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Relation of dietary glycemic load with ischemic and hemorrhagic stroke: a cohort study in Greece and a meta-analysis

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A Letter to the Editor to this article was published on 13 June 2014

Abstract

Purpose

High glycemic load (GL) has been associated with excess stroke risk. Data suggest a different role of diet in the etiology of ischemic and hemorrhagic stroke.

Methods

We analyzed data from 19,824 participants of the Greek cohort of the population-based European Prospective Investigation into Cancer and nutrition (EPIC), who were free of cardiovascular diseases, cancer, and diabetes at baseline and had not developed diabetes. Diet was assessed at enrollment through a validated, interviewer-administered semi-quantitative food frequency questionnaire. The average daily GL was derived using standard tables. We also conducted a meta-analysis on GL and stroke (overall, ischemic and hemorrhagic), using random-effects models.

Results

In the Greek EPIC cohort, 304 incident stroke cases were identified (67 ischemic, 49 hemorrhagic). Using Cox proportional hazards regression models adjusted for potential confounders, the hazard ratios for the highest versus the lowest GL tertiles were 1.07 [95 % confidence interval (CI) 0.74–1.54] for overall stroke, 1.55 (95 % CI 0.72–3.36) for ischemic and 0.48 (95 % CI 0.18–1.25) for hemorrhagic stroke (p-heterogeneity <0.01). The meta-analysis, including a total of 3,088 incident cases and 247 deaths from stroke (1,469 cases and 126 deaths ischemic; 576 cases and 94 deaths hemorrhagic), estimated pooled relative risks for the highest versus the lowest GL levels of 1.23 (95 % CI 1.07–1.41) for overall, 1.35 (95 % CI 1.06–1.72) for ischemic, and 1.09 (95 % CI 0.81–1.47) for hemorrhagic stroke (p-heterogeneity = 0.275).

Conclusions

This study indicates that GL is an important determinant of the more common ischemic—though not of the hemorrhagic—stroke.

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References

  1. Beulens JW, de Bruijne LM, Stolk RP, Peeters PH, Bots ML, Grobbee DE, van der Schouw YT (2007) High dietary glycemic load and glycemic index increase risk of cardiovascular disease among middle-aged women: a population-based follow-up study. J Am Coll Cardiol 50:14–21

    Article  Google Scholar 

  2. Burger KN, Beulens JW, Boer JM, Spijkerman AM, Van der AD (2011) Dietary glycemic load and glycemic index and risk of coronary heart disease and stroke in Dutch men and women: the EPIC-MORGEN study. PLoS ONE 6:e25955

    Article  CAS  Google Scholar 

  3. Cassidy A, Rimm EB, O’Reilly EJ, Logroscino G, Kay C, Chiuve SE, Rexrode KM (2012) Dietary flavonoids and risk of stroke in women. Stroke 43:946–951

    Article  CAS  Google Scholar 

  4. Chiuve SE, Rexrode KM, Spiegelman D, Logroscino G, Manson JE, Rimm EB (2008) Primary prevention of stroke by healthy lifestyle. Circulation 118:947–954

    Article  Google Scholar 

  5. Cust AE, Skilton MR, van Bakel MM, Halkjaer J, Olsen A, Agnoli C, Psaltopoulou T, Buurma E, Sonestedt E, Chirlaque MD, Rinaldi S, Tjonneland A, Jensen MK, Clavel-Chapelon F, Boutron-Ruault MC, Kaaks R, Nothlings U, Chloptsios Y, Zylis D, Mattiello A, Caini S, Ocke MC, van der Schouw YT, Skeie G, Parr CL, Molina-Montes E, Manjer J, Johansson I, McTaggart A, Key TJ, Bingham S, Riboli E, Slimani N (2009) Total dietary carbohydrate, sugar, starch and fibre intakes in the European prospective investigation into cancer and nutrition. Eur J Clin Nutr 63(Suppl 4):S37–S60

    Article  CAS  Google Scholar 

  6. Del Rio D, Agnoli C, Pellegrini N, Krogh V, Brighenti F, Mazzeo T, Masala G, Bendinelli B, Berrino F, Sieri S, Tumino R, Rollo PC, Gallo V, Sacerdote C, Mattiello A, Chiodini P, Panico S (2011) Total antioxidant capacity of the diet is associated with lower risk of ischemic stroke in a large Italian cohort. J Nutr 141:118–123

    Article  Google Scholar 

  7. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  Google Scholar 

  8. Fan J, Song Y, Wang Y, Hui R, Zhang W (2012) Dietary glycemic index, glycemic load, and risk of coronary heart disease, stroke, and stroke mortality: a systematic review with meta-analysis. PLoS ONE 7:e52182

    Article  CAS  Google Scholar 

  9. Foster-Powell K, Holt SH, Brand-Miller JC (2002) International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr 76:5–56

    CAS  Google Scholar 

  10. Gnardellis C, Trichopoulou A, Katsouyanni K, Polychronopoulos E, Rimm EB, Trichopoulos D (1995) Reproducibility and validity of an extensive semiquantitative food frequency questionnaire among Greek school teachers. Epidemiology 6:74–77

    Article  CAS  Google Scholar 

  11. Goldin A, Beckman JA, Schmidt AM, Creager MA (2006) Advanced glycation end products: sparking the development of diabetic vascular injury. Circulation 114:597–605

    Article  CAS  Google Scholar 

  12. He K, Rimm EB, Merchant A, Rosner BA, Stampfer MJ, Willett WC, Ascherio A (2002) Fish consumption and risk of stroke in men. JAMA 288:3130–3136

    Article  CAS  Google Scholar 

  13. Henry CJ, Lightowler HJ, Strik CM, Storey M (2005) Glycaemic index values for commercially available potatoes in Great Britain. Br J Nutr 94:917–921

    Article  CAS  Google Scholar 

  14. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558

    Article  Google Scholar 

  15. Janghorbani M, Hu FB, Willett WC, Li TY, Manson JE, Logroscino G, Rexrode KM (2007) Prospective study of type 1 and type 2 diabetes and risk of stroke subtypes: the Nurses’ Health Study. Diabetes Care 30:1730–1735

    Article  Google Scholar 

  16. Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM, Bowling AC, Newman HC, Jenkins AL, Goff DV (1981) Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr 34:362–366

    CAS  Google Scholar 

  17. Kaushik S, Wang JJ, Wong TY, Flood V, Barclay A, Brand-Miller J, Mitchell P (2009) Glycemic index, retinal vascular caliber, and stroke mortality. Stroke 40:206–212

    Article  Google Scholar 

  18. Kurth T, Moore SC, Gaziano JM, Kase CS, Stampfer MJ, Berger K, Buring JE (2006) Healthy lifestyle and the risk of stroke in women. Arch Intern Med 166:1403–1409

    Article  Google Scholar 

  19. Levi F, Chatenoud L, Bertuccio P, Lucchini F, Negri E, La Vecchia C (2009) Mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world: an update. Eur J Cardiovasc Prev Rehabil 16:333–350

    Article  Google Scholar 

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

    CAS  Google Scholar 

  21. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34

    Article  Google Scholar 

  22. Ludwig DS (2002) The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA 287:2414–2423

    Article  CAS  Google Scholar 

  23. Misirli G, Benetou V, Lagiou P, Bamia C, Trichopoulos D, Trichopoulou A (2012) Relation of the traditional Mediterranean diet to cerebrovascular disease in a Mediterranean population. Am J Epidemiol 176:1185–1192

    Article  Google Scholar 

  24. Murakami Y, Huxley RR, Lam TH, Tsukinoki R, Fang X, Kim HC, Woodward M (2012) Diabetes, body mass index and the excess risk of coronary heart disease, ischemic and hemorrhagic stroke in the Asia pacific cohort studies collaboration. Prev Med 54:38–41

    Article  Google Scholar 

  25. Neaton JD, Wentworth DN, Cutler J, Stamler J, Kuller L (1993) Risk factors for death from different types of stroke. Multiple risk factor intervention trial research group. Ann Epidemiol 3:493–499

    Article  CAS  Google Scholar 

  26. Oba S, Nagata C, Nakamura K, Fujii K, Kawachi T, Takatsuka N, Shimizu H (2010) Dietary glycemic index, glycemic load, and intake of carbohydrate and rice in relation to risk of mortality from stroke and its subtypes in Japanese men and women. Metabolism 59:1574–1582

    Article  CAS  Google Scholar 

  27. Oh K, Hu FB, Cho E, Rexrode KM, Stampfer MJ, Manson JE, Liu S, Willett WC (2005) Carbohydrate intake, glycemic index, glycemic load, and dietary fiber in relation to risk of stroke in women. Am J Epidemiol 161:161–169

    Article  Google Scholar 

  28. Ross CM (2005) Re: carbohydrate intake, glycemic index, glycemic load, and dietary fiber in relation to risk of stroke in women. Am J Epidemiol 161:995

    Article  Google Scholar 

  29. Rossi M, Turati F, Lagiou P, Trichopoulos D, Augustin L, La Vecchia C, Trichopoulou A (2013) Mediterranean diet and glycemic load in relation to type 2 diabetes. Diabetologia. doi:10.1007/s00125-013-3013-y

    Google Scholar 

  30. Sieri S, Brighenti F, Agnoli C, Grioni S, Masala G, Bendinelli B, Sacerdote C, Ricceri F, Tumino R, Giurdanella MC, Pala V, Berrino F, Mattiello A, Chiodini P, Panico S, Krogh V (2013) Dietary glycemic load and glycemic index and risk of cerebrovascular disease in the EPICOR cohort. PLoS ONE 8:e62625

    Article  CAS  Google Scholar 

  31. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348:2599–2608

    Article  Google Scholar 

  32. Trichopoulou A, Georga K (2004) Composition Tables of Foods and Greek Dishes. Athens, Greece, Parisianos

    Google Scholar 

  33. van Bakel MM, Kaaks R, Feskens EJ, Rohrmann S, Welch AA, Pala V, Avloniti K, van der Schouw YT, van der AD, Du H, Halkjaer J, Tormo MJ, Cust AE, Brighenti F, Beulens JW, Ferrari P, Biessy C, Lentjes M, Spencer EA, Panico S, Masala G, Bueno-de-Mesquita HB, Peeters PH, Trichopoulou A, Psaltopoulou T, Clavel-Chapelon F, Touvier M, Skeie G, Rinaldi S, Sonestedt E, Johansson I, Schulze M, Ardanaz E, Buckland G, Tjonneland A, Overvad K, Bingham S, Riboli E, Slimani N (2009) Dietary glycaemic index and glycaemic load in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 63(Suppl 4):S188–S205

    Article  CAS  Google Scholar 

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Acknowledgments

The research leading to these results has received funding from the European Community’s Seventh Framework Programme (FP7/2007-2013) under CHANCES Project grant agreement no. HEALTH–F3-2010-242244. The work of CLV, MR, and FT was partially supported by the Italian Foundation for Cancer Research (AIRC), Milan, Italy. The authors thank Ms Garimoldi for editorial assistance.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy

    Marta Rossi & Federica Turati

  2. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Pagona Lagiou & Dimitrios Trichopoulos

  3. Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece

    Pagona Lagiou & Antonia Trichopoulou

  4. Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

    Carlo La Vecchia

  5. Laboratory of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa, 19, 20156, Milan, Italy

    Carlo La Vecchia

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  1. Marta Rossi
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  2. Federica Turati
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  3. Pagona Lagiou
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  4. Dimitrios Trichopoulos
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  5. Carlo La Vecchia
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  6. Antonia Trichopoulou
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Corresponding author

Correspondence to Carlo La Vecchia.

Additional information

Carlo La Vecchia and Antonia Trichopoulou share senior co-authorship.

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Rossi, M., Turati, F., Lagiou, P. et al. Relation of dietary glycemic load with ischemic and hemorrhagic stroke: a cohort study in Greece and a meta-analysis. Eur J Nutr 54, 215–222 (2015). https://doi.org/10.1007/s00394-014-0702-3

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