A large body of epidemiologic evidence has demonstrated that the combination of a Western diet and lifestyle is primarily responsible for the increased metabolic disease risk, such as obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome, noted in society today. Thus finding optimal intervention strategies to combat these growing epidemics is imperative. Despite some controversy, a growing body of literature indicates that one aspect of diet that likely affects phenotypic outcomes and metabolic disease risk is the glycemic load (GL). This brief review will provide an overview of the GL concept, discuss epidemiologic work investigating relationships between both GL and metabolic risk factors, as well as intervention studies that have assessed the impact of GL on phenotypic outcomes related to T2DM and cardiovascular disease. Overall, a low dietary GL may be protective against metabolic disease and should be considered as a healthful dietary component.
FlegalKMCarrollMDOgdenCLJohnsonCL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA.2002;288 (14): 1723–7.
2.
FordESGilesWHDietzWH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA.2002;287 (3): 356–9.
3.
American Diabetes Association. Type 2 diabetes in children and adolescents. Pediatrics.2000;105 (3 Pt 1): 671–80.
4.
CowieCCRustKFByrd-HoltDDEberhardtMSFlegalKMEngelgauMMSaydahSHWilliamsDEGeissLSGreggEW. Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health and Nutrition Examination Survey 1999–2002. Diabetes Care.2006;29 (6): 1263–8.
5.
BazzanoLASerdulaMLiuS. Prevention of type 2 diabetes by diet and lifestyle modification. J Am Coll Nutr.2005;24 (5): 310–9.
6.
RobertsCKBarnardRJ. Effects of exercise and diet on chronic disease. J Appl Physiol.2005;98 (1): 3–30.
7.
LiuS. Insulin resistance, hyperglycemia and risk of major chronic diseases—a dietary perspective. Proc Nutrition Soc Australia.1998;22: 140–50.
8.
GohdesDKaufmanSValwayS. Diabetes in American Indians. An overview.Diabetes Care.1993;16 (1): 239–43.
9.
SimmonsDFlemingCVoyleJFouFFeoSGatlandB. A pilot urban church-based programme to reduce risk factors for diabetes among Western Samoans in New Zealand. Diabet Med.1998;15 (2): 136–42.
10.
HuFBMansonJEStampferMJColditzGLiuSSolomonCGWillettWC. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med.2001;345 (11): 790–7.
11.
PanXRLiGWHuYHWangJXYangWYAnZXHuZXLinJXiaoJZCaoHBLiuPAJiangXGJiangYYWangJPZhengHZhangHBennettPHHowardBV. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care.1997;20 (4): 537–44.
12.
TuomilehtoJLindströmJErikssonJGValleTTHämäläinenHIlanne-ParikkaPKeinänen-KiukaanniemiSLaaksoMLouherantaARastasMSalminenVUusitupaM, Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med.2001;344 (18): 1343–50.
13.
KnowlerWCBarrett-ConnorEFowlerSEHammanRFLachinJMWalkerEANathanDM, Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med.2002;346 (6): 393–403.
14.
KeysAGrandeF. Role of Dietary Fat in Human Nutrition. III. Diet and the epidemiology of coronary heart disease. Am J Public Health Nations Health.1957;47 (12): 1520–30.
15.
KeysA. Seven countries: a mulitvariate analysis of death and coronary heart disease. Cambridge: Harvard University Press; 1980.
16.
GrossLSLiLFordESLiuS. 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 (5): 774–9.
17.
BurkittDPTrowellHC. Refined carbohydrate foods and disease: some implication of dietary fibre. London: Academic Press; 1975.
18.
JenkinsDJWoleverTMTaylorRHBarkerHFieldenHBaldwinJMBowlingACNewmanHCJenkinsALGoffDV. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr.1981;34 (3): 362–6.
19.
EnglystKNLiuSEnglystHN. Nutritional characterization and measurement of dietary carbohydrates. Eur J Clin Nutr.2007;61Suppl 1: S19–39.
20.
WoleverTMJenkinsDJJenkinsALJosseRG. The glycemic index: methodology and clinical implications. Am J Clin Nutr.1991;54 (5): 846–54.
21.
JenkinsDJWoleverTMTaylorRHBarkerHFieldenHBaldwinJMBowlingACNewmanHCJenkinsALGoffDV. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr.1981;34 (3): 362–6.
WoleverTM. The glycemic index. World Rev Nutr Diet.1990;62: 120–85.
24.
CoulstonAMHollenbeckCBSwislockiALReavenGM. Effect of source of dietary carbohydrate on plasma glucose and insulin responses to mixed meals in subjects with NIDDM. Diabetes Care.1987;10 (4): 395–400.
25.
HollenbeckCBCoulstonAMReavenGM. Comparision of plasma glucose and insulin responses to mixed meals of high-, intermediate-, and low-glycemic potential. Diabetes Care.1988;11 (4): 323–9.
26.
WoleverTMJenkinsDJ. The use of the glycemic index in predicting the blood glucose response to mixed meals. Am J Clin Nutr.1986;43 (1): 167–72.
27.
ChewIBrandJCThorburnAWTruswellAS. Application of glycemic index to mixed meals. Am J Clin Nutri.1988;47 (1): 53–6.
28.
AtkinsonFSFoster-PowellKBrand-MillerJC. International tables of glycemic index and glycemic load values: 2008. Diabetes Care.2008;31 (12): 2281–3.
29.
Brand-MillerJCThomasMSwanVAhmadZIPetoczPColagiuriS. Physiological validation of the concept of glycemic load in lean young adults. J Nutr.2003;133 (9): 2728–32.
30.
LiuSMansonJEStampferMJHolmesMDHuFBHankinsonSEWillettWC. 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 (3): 560–6.
31.
FordESLiuS. Glycemic index and serum high-density lipoprotein cholesterol concentration among US adults. Arch Intern Med.2001;161 (4): 572–6.
32.
WuTGiovannucciEPischonTHankinsonSEMaJRifaiNRimmEB. Fructose, glycemic load, and quantity and quality of carbohydrate in relation to plasma C-peptide concentrations in US women. Am J Clin Nutr.2004;80 (4): 1043–9.
33.
MurakamiKSasakiSTakahashiYOkuboHHosoiYHoriguchiHOgumaEKayamaF. Dietary glycemic index and load in relation to metabolic risk factors in Japanese female farmers with traditional dietary habits. Am J Clin Nutr.2006;83 (5): 1161–9.
34.
McKeownNMMeigsJBLiuSSaltzmanEWilsonPWJacquesPF. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care.2004;27 (2): 538–46.
35.
DuHvan der ADLvan BakelMMvan der KallenCJBlaakEEvan GreevenbroekMMJansenEHNijpelsGStehouwerCDDekkerJMFeskensEJ. Glycemic index and glycemic load in relation to food and nutrient intake and metabolic risk factors in a Dutch population. Am J Clin Nutr.2008;87 (3): 655–61.
36.
DumesnilJGTurgeonJTremblayAPoirierPGilbertMGagnonLSt-PierreSGarneauCLemieuxIPascotABergeronJDesprésJP. Effect of a low-glycaemic index—low-fat—high protein diet on the atherogenic metabolic risk profile of abdominally obese men. Br J Nutr.2001;86 (5): 557–68.
37.
FrostGLeedsATrewGMargaraRDornhorstA. Insulin sensitivity in women at risk of coronary heart disease and the effect of a low glycemic diet. Metabolism.1998;47 (10): 1245–51.
38.
EbbelingCBLeidigMMSinclairKBSeger-ShippeeLGFeldmanHALudwigDS. Effects of an ad libitum low-glycemic load diet on cardiovascular disease risk factors in obese young adults. Am J Clin Nutr.2005;81 (5): 976–82.
39.
McMillan-PriceJPetoczPAtkinsonFO'neillKSammanSSteinbeckKCatersonIBrand-MillerJ. Comparison of 4 diets of varying glycemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults: a randomized controlled trial. Arch Intern Med.2006;166 (14): 1466–75.
40.
PereiraMASwainJGoldfineABRifaiNLudwigDS. Effects of a low-glycemic load diet on resting energy expenditure and heart disease risk factors during weight loss. JAMA.2004;292 (20): 2482–90.
41.
PittasAGDasSKHajdukCLGoldenJSaltzmanEStarkPCGreenbergASRobertsSB. A low-glycemic load diet facilitates greater weight loss in overweight adults with high insulin secretion but not in overweight adults with low insulin secretion in the CALERIE Trial. Diabetes Care.2005;28 (12): 2939–41.
42.
StevensonEWilliamsCNuteM. The influence of the glycaemic index of breakfast and lunch on substrate utilisation during the postprandial periods and subsequent exercise. Br J Nutr.2005;93 (6): 885–93.
43.
Hare-BruunHFlintAHeitmannBL. Glycemic index and glycemic load in relation to changes in body weight, body fat distribution, and body composition in adult Danes. Am J Clin Nutr.2006;84 (4): 871–9; quiz 952–3.
44.
LiuSMansonJEBuringJEStampferMJWillettWCRidkerPM. 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 (3): 492–8.
MaYHébertJRLiWBertone-JohnsonEROlendzkiBPagotoSLTinkerLRosalMCOckeneISOckeneJKGriffithJALiuS. Association between dietary fiber and markers of systemic inflammation in the Women's Health Initiative Observational Study. Nutrition.2008;24 (10): 941–9.
47.
QiLvan DamRMLiuSFranzMMantzorosCHuFB. Whole-grain, bran, and cereal fiber intakes and markers of systemic inflammation in diabetic women. Diabetes Care.2006;29 (2): 207–11.
48.
QiLRimmELiuSRifaiNHuFB. Dietary glycemic index, glycemic load, cereal fiber, and plasma adiponectin concentration in diabetic men. Diabetes Care.2005;28 (5): 1022–8.
49.
QiLMeigsJBLiuSMansonJEMantzorosCHuFB. Dietary fibers and glycemic load, obesity, and plasma adiponectin levels in women with type 2 diabetes. Diabetes Care.2006;29 (7): 1501–5.
50.
Lopez-GarciaESchulzeMBFungTTMeigsJBRifaiNMansonJEHuFB. Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr.2004;80 (4): 1029–35.
51.
GonzálezFMiniumJRoteNSKirwanJP. Hyperglycemia alters tumor necrosis factor-alpha release from mononuclear cells in women with polycystic ovary syndrome. J Clin Endocrinol Metab.2005;90 (9): 5336–42.
52.
MottonDDKeimNLTenorioFAHornWFRutledgeJC. Postprandial monocyte activation in response to meals with high and low glycemic loads in overweight women. Am J Clin Nutr.2007;85 (1): 60–5.
53.
RudofskyGJrReismannPSchiekoferSPetrovDEynattenMHumpertPMIsermannBMüller-HoffCThaiTPLichtensteinSBärtschUHamannANawrothPBierhausA. Reduction of postprandial hyperglycemia in patients with type 2 diabetes reduces NF-kappaB activation in PBMCs. Horm Metab Res.2004;36 (9): 630–8.
54.
PittasAGRobertsSBDasSKGilhoolyCHSaltzmanEGoldenJStarkPCGreenbergAS. The effects of the dietary glycemic load on type 2 diabetes risk factors during weight loss. Obesity (Silver Spring).2006;14 (12): 2200–9.
55.
Brand-MillerJDickinsonSBarclayACelermajerD. The glycemic index and cardiovascular disease risk. Curr Atheroscler Rep.2007;9 (6): 479–85.
56.
CerielloABortolottiNMotzEPieriCMarraMTonuttiLLizzioSFelettoFCatoneBTabogaC. Meal-induced oxidative stress and low-density lipoprotein oxidation in diabetes: the possible role of hyperglycemia. Metabolism.1999;48 (12): 1503–8.
57.
KawanoHMotoyamaTHirashimaOHiraiNMiyaoYSakamotoTKugiyamaKOgawaHYasueH. Hyperglycemia rapidly suppresses flow-mediated endothelium-dependent vasodilation of brachial artery. J Am Coll Cardiol.1999;34 (1): 146–54.
58.
TitleLMCummingsPMGiddensKNassarBA. Oral glucose loading acutely attenuates endothelium-dependent vasodilation in healthy adults without diabetes: an effect prevented by vitamins C and E. J Am Coll Cardiol.2000;36 (7): 2185–91.
59.
HuYBlockGNorkusEPMorrowJDDietrichMHudesM. Relations of glycemic index and glycemic load with plasma oxidative stress markers. Am J Clin Nutr.2006;84 (1): 70–6.
60.
BrockDWDavisCKIrvingBARodriguezJBarrettEJWeltmanATaylorAGGaesserGA. A high-carbohydrate, high-fiber meal improves endothelial function in adults with the metabolic syndrome. Diabetes Care.2006;29 (10): 2313–5.
61.
SalmerónJMansonJEStampferMJColditzGAWingALWillettWC. Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA.1997;277 (6): 472–7.
62.
SalmerónJAscherioARimmEBColditzGASpiegelmanDJenkinsDJStampferMJWingALWillettWC. Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care.1997;20 (4): 545–50.
63.
SchulzeMBLiuSRimmEBMansonJEWillettWCHuFB. 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 (2): 348–56.
64.
VillegasRLiuSGaoYTYangGLiHZhengWShuXO. Prospective study of dietary carbohydrates, glycemic index, glycemic load, and incidence of type 2 diabetes mellitus in middle-aged Chinese women. Arch Intern Med.2007;167 (21): 2310–6.
65.
KrishnanSRosenbergLSingerMHuFBDjousséLCupplesLAPalmerJR. Glycemic index, glycemic load, and cereal fiber intake and risk of type 2 diabetes in US black women. Arch Intern Med.2007;167 (21): 2304–9.
66.
StevensJAhnKJuhaeriHoustonDSteffanLCouperD. Dietary fiber intake and glycemic index and incidence of diabetes in African-American and white adults: the ARIC Study. Diabetes Care.2002;25 (10): 1715–21.
67.
SahyounNRAndersonALTylavskyFALeeJSSellmeyerDEHarrisTBHealth, Aging, and Body Composition Study. Dietary glycemic index and glycemic load and the risk of type 2 diabetes in older adults. Am J Clin Nutr.2008;87 (1): 126–31.
68.
HodgeAMEnglishDRO'DeaKGilesGG. Glycemic index and dietary fiber and the risk of type 2 diabetes. Diabetes Care.2004;27 (11): 2701–6.
69.
MeyerKAKushiLHJacobsDRJrSlavinJSellersTAFolsomAR. Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr.2000;71 (4): 921–30.
70.
LiuSWillettWCStampferMJHuFBFranzMSampsonLHennekensCHMansonJE. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr.2000;71 (6): 1455–61.
71.
QiLvan DamRMLiuSFranzMMantzorosCHuFB. Whole-grain, bran, and cereal fiber intakes and markers of systemic inflammation in diabetic women. Diabetes Care.2006;29 (2): 207–11.
72.
FungTTHuFBPereiraMALiuSStampferMJColditzGAWillettWC. Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. Am J Clin Nutr.2002;76 (3): 535–40.
73.
ChandaliaMGargALutjohannDvon BergmannKGrundySMBrinkleyLJ. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med.2000;342 (19): 1392–8.
74.
JenkinsDJWoleverTMJenkinsALGiordanoCGiudiciSThompsonLUKalmuskyJJosseRGWongGS. Low glycemic response to traditionally processed wheat and rye products: bulgur and pumpernickel bread. Am J Clin Nutr.1986;43 (4): 516–20.
75.
JangYLeeJHKimOYParkHYLeeSY. Consumption of whole grain and legume powder reduces insulin demand, lipid peroxidation, and plasma homocysteine concentrations in patients with coronary artery disease: randomized controlled clinical trial. Arterioscler Thromb Vasc Biol.2001;21 (12): 2065–71.
76.
PereiraMAJacobsDRJrPinsJJRaatzSKGrossMDSlavinJLSeaquistER. Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. Am J Clin Nutr.2002;75 (5): 848–55.
77.
LiuS. Intake of refined carbohydrates and whole grain foods in relation to risk of type 2 diabetes mellitus and coronary heart disease. J Am Coll Nutr.2002;21 (4): 298–306.
78.
LiuSStampferMJHuFBGiovannucciERimmEMansonJEHennekensCHWillettWC. Whole-grain consumption and risk of coronary heart disease: results from the Nurses' Health Study. Am J Clin Nutr.1999;70 (3): 412–9.
79.
WoleverTMJenkinsDJVuksanVJenkinsALBuckleyGCWongGSJosseRG. Beneficial effect of a low glycaemic index diet in type 2 diabetes. Diabet Med.1992;9 (5): 451–8.
80.
JärviAEKarlströmBEGranfeldtYEBjörckIEAspNGVessbyBO. 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 (1): 10–8.
81.
Jimenez-CruzABacardi-GasconMTurnbullWHRosales-GarayPSeverino-LugoI. A flexible, low-glycemic index Mexican-style diet in overweight and obese subjects with type 2 diabetes improves metabolic parameters during a 6-week treatment period. Diabetes Care.2003;26 (7): 1967–70.
82.
WoleverTMGibbsALMehlingCChiassonJLConnellyPWJosseRGLeiterLAMaheuxPRabasa-LhoretRRodgerNWRyanEA. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Am J Clin Nutr.2008;87 (1): 114–25.
83.
WoleverTMMehlingCChiassonJLJosseRGLeiterLAMaheuxPRabasa-LhoretRRodgerNWRyanEA. Low glycaemic index diet and disposition index in type 2 diabetes (the Canadian Trial of Carbohydrates in Diabetes): a randomised controlled trial. Diabetologia.2008;51 (9): 1607–15.
84.
WoleverTMMehlingC. High-carbohydrate, low-glycaemic index dietary advice improves glucose disposition index in subjects with impaired glucose tolerance. Br J Nutr.2002;87 (5): 477–87.
85.
JenkinsDJKendallCWMcKeown-EyssenGJosseRGSilverbergJBoothGLVidgenEJosseARNguyenTHCorriganSBanachMSAresSMitchellSEmamAAugustinLSParkerTLLeiterLA. Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial. JAMA.2008;300 (23): 2742–53.
86.
Pi-SunyerFX. Glycemic index and disease. Am J Clin Nutr.2002;76 (1): 290S–8S.
87.
WoleverTM. The glycemic index: flogging a dead horse?Diabetes Care.1997;20 (3): 452–6.
88.
CoulstonAMReavenGM. Much ado about (almost) nothing. Diabetes Care.1997;20 (3): 241–3.
