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Earl S. Ford, MD; Simin Liu, MD

Arch Intern Med. 2001;161:572-576.

Background  Dietary glycemic index, an indicator of the ability of the carbohydrate to raise blood glucose levels, and glycemic load, the product of glycemic index and carbohydrate intake, have been positively related to risk of coronary heart disease. However, the relationships between glycemic index and glycemic load and high-density lipoprotein cholesterol (HDL-C) concentration in the US population are unknown.

Methods  Using data from 13 907 participants aged 20 years and older in the Third National Health and Nutrition Examination Survey (1988-1994), we examined the relationships between glycemic index and glycemic load, which were determined from a food frequency questionnaire and HDL-C concentration.

Results  The age-adjusted mean HDL-C concentrations for increasing quintiles of glycemic index distribution were 1.38, 1.32, 1.30, 1.26, and 1.27 mmol/L (P<.001 for trend). (To convert millimoles per liter to milligrams per deciliter, divide by 0.0259.) After additional adjustment for sex, ethnicity, education, smoking status, body mass index, alcohol intake, physical activity, energy fraction from carbohydrates and fat, and total energy intake, the mean HDL-C concentrations for ascending quintiles of glycemic index were 1.36, 1.31, 1.30, 1.27, and 1.28 mmol/L (P<.001 for trend). Adjusting for the same covariates and considering glycemic index as a continuous variable, we found a change in HDL-C concentration of -0.06 mmol/L per 15-unit increase in glycemic index (P<.001). The multiple R² for the model was 0.23. Similarly, the multivariate-adjusted mean HDL-C concentrations for ascending quintiles of glycemic load distribution were 1.35, 1.31, 1.31, 1.30, and 1.26 mmol/L (P<.001 for linear trend). The inverse relationships between glycemic index and glycemic load and HDL-C persisted across all subgroups of participants categorized by sex or body mass index.

Conclusions  These findings from a nationally representative sample of US adults suggest that high dietary glycemic index and high glycemic load are associated with a lower concentration of plasma HDL-C.

From the Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Ford); and the Division of Preventive Medicine, Harvard Medical School, Boston, Mass (Dr Liu).

Corresponding author and reprints: Earl S. Ford, MD, Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS K26, Atlanta, GA 30341 (e-mail: esf2{at}cdc.gov).

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