A high dietary glycemic index increases total mortality in a Mediterranean population at high cardiovascular risk

Itandehui Castro-Quezada; Almudena Sánchez-Villegas; Ramón Estruch; Jordi Salas-Salvadó; Dolores Corella; Helmut Schröder; Jacqueline Alvarez-Pérez; María Dolores Ruiz-López; Reyes Artacho; Emilio Ros; Mónica Bulló; María-Isabel Covas; Valentina Ruiz-Gutiérrez; Miguel Ruiz-Canela; Pilar Buil-Cosiales; Enrique Gómez-Gracia; José Lapetra; Xavier Pintó; Fernando Arós; Miquel Fiol; Rosa María Lamuela-Raventós; Miguel Ángel Martínez-González; Lluís Serra-Majem; PREDIMED Study Investigators

doi:10.1371/journal.pone.0107968

A high dietary glycemic index increases total mortality in a Mediterranean population at high cardiovascular risk

PLoS One. 2014 Sep 24;9(9):e107968. doi: 10.1371/journal.pone.0107968. eCollection 2014.

Authors

Itandehui Castro-Quezada¹, Almudena Sánchez-Villegas², Ramón Estruch³, Jordi Salas-Salvadó⁴, Dolores Corella⁵, Helmut Schröder⁶, Jacqueline Alvarez-Pérez², María Dolores Ruiz-López⁷, Reyes Artacho⁸, Emilio Ros⁹, Mónica Bulló⁴, María-Isabel Covas¹⁰, Valentina Ruiz-Gutiérrez¹¹, Miguel Ruiz-Canela¹², Pilar Buil-Cosiales¹², Enrique Gómez-Gracia¹³, José Lapetra¹⁴, Xavier Pintó¹⁵, Fernando Arós¹⁶, Miquel Fiol¹⁷, Rosa María Lamuela-Raventós¹⁸, Miguel Ángel Martínez-González¹², Lluís Serra-Majem²; PREDIMED Study Investigators

Affiliations

¹ Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
² Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain.
³ Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Internal Medicine, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
⁴ Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Human Nutrition Department, School of Medicine, University Rovira i Virgili, Reus, Tarragona, Spain.
⁵ Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Preventive Medicine, School of Medicine, University of Valencia, Valencia, Spain.
⁶ Cardiovascular Risk and Nutrition Research Group, Institut Municipal d'Investigació Medica (IMIM)-Institut de Recerca del Hospital del Mar, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain.
⁷ Department of Nutrition and Food Science, School of Pharmacy, University of Granada, Granada, Spain; Institute of Nutrition and Food Technologies, University of Granada. Armilla, Granada, Spain.
⁸ Department of Nutrition and Food Science, School of Pharmacy, University of Granada, Granada, Spain.
⁹ Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Lipid Clinic, Endocrinology and Nutrition Service, Hospital Clinic, l'Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
¹⁰ Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Cardiovascular Risk and Nutrition Research Group, Institut Municipal d'Investigació Medica (IMIM)-Institut de Recerca del Hospital del Mar, Barcelona, Spain.
¹¹ Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Group of Nutrition and Lipid Metabolism, Instituto de la Grasa (CSIC), Seville, Spain.
¹² Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine - Clinica Universitaria de Navarra, University of Navarra, Pamplona, Navarra, Spain.
¹³ Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Preventive Medicine, School of Medicine, University of Malaga, Malaga, Spain.
¹⁴ Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Family Medicine, Primary Care Division of Sevilla, San Pablo Health Center, Sevilla, Spain.
¹⁵ Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Internal Medicine Service, Hospital of Bellvitge, Barcelona, Spain.
¹⁶ Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Cardiology, Hospital Txagorritxu, Vitoria, Alava, Spain.
¹⁷ Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; University Institute for Health Sciences Investigation, University of Balearic Islands, Palma de Mallorca, Spain; Department of Cardiology, Hospital Son Espases, Palma de Mallorca, Spain.
¹⁸ Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain; Department of Nutrition and Bromatology, School of Pharmacy, University of Barcelona, Barcelona, Spain.

Abstract

Objective: Different types of carbohydrates have diverse glycemic response, thus glycemic index (GI) and glycemic load (GL) are used to assess this variation. The impact of dietary GI and GL in all-cause mortality is unknown. The objective of this study was to estimate the association between dietary GI and GL and risk of all-cause mortality in the PREDIMED study.

Material and methods: The PREDIMED study is a randomized nutritional intervention trial for primary cardiovascular prevention based on community-dwelling men and women at high risk of cardiovascular disease. Dietary information was collected at baseline and yearly using a validated 137-item food frequency questionnaire (FFQ). We assigned GI values of each item by a 5-step methodology, using the International Tables of GI and GL Values. Deaths were ascertained through contact with families and general practitioners, review of medical records and consultation of the National Death Index. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) and their 95% CI for mortality, according to quartiles of energy-adjusted dietary GI/GL. To assess repeated measures of exposure, we updated GI and GL intakes from the yearly FFQs and used Cox models with time-dependent exposures.

Results: We followed 3,583 non-diabetic subjects (4.7 years of follow-up, 123 deaths). As compared to participants in the lowest quartile of baseline dietary GI, those in the highest quartile showed an increased risk of all-cause mortality [HR = 2.15 (95% CI: 1.15-4.04); P for trend = 0.012]. In the repeated-measures analyses using as exposure the yearly updated information on GI, we observed a similar association. Dietary GL was associated with all-cause mortality only when subjects were younger than 75 years.

Conclusions: High dietary GI was positively associated with all-cause mortality in elderly population at high cardiovascular risk.

Publication types

Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Age Factors
Aged
Aged, 80 and over
Cardiovascular Diseases / complications*
Cardiovascular Diseases / epidemiology*
Cardiovascular Diseases / metabolism
Cardiovascular Diseases / mortality
Cause of Death
Diet / adverse effects*
Dietary Carbohydrates / adverse effects
Feeding Behavior
Female
Glycemic Index*
Humans
Male
Middle Aged
Proportional Hazards Models
Risk Factors

Substances

Dietary Carbohydrates

Grants and funding

This report has been supported by the official funding agency for biomedical research of the Spanish government, Instituto de Salud Carlos III (ISCIII), through grants provided to research networks specifically developed for the trial [RTIC G03/140, to R E; RTIC RD 06/0045, to MA M-G] and through Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn); Centro Nacional de Investigaciones Cardiovasculares [CNIC 06/2007]; Fondo de Investigación Sanitaria–Fondo Europeo de Desarrollo Regional [PI04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, and P11/02505]; Ministerio de Ciencia e Innovación [AGL-2009-13906-C02 and AGL2010-22319-C03]; Fundación Mapfre 2010; Agencia Canaria de Investigación, Innovación y Sociedad de la Información-EU FEDER [PI 2007/050]; Consejería de Salud de la Junta de Andalucía [PI0105/2007]; Public Health Division of the Department of Health of the Autonomous Government of Catalonia; Generalitat Valenciana [ACOMP06109, GVACOMP2010-181, GVACOMP2011-151, CS2010-AP-111, and CS2011-AP-042]; Regional Government of Navarra [P27/2011] and IC-Q is supported by a scholarship of the Consejo Nacional de Ciencia y Tecnología de México (National Council on Science and Technology of México, CONACYT). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.