Download PDF
Semin Thromb Hemost 2009; 35(1): 111-118
DOI: 10.1055/s-0029-1214154
© Thieme Medical Publishers

Glycemic Index, Glycemic Load, and Thrombogenesis

Jennie Brand-Miller1 , Scott Dickinson1 , Alan Barclay1 , Margaret Allman-Farinelli1
  • 1Institute of Obesity, Nutrition and Exercise, and Department of Medicine, University of Sydney and Royal Prince Alfred Hospital, Camperdown, NSW, Australia
Further Information

Publication History

Publication Date:
23 March 2009 (online)

    Permissions and Reprints

ABSTRACT

Hyperglycemia and insulin resistance are independent risk factors for cardiovascular disease (CVD). Postprandial glycemic “spikes” adversely affect vascular structure and function via multiple mechanisms including oxidative stress, inflammation, low-density lipoprotein oxidation, protein glycation, and procoagulant activity. Glycemic responses can be reliably predicted by considering both the quantity and quality of carbohydrate. The glycemic index (GI), a measure of carbohydrate quality, has provided insights that knowledge of the sugar or starch content has not. In prospective observational studies, dietary GI and/or glycemic load (GL; the product of the amount of carbohydrate and GI) independently predict CVD, with relative risk ratios of 1.2 to 1.9 comparing highest and lowest quartiles. In randomized controlled trials in overweight subjects, diets based on low GI carbohydrates have decreased plasminogen activator inhibitor-1 activity and other CVD risk factors over and above that of conventional low-fat diets. Taken together, the findings suggest that clinicians may be able to improve CVD outcomes by recommending the judicious use of low GI/GL foods.

KEYWORDS

Glycemic index - cardiovascular disease - carbohydrates - glycemic load - postprandial glycemia

REFERENCES

  • 1 Malmberg K, Yusuf S, Gerstein H C et al.. Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) Registry.  Circulation. 2000;  102 1014-1019
    PubMedSearch in Google Scholar
  • 2 Levitan E, Song Y, Ford E, Liu S. Is nondiabetic hyperglycemia a risk factor for postchallenge blood glucose levels? A meta-analysis of prospective studies.  Arch Intern Med. 2004;  164 2147-2155
    CrossrefPubMedSearch in Google Scholar
  • 3 Temelkova-Kurktschiev T, Koehler C, Henkel E et al.. Postchallenge plasma glucose and glycemic spikes are more strongly associated with atherosclerosis than fasting glucose or HbA1c level.  Diabetes Care. 2000;  23 1830-1834
    CrossrefPubMedSearch in Google Scholar
  • 4 Gross L, Li L, Ford E, Liu S. Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment.  Am J Clin Nutr. 2004;  79 774-779
    PubMedSearch in Google Scholar
  • 5 Schulze M, Liu S, Rimm E et al.. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women.  Am J Clin Nutr. 2004;  80 348-356
    PubMedSearch in Google Scholar
  • 6 Wahlqvist M, Wilmshurst E, Richardson E. The effect of chain length on glucose absorption and the related metabolic response.  Am J Clin Nutr. 1978;  31 1998-2001
    PubMedSearch in Google Scholar
  • 7 Standards Australia .Glycemic Index of Foods. Australian Standard AS4694_2007. Sydney, Australia; Standards Australia 2007
    Search in Google Scholar
  • 8 Atkinson F, Foster-Powell K, Brand-Miller J. International tables of glycemic index and glycemic load values: 2008.  Diabetes Care. 2008;  , in press
    PubMedSearch in Google Scholar
  • 9 McMillan-Price J, Petocz P, Atkinson F et al.. Comparison of 4 diets of varying glycemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults: a randomised controlled trial.  Arch Intern Med. 2006;  166 1466-1475
    CrossrefPubMedSearch in Google Scholar
  • 10 Brand-Miller J, Thomas M, Swan V et al.. Physiological validation of the concept of glycemic load in lean young adults.  J Nutr. 2003;  133 2728-2732
    PubMedSearch in Google Scholar
  • 11 Wolever T M, Mehling C. High-carbohydrate-low-glycaemic index dietary advice improves glucose disposition index in subjects with impaired glucose tolerance.  Br J Nutr. 2002;  87 477-487
    CrossrefPubMedSearch in Google Scholar
  • 12 Wolever T M, Mehling C. Long-term effect of varying the source or amount of dietary carbohydrate on postprandial plasma glucose, insulin, triacylglycerol, and free fatty acid concentrations in subjects with impaired glucose tolerance.  Am J Clin Nutr. 2003;  77 612-621
    PubMedSearch in Google Scholar
  • 13 Ball S D, Keller K R, Moyer-Mileur L J et al.. Prolongation of satiety after low versus moderately high glycemic index meals in obese adolescents.  Pediatrics. 2003;  111 488-494
    CrossrefPubMedSearch in Google Scholar
  • 14 Wolever T M, Yang M, Zeng X, Atkinson F, Brand-Miller J. Food glycemic index, as given in glycemic index tables, is a significant determinant of glycemic responses elicited by composite breakfast meals.  Am J Clin Nutr. 2006;  83 1306-1312
    PubMedSearch in Google Scholar
  • 15 Brynes A, Lee J, Brighton R et al.. A low glycemic diet significantly improves the 24-h blood glucose profile in people with type 2 diabetes as assessing using the Continuous Glucose Minimed Monitor.  Diabetes Care. 2003;  26 548-549
    CrossrefPubMedSearch in Google Scholar
  • 16 Brynes A, Edwards M, Ghatei M et al.. A randomised four-intervention crossover study investigating the effect of carbohydrates on daytime profiles of insulin, glucose, non-esterified fatty acids and triacylglycerols in middle-aged men.  Br J Nutr. 2003;  89 207-218
    CrossrefPubMedSearch in Google Scholar
  • 17 Sheard N F, Clark N G, Brand-Miller J C et al.. Dietary carbohydrate (amount and type) in the prevention and management of diabetes: a statement by the American Diabetes Association.  Diabetes Care. 2004;  27 2266-2271
    CrossrefPubMedSearch in Google Scholar
  • 18 McKeown N, Meigs J, Liu S et al.. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham offspring cohort.  Diabetes Care. 2004;  27 538-546
    CrossrefPubMedSearch in Google Scholar
  • 19 Brownlee M. Biochemistry and molecular biology of diabetes complications.  Nature. 2001;  414 813-820
    CrossrefPubMedSearch in Google Scholar
  • 20 Kawano H, Motoyama T, Hirashima O et al.. Hyperglycemia rapidly suppresses flow-mediated endothelium-dependent vasodilation of brachial artery.  J Am Coll Cardiol. 1999;  34 146-154
    CrossrefPubMedSearch in Google Scholar
  • 21 Eliasson M, Asplund K, Evrin P E, Lindahl B, Lundblad D. Hyperinsulinemia predicts low tissue plasminogen activator activity in a healthy population: the Northern Sweden MONICA Study.  Metabolism. 1994;  43 1579-1586
    CrossrefPubMedSearch in Google Scholar
  • 22 Lopez-Segura F, Velasco F, Lopez-Miranda J et al.. Monounsaturated fatty acid-enriched diet decreases plasma plasminogen activator inhibitor type 1.  Arterioscler Thromb Vasc Biol. 1996;  16 82-88
    PubMedSearch in Google Scholar
  • 23 Ceriello A. Coagulation activation in diabetes mellitus: the role of hyperglycaemia and therapeutic prospects.  Diabetologia. 1993;  36 1119-1125
    CrossrefPubMedSearch in Google Scholar
  • 24 Brownlee M. The pathobiology of diabetic complications: a unifying mechanism.  Diabetes. 2005;  54 1615-1625
    CrossrefPubMedSearch in Google Scholar
  • 25 Dickinson S, Hancock D, Petocz P, Ceriello A, Brand-Miller J. High glycemic index carbohydrate increases NF-kB activation in mononuclear cells of young lean healthy subjects.  Am J Clin Nutr. 2008;  87 1188-1193
    PubMedSearch in Google Scholar
  • 26 Liu S, Stampfer M, Hu F et al.. Whole-grain consumption and risk of coronary heart disease: results from the Nurses' Health Study.  Am J Clin Nutr. 1999;  70 412-419
    PubMedSearch in Google Scholar
  • 27 Halton T, Willett W, Liu S et al.. Low-carbohydrate-diet score and the risk of coronary heart disease in women.  N Engl J Med. 2006;  355 1991-2002
    CrossrefPubMedSearch in Google Scholar
  • 28 Beulens J, de Bruijne L, Stolk R et al.. High dietary glycemic load and glycemic index increase risk of cardiovascular disease among middle-aged women.  J Am Coll Cardiol. 2007;  50 14-21
    CrossrefPubMedSearch in Google Scholar
  • 29 Levitan E B, Mittleman M A, Hakansson N, Wolk A. Dietary glycemic index, dietary glycemic load, and cardiovascular disease in middle-aged and older Swedish men.  Am J Clin Nutr. 2007;  85 1521-1526
    PubMedSearch in Google Scholar
  • 30 Liu S, Willett W, Stampfer M et al.. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women.  Am J Clin Nutr. 2000;  71 1455-1461
    PubMedSearch in Google Scholar
  • 31 Oh K, Hu F B, Cho E et al.. Carbohydrate intake, glycemic index, glycemic load, and dietary fiber in relation to risk of stroke in women.  Am J Epidemiol. 2005;  161 161-169
    CrossrefPubMedSearch in Google Scholar
  • 32 van Dam R, Visscher A, Feskens E, Verhoef P, Kromhout D. Dietary glycemic index in relation to metabolic risk factors and incidence of coronary heart disease: the Zutphen Elderly Study.  Eur J Clin Nutr. 2000;  54 726-731
    CrossrefPubMedSearch in Google Scholar
  • 33 Barclay A W, Flood V M, Brand-Miller J C, Mitchell P. Validity of carbohydrate, glycaemic index and glycaemic load data obtained using a semi-quantitative food-frequency questionnaire.  Public Health Nutr. 2008;  11 573-580
    PubMedSearch in Google Scholar
  • 34 Barclay A W, Petocz P, McMillan-Price J et al.. Glycemic index, glycemic load, and chronic disease risk—a meta-analysis of observational studies.  Am J Clin Nutr. 2008;  87 627-637
    PubMedSearch in Google Scholar
  • 35 Ford E, Liu S. Glycemic index and serum high-density lipoprotein cholesterol concentration among us adults.  Arch Intern Med. 2001;  161 572-576
    CrossrefPubMedSearch in Google Scholar
  • 36 Frost G, Leeds A, Dore C et al.. Glycaemic index as a determinant of serum HDL-cholesterol concentration.  Lancet. 1999;  353 1045-1048
    CrossrefPubMedSearch in Google Scholar
  • 37 Liu S, Manson J, Stampfer M et al.. Dietary glycemic load assessed by food-frequency questionnaire in relation to plasma high-density-lipoprotein cholesterol and fasting plasma triacylglycerols in postmenopausal women.  Am J Clin Nutr. 2001;  73 560-566
    PubMedSearch in Google Scholar
  • 38 Liu S, Manson J, Buring J et al.. Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women.  Am J Clin Nutr. 2002;  75 492-498
    Search in Google Scholar
  • 39 O'Keefe J H, Gheewala N M, O'Keefe J O. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health.  J Am Coll Cardiol. 2008;  51 249-255
    CrossrefPubMedSearch in Google Scholar
  • 40 Weickert M, Mohlig M, Koebnick C et al.. Impact of cereal fibre on glucose-regulating factors.  Diabetologia. 2005;  48 2343-2353
    CrossrefPubMedSearch in Google Scholar
  • 41 Brand-Miller J C, Fatema K, Middlemiss C et al.. Effect of alcoholic beverages on postprandial glycemia and insulinemia in lean, young, healthy adults.  Am J Clin Nutr. 2007;  85 1545-1551
    PubMedSearch in Google Scholar
  • 42 Jensen L, Sloth B, Krog-Mikkelsen I et al.. A low-glycemic-index diet reduces plasma plasminogen activator inhibitor-1 activity, but not tissue inhibitor of proteinases-1 or plasminogen activator inhibitor-1 protein, in overweight women.  Am J Clin Nutr. 2008;  87 97-105
    PubMedSearch in Google Scholar
  • 43 Ebbeling C, Leidig M, Sinclair K et al.. Effects of an ad libitum reduced glycemic load diet on cardiovascular disease risk factors in obese young adults.  Am J Clin Nutr. 2005;  81 976-982
    PubMedSearch in Google Scholar
  • 44 Jarvi A, Karlstrom B, Granfeldt Y et al.. Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low-glycemic index diet in type 2 diabetic patients.  Diabetes Care. 1999;  22 10-18
    CrossrefPubMedSearch in Google Scholar
  • 45 Rizkalla S, Taghrid L, Laromiguiere M et al.. Improved plasma glucose control, whole-body glucose utilization, and lipid profile on a low-glycemic index diet in type 2 diabetic men: a randomized controlled trial.  Diabetes Care. 2004;  27 1866-1872
    CrossrefPubMedSearch in Google Scholar
  • 46 Fain J N, Madan A K. Insulin enhances vascular endothelial growth factor, interleukin-8, and plasminogen activator inhibitor 1 but not interleukin-6 release by human adipocytes.  Metabolism. 2005;  54 220-226
    CrossrefPubMedSearch in Google Scholar
  • 47 Rikitake Y, Liao J K. Rho-kinase mediates hyperglycemia-induced plasminogen activator inhibitor-1 expression in vascular endothelial cells.  Circulation. 2005;  111 3261-3268
    CrossrefPubMedSearch in Google Scholar
  • 48 Sloth B, Krog-Mikkelsen I, Flint A et al.. No difference in body weight decrease between a low-glycemic-index and a high-glycemic-index diet but reduced LDL cholesterol after 10-wk ad libitum intake of the low-glycemic-index diet.  Am J Clin Nutr. 2004;  80 337-347
    PubMedSearch in Google Scholar
  • 49 Opperman A, Venter C, Oosthuizen W, Thompson R, Voster H. Meta-analysis of the health effects of using the glycaemic index in meal-planning.  Br J Nutr. 2004;  92 367-381
    CrossrefPubMedSearch in Google Scholar
  • 50 Jenkins D J, Wolever T M, Kalmusky J et al.. Low-glycemic index diet in hyperlipidemia: use of traditional starchy foods.  Am J Clin Nutr. 1987;  46 66-71
    PubMedSearch in Google Scholar
  • 51 Frost G, Leeds A, Trew G, Margara R, Dornhorst A. Insulin sensitivity in women at risk of coronary heart disease and the effect of a low glycemic diet.  Metabolism. 1998;  47 1245-1251
    CrossrefPubMedSearch in Google Scholar
  • 52 Patel V, Aldridge R, Leeds A, Dornhorst A, Frost G. Retrospective analysis of the impact of a low glycaemic index diet on hospital stay following coronary artery bypass grafting: a hypothesis.  J Hum Nutr Diet. 2004;  17 241-247
    CrossrefPubMedSearch in Google Scholar
  • 53 Mozaffarian D, Rimm E, Herrington D. Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women.  Am J Clin Nutr. 2004;  80 1175-1184
    PubMedSearch in Google Scholar
  • 54 Pawlak D B, Kushner J, Ludwig D. Effects of dietary glycaemic index on adiposity, glucose homoeostasis, and plasma lipids in animals.  Lancet. 2004;  364 778-785
    CrossrefPubMedSearch in Google Scholar
  • 55 Chiasson J, Josse R G, Gomis R et al.. Acarbose treatment and the risk kof cardiovascular disease and hypertension in patients with impaired glucose tolerance.  JAMA. 2003;  290 486-494
    CrossrefPubMedSearch in Google Scholar
  • 56 Shinoda Y, Inoue I, Nakano T et al.. Acarbose improves fibrinolytic activity in patients with impaired glucose tolerance.  Metabolism. 2006;  55 935-939
    CrossrefPubMedSearch in Google Scholar
  • 57 GIsymbol.com . Available at: http://www.gisymbol.com.au Accessed October 25, 2008; 
    PubMed

Prof. J. Brand-Miller

Human Nutrition Unit (G08), University of Sydney, Camperdown

NSW 2006, Australia

Email: j.brandmiller@mmb.usyd.edu.au