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Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian CohortThe EPICOR Study
Sabina Sieri, PhD;
Vittorio Krogh, MD, MS;
Franco Berrino, MD;
Alberto Evangelista, BSc;
Claudia Agnoli, PhD;
Furio Brighenti, PhD;
Nicoletta Pellegrini, PhD;
Domenico Palli, MD;
Giovanna Masala, MD;
Carlotta Sacerdote, MD;
Fabrizio Veglia, MD;
Rosario Tumino, MD;
Graziella Frasca, PhD;
Sara Grioni, BSc;
Valeria Pala, PhD;
Amalia Mattiello, MD;
Paolo Chiodini, PhD;
Salvatore Panico, MD
Arch Intern Med. 2010;170(7):640-647.
Background Dietary glycemic load (GL) and glycemic index (GI) in relation to cardiovascular disease have been investigated in a few prospective studies with inconsistent results, particularly in men. The present EPICOR study investigated the association of GI and GL with coronary heart disease (CHD) in a large and heterogeneous cohort of Italian men and women originally recruited to the European Prospective Investigation into Cancer and Nutrition study.
Methods We studied 47 749 volunteers (15 171 men and 32 578 women) who completed a dietary questionnaire. Multivariate Cox proportional hazards modeling estimated adjusted relative risks (RRs) of CHD and 95% confidence intervals (CIs).
Results During a median of 7.9 years of follow-up, 463 CHD cases (158 women and 305 men) were identified. Women in the highest carbohydrate intake quartile had a significantly greater risk of CHD than did those in the lowest quartile (RR, 2.00; 95% CI, 1.16-3.43), with no association found in men (P = .04 for interaction). Increasing carbohydrate intake from high-GI foods was also significantly associated with greater risk of CHD in women (RR, 1.68; 95% CI, 1.02-2.75), whereas increasing the intake of low-GI carbohydrates was not. Women in the highest GL quartile had a significantly greater risk of CHD than did those in the lowest quartile (RR, 2.24; 95% CI, 1.26-3.98), with no significant association in men (P = .03 for interaction).
Conclusion In this Italian cohort, high dietary GL and carbohydrate intake from high-GI foods increase the overall risk of CHD in women but not men.
Author Affiliations: Nutritional Epidemiology Unit (Drs Sieri, Krogh, Agnoli, and Pala; Mr Evangelista; and Ms Grioni) and Etiological and Preventive Epidemiology Unit (Dr Berrino), Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale Tumori, and Centro Cardiologico Monzino, IRCCS (Dr Veglia), Milan, Italy; Department of Public Health, University of Parma, Parma, Italy (Drs Brighenti and Pellegrini); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, Florence, Italy (Drs Palli and Masala); Institute for Scientific Interchange Foundation and Department of Genetics, Biology, and Biochemistry, University of Turin, Turin, Italy (Drs Sacerdote and Veglia); Cancer Registry (Drs Tumino and Frasca) and Histopathology Unit (Dr Tumino), Department of Oncology, Civile M. P. Arezzo Hospital, Ragusa, Italy; and Department of Clinical and Experimental Medicine, University of Naples Federico II (Drs Mattiello and Panico), and Department of Public Health and Preventive Medicine, University II of Naples (Dr Chiodini), Naples, Italy.
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