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The relationship between carbohydrate quality and the prevalence of metabolic syndrome: challenges of glycemic index and glycemic load



To estimate the prevalence of metabolic syndrome (MetS) and its components in adults and older adults residents of São Paulo, the association of MetS with the glycemic index (GI) and glycemic load (GL) and the foods that contribute to dietary GI and GL in this population.


Data from 591 adults and older adults participants in the Health Survey of São Paulo were used. This is a cross-sectional, population-based study with a complex multistage sample design of residents in the urban area of the municipality. Dietary consumption data, anthropometric measurements, blood pressure and blood samples were collected. The associations between GI, GL and MetS and its components were tested using logistic regression models, considering the sample design of the study.


The prevalence of MetS in the adult and older adults residents of São Paulo was 30.3%. There was no association between GI, GL and MetS. GI and GL were positively associated with low high-density lipoprotein cholesterol (HDL-c), OR = 1.113 (95% CI 1.007–1.230) and OR = 1.019 (95% CI 1.002–1.037), respectively. GL was inversely associated with high blood pressure and this association differed by age group (OR = 0.981; 95% CI 0.964–0.998). Foods that most contributed to dietary GI and GL were sugar, white rice and French bread.


Considering the high prevalence of low HDL-c in the population of São Paulo, GI and GL may contribute to the nutritional therapy of this dyslipidemia. However, findings should be treated with caution, considering several conflicting results between studies.

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We are grateful to Prof. Dr. Chester Luiz Galvão Cesar, Prof. Dr. Moisés Goldbaum, Maria Cecilia Goi Porto Alves, and all Health Survey of São Paulo staff for conception and design of the study and to the Food Consumption Research Group (GAC) for their support. The São Paulo Municipal Health Department (no grant number), National Council for Scientific and Technological Development (CNPq; Process # 481176/2008-0 e 473100/2009-6), Foundation for Research Support of the State of Paulo (FAPESP; Process # 2009/15831-0 and # 2012/22113-9) and Higher Education Personnel Training Coordination (CAPES; no grant numbers) supported this study.

Author contributions

MMF was involved in the analysis and interpretation of the data and drafting the article. CHS and AAFC were involved in the analysis and interpretation of the data, drafting the article, and revising it critically for important intellectual content. DMM was involved in the conception and design of the study and revising it critically for important intellectual content. RMF was involved in the conception and design of the study, interpretation of the data, and revising the manuscript critically for important intellectual content. All authors approved the final version to be submitted.

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Correspondence to Regina Mara Fisberg.

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de Mello Fontanelli, M., Sales, C.H., Carioca, A.A.F. et al. The relationship between carbohydrate quality and the prevalence of metabolic syndrome: challenges of glycemic index and glycemic load. Eur J Nutr 57, 1197–1205 (2018).

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  • Metabolic Syndrome
  • Glycemic Index
  • Glycemic Load
  • Cross-sectional studies
  • Prevalence