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Clinical Nutrition
Available online 19 August 2023
In Press, Journal Pre-proof

Meta-analyses
Dietary glycemic index, glycemic load and all-cause and cause-specific mortality: a meta-analysis of prospective cohort studies

https://doi.org/10.1016/j.clnu.2023.08.014

Abstract

Background & aims
The findings of previous studies investigating the association between dietary glycemic index, glycemic load, and the risk of mortality have been inconsistent. We performed a meta-analysis to evaluate this association.

Methods
A systematic search in PubMed and Web of Science databases was conducted to identify prospective cohort studies on dietary glycemic index and load with risk of mortality through January 2023. Study-specific relative risks (RR) were combined by using random effects models.

Results
Fifteen prospective cohort studies with a total of 527,650 participants and 48,598 all-cause and cause-specific deaths were included in the current meta-analysis. Pooled analyses indicated a higher risk of all-cause mortality (RR = 1.10, 95% CI: 1.00-1.20) and stroke mortality (RR = 1.30, 95% CI: 1.04-1.62) for the highest versus lowest levels of glycemic index. A significant non-linear association was found between glycemic index and mortality of all-causes (P for non-linearity = 0.02) and CVD (P for non-linearity < 0.001), indicating increased risk at high levels of glycemic index (≥63.1 for all-cause mortality; ≥72.8 for CVD mortality). Glycemic load was positively associated with risk of CVD mortality (RR= 1.18, 95% CI: 1.09-1.27) and stroke mortality (RR= 1.30, 95% CI: 1.05-1.60) in the highest versus lowest meta-analysis. For cancer mortality, there was no significant association with glycemic index, but the association with glycemic load differed by sex.

Conclusions
Our results indicated that high glycemic index and glycemic load was associated with an increased risk of mortality from CVD and stroke. Further large prospective studies are warranted to provide definitive evidence in subgroups.