在构成主要结局的各项中,高升糖指数也与心血管原因死亡风险增加相关。在基线时有心血管疾病的参与者中,血糖负荷的结果与升糖指数的结果相似,但在之前无心血管疾病的参与者中,关联不显著。

 

结论

在本研究中,高升糖指数饮食与心血管疾病和死亡风险增加相关(由加拿大人口健康研究所[Population Health Research Institute]等资助)。





作者信息

David J.A. Jenkins, M.D., Ph.D., Mahshid Dehghan, Ph.D., Andrew Mente, Ph.D., Shrikant I. Bangdiwala, Ph.D., Sumathy Rangarajan, M.Sc., Kristie Srichaikul, M.D., Viswanathan Mohan, D.Sc., Alvaro Avezum, M.D., Rafael Díaz, M.D., Annika Rosengren, M.D., Fernando Lanas, M.D., Patricio Lopez-Jaramillo, M.D., Wei Li, Ph.D., Aytekin Oguz, M.D., Rasha Khatib, Ph.D., Paul Poirier, M.D., Ph.D., Noushin Mohammadifard, Ph.D., Andrea Pepe, M.Sc., Khalid F. Alhabib, M.B., B.S., Jephat Chifamba, D.Phil., Afzal Hussein Yusufali, M.D., Romaina Iqbal, Ph.D., Karen Yeates, M.D., Khalid Yusoff, M.D., Noorhassim Ismail, M.D., Koon Teo, M.B., B.Ch., Sumathi Swaminathan, Ph.D., Xiaoyun Liu, Ph.D., Katarzyna Zatońska, M.D., Rita Yusuf, Ph.D., and Salim Yusuf, D.Phil. for the PURE Study Investigators*
From the Departments of Nutritional Sciences and Medicine, Temerty Faculty of Medicine, University of Toronto (D.J.A.J.), and Li Ka Shing Knowledge Institute, St. Michael’s Hospital Toronto (D.J.A.J., K.S.), Toronto, the Population Health Research Institute (M.D., S.I.B., K.T., S.Y.) and Department of Health Research Methods, Evidence, and Impact (A.M., S.I.B.), McMaster University, and McMaster University and Hamilton Health Sciences (S.R.), Hamilton, ON, Faculté de Pharmacie, Université Laval, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (P.P.), the Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa (A.P.), and the Department of Medicine, Queen’s University, Kingston, ON (K. Yeates) — all in Canada; the Madras Diabetes Research Foundation, Chennai (V.M.), and St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore (S.S.) — both in India; the International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo (A.A.); Estudios Clínicos Latino América, Rosario, Santa Fe, Argentina (R.D.); the Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, and Sahlgrenska University Hospital, Gothenburg, Sweden (A.R.); Universidad de la Frontera, Temuco, Chile (F.L.); the Masira Research Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia (P.L.-J.); the Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing (W.L., X.L.); the Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey (A.O.); the Institute for Community and Public Health, Birzeit University, Birzeit, Palestine (R.K.); Advocate Research Institute, Advocate Health Care, Downers Grove, IL (R.K.); Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran (N.M.); the Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia (K.F.A.); the Department of Physiology, University of Zimbabwe College of Health Sciences, Harare (J.C.); Hatta Hospital, Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates (A.H.Y.); the Department of Community Health Sciences and Medicine, Aga Khan University, Pakistan (R.I.); Universiti Teknologi MARA, Sungai Buloh, and UCSI University, Selangor (K. Yusoff), and the Department of Community Health, University Kebangsaan Malaysia Medical Center, Kuala Lumpur (N.I.) — both in Malaysia; the Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland (K.Z.); and the School of Life Sciences, Independent University, Dhaka, Bangladesh (R.Y.). Address reprint requests to Dr. Jenkins at the Department of Nutritional Sciences, Medical Sciences Bldg., 5th Fl., Rm. 5336B, 1 King’s College Cir., Toronto, ON M5S 1A8, Canada, or at david.jenkins@utoronto.ca. *A complete list of investigators in the PURE study is provided in the Supplementary Appendix, available at NEJM.org.

 

参考文献

1. Paleo diet: what is it and why is it so popular? Rochester, MN: Mayo Clinic, 2020 (https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/paleo-diet/art-20111182. opens in new tab).

2. Diet review: ketogenic diet for weight loss. Boston: Harvard T.H. Chan School of Public Health (https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/ketogenic-diet/. opens in new tab).

3. Schulze MB, Manson JE, Ludwig DS, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 2004;292:927-934.

4. Augustin LSA, Kendall CWC, Jenkins DJA, et al. Glycemic index, glycemic load and glycemic response: an international scientific consensus summit from the International Carbohydrate Quality Consortium (ICQC). Nutr Metab Cardiovasc Dis 2015;25:795-815.

5. Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet 2019;393:434-445.

6. Ludwig DS. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA 2002;287:2414-2423.

7. Jacobs DR Jr, Meyer KA, Kushi LH, Folsom AR. Whole-grain intake may reduce the risk of ischemic heart disease death in postmenopausal women: the Iowa Women’s Health Study. Am J Clin Nutr 1998;68:248-257.

8. Liu S, Willett WC, Stampfer MJ, et al. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr 2000;71:1455-1461.

9. Livesey G, Livesey H. Coronary heart disease and dietary carbohydrate, glycemic index, and glycemic load: dose-response meta-analyses of prospective cohort studies. Mayo Clin Proc Innov Qual Outcomes 2019;3:52-69.

10. Brand-Miller J, Hayne S, Petocz P, Colagiuri S. Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 2003;26:2261-2267.

11. Mirrahimi A, de Souza RJ, Chiavaroli L, et al. Associations of glycemic index and load with coronary heart disease events: a systematic review and meta-analysis of prospective cohorts. J Am Heart Assoc 2012;1(5):e000752-e000752.

12. Wolever TM, Jenkins DJ, Jenkins AL, Josse RG. The glycemic index: methodology and clinical implications. Am J Clin Nutr 1991;54:846-854.

13. Dehghan M, Mente A, Zhang X, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet 2017;390:2050-2062.

14. Mente A, O’Donnell MJ, Rangarajan S, et al. Association of urinary sodium and potassium excretion with blood pressure. N Engl J Med 2014;371:601-611.

15. Yusuf S, Islam S, Chow CK, et al. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey. Lancet 2011;378:1231-1243.

16. Yusuf S, Rangarajan S, Teo K, et al. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med 2014;371:818-827.

17. Miller V, Mente A, Dehghan M, et al. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet 2017;390:2037-2049.

18. Atkinson FS, Foster-Powell K, Brand-Miller JC. International tables of glycemic index and glycemic load values: 2008. Diabetes Care 2008;31:2281-2283.

19. Salmerón J, Ascherio A, Rimm EB, et al. Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 1997;20:545-550.

20. Jenkins DJ, Kendall CW, McKeown-Eyssen G, et al. Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial. JAMA 2008;300:2742-2753.

21. Harrell F. Logistic regression and survival analysis: regression modeling strategies with applications to linear models. New York: Springer-Verlag, 2001.

22. Carroll JF, Kaiser KA, Franks SF, Deere C, Caffrey JL. Influence of BMI and gender on postprandial hormone responses. Obesity (Silver Spring) 2007;15:2974-2983.

23. Salmerón J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC. Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA 1997;277:472-477.

24. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-1062.

25. Su C, Zhao J, Wu Y, et al. Temporal trends in dietary macronutrient intakes among adults in rural China from 1991 to 2011: findings from the CHNS. Nutrients 2017;9:227-227.

26. Shahdadian F, Saneei P, Milajerdi A, Esmaillzadeh A. Dietary glycemic index, glycemic load, and risk of mortality from all causes and cardiovascular diseases: a systematic review and dose-response meta-analysis of prospective cohort studies. Am J Clin Nutr 2019;110:921-937.

27. Levitan EB, Mittleman MA, Håkansson N, Wolk A. Dietary glycemic index, dietary glycemic load, and cardiovascular disease in middle-aged and older Swedish men. Am J Clin Nutr 2007;85:1521-1526.

28. Nagata C, Wada K, Tsuji M, Kawachi T, Nakamura K. Dietary glycaemic index and glycaemic load in relation to all-cause and cause-specific mortality in a Japanese community: the Takayama study. Br J Nutr 2014;112:2010-2017.

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