Abstract
Aims
Low glycaemic index (GI) diets are beneficial in the management of hyperglycemia.
Cardiovascular diseases are the major cause of mortality in diabetes therefore it
is important to understand the effects of GI on blood lipids. The aim was to systematically
review randomised controlled trials (RCTs) of low GI diets on blood lipids.
Data synthesis
We searched OVID Medline, Embase and Cochrane library to March 2012. Random effects
meta-analyses were performed on twenty-eight RCTs comparing low- with high GI diets
over at least 4 weeks (1272 participants; studies ranged from 6 to 155 participants);
one was powered on blood lipids, 3 had adequate allocation concealment. Low GI diets
significantly reduced total (−0.13 mmol/l, 95%CI −0.22 to −0.04, P = 0.004, 27 trials, 1441 participants, I2 = 0%) and LDL-cholesterol (−0.16 mmol/l, 95%CI −0.24 to −0.08, P < 0.0001, 23 trials, 1281 participants, I2 = 0%) compared with high GI diets and independently of weight loss. Subgroup analyses
suggest that reductions in LDL-C are greatest in studies of shortest duration and
greatest magnitude of GI reduction. Furthermore, lipid improvements appear greatest
and most reliable when the low GI intervention is accompanied by an increase in dietary
fibre. Sensitivity analyses, removing studies without adequate allocation concealment,
lost statistical significance but retained suggested mean falls of ∼0.10 mmol/l in
both. There were no effects on HDL-cholesterol (MD −0.03 mmol/l, 95%CI −0.06 to 0.00,
I2 = 0%), or triglycerides (MD 0.01 mmol/l, 95%CI −0.06 to 0.08, I2 = 0%).
Conclusions
This meta-analysis provides consistent evidence that low GI diets reduce total and
LDL-cholesterol and have no effect on HDL-cholesterol or triglycerides.
Keywords
Abbreviations:
CVD (cardiovascular disease), GI (glycaemic index), MetS (metabolic syndrome), RCT (randomised controlled trial), T2DM (type 2 diabetes mellitus)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Nutrition, Metabolism and Cardiovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Glycemic index of foods: a physiological basis for carbohydrate exchange.Am J Clin Nutr. 1981; 34: 362-366
- The relevance of the glycaemic index to our understanding of dietary carbohydrates.Diabet Med. 2000; 17: 336-345
- Glycemic index, glycemic load, and risk of type 2 diabetes.Am J Clin Nutr. 2002; 76: 274S-280S
- The glycemic index.World Rev Nutr Diet. 1990; 62: 120-185
- Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults.Am J Clin Nutr. 2002; 75: 848-855
- Glycemic index, glycemic load, and chronic disease risk–a meta-analysis of observational studies.Am J Clin Nutr. 2008; 87: 627-637
- Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials.Diabetes Care. 2003; 26: 2261-2267
- Low glycaemic index, or low glycaemic load, diets for diabetes mellitus.Cochrane Database Syst Rev. 2009; : CD006296
- National service framework for diabetes standards.2001
- Pathophysiology of insulin resistance in human disease.Physiol Rev. 1995; 75: 473-486
- Glycaemic index as a determinant of serum HDL-cholesterol concentration.Lancet. 1999; 353: 1045-1048
- Glycemic index and serum high-density lipoprotein cholesterol concentration among us adults.Arch Intern Med. 2001; 161: 572-576
- 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
- Association between carbohydrate intake and serum lipids.J Am Coll Nutr. 2006; 25: 155-163
- Low glycaemic index diets for coronary heart disease (Review).Cochrane Database Syst Rev. 2008; : CD004467
- Assessing the quality of reports of randomized clinical trials: is blinding necessary?.Control Clin Trials. 1996; 17: 1-12
- Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials.JAMA. 1995; 273: 408-412
Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions, version 5.0.2 [updated September 2009]. The Cochrane Collaboration. 2008. 11-7-2010.
- Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III).JAMA. 2001; 285: 2486-2497
- Energy-restricted diets based on a distinct food selection affecting the glycemic index induce different weight loss and oxidative response.Clin Nutr. 2008; 27: 545-551
- Beneficial effects of a 5-week low-glycaemic index regimen on weight control and cardiovascular risk factors in overweight non-diabetic subjects.Br J Nutr. 2007; 98: 1288-1298
- The use of low glycaemic index foods improves metabolic control of diabetic patients over five weeks.Diabet Med. 1992; 9: 444-450
- Dietary advice based on the glycaemic index improves dietary profile and metabolic control in type 2 diabetic patients.Diabet Med. 1994; 11: 397-401
- A prospective randomised trial to determine the efficacy of a low glycaemic index diet given in addition to healthy eating and weight loss advice in patients with coronary heart disease.Eur J Clin Nutr. 2004; 58: 121-127
- Long-term dietary treatment with increased amounts of fiber-rich low-glycemic index natural foods improves blood glucose control and reduces the number of hypoglycemic events in type 1 diabetic patients.Diabetes Care. 2000; 23: 1461-1466
- The effect of high- and low-glycemic index energy restricted diets on plasma lipid and glucose profiles in type 2 diabetic subjects with varying glycemic control.J Am Coll Nutr. 2002; 21: 120-127
- Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial.JAMA. 2008; 300: 2742-2753
- The effect of a 12-week low glycaemic index diet on heart disease risk factors and 24 h glycaemic response in healthy middle-aged volunteers at risk of heart disease: a pilot study.Eur J Clin Nutr. 2008; 62: 145-149
- Preliminary report: the effect of a 6-month dietary glycemic index manipulation in addition to healthy eating advice and weight loss on arterial compliance and 24-hour ambulatory blood pressure in men: a pilot study.Metabolism. 2009; 58: 1703-1708
- Reduced glycemic index and glycemic load diets do not increase the effects of energy restriction on weight loss and insulin sensitivity in obese men and women.J Nutr. 2005; 135: 2387-2391
- An 18-mo randomized trial of a low-glycemic-index diet and weight change in Brazilian women.Am J Clin Nutr. 2007; 86: 707-713
- 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
- Comparison of high- and low-glycemic-index breakfast cereals with monounsaturated fat in the long-term dietary management of type 2 diabetes.Am J Clin Nutr. 2000; 72: 439-449
- 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
- A low-GI diet is associated with a short-term improvement of glycaemic control in Asian patients with type 2 diabetes.Diabetes Obes Metab. 2009; 11: 387-396
- 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: 114-125
- Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome.Am J Clin Nutr. 2010; 92: 83-92
- The effect of increasing consumption of pulses and wholegrains in obese people: a randomized controlled trial.J Am Coll Nutr. 2010; 29: 365-372
- Five-week, low-glycemic index diet decreases total fat mass and improves plasma lipid profile in moderately overweight nondiabetic men.Diabetes Care. 2002; 25: 822-828
- Low-glycemic index foods improve long-term glycemic control in NIDDM.Diabetes Care. 1991; 14: 95-101
- The effect of low-glycemic carbohydrate on insulin and glucose response in vivo and in vitro in patients with coronary heart disease.Metabolism. 1996; 45: 669-672
- 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: 1967-1970
- Four-week low-glycemic index breakfast with a modest amount of soluble fibers in type 2 diabetic men.Metabolism. 2002; 51: 819-826
- Diets high and low in glycemic index versus high monounsaturated fat diets: effects on glucose and lipid metabolism in NIDDM.Eur J Clin Nutr. 1999; 53: 473-478
- 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
- Effects of low- and high-glycemic index/glycemic load diets on coronary heart disease risk factors in overweight/obese men.Metabolism. 2009; 58: 1793-1801
- Beneficial effect of low-glycemic index diet in overweight NIDDM subjects.Diabetes Care. 1992; 15: 562-564
- A high legume low glycemic index diet improves serum lipid profiles in men.Lipids. 2010; 45: 765-775
- Glycemic response and health–a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes.Am J Clin Nutr. 2008; 87: 258S-268S
- Glycaemic index methodology.Nutr Res Rev. 2005; 18: 145-171
- 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
- Effect of pectin, guar gum, and wheat fibre on serum-cholesterol.Lancet. 1975; 1: 1116-1117
- Dietary fibre and blood lipids.Curr Opin Lipidol. 1995; 6: 14-19
- Metabolic effects of low glycaemic index diets.Nutr J. 2009; 8: 5
- Dietary advice for reducing cardiovascular risk.Cochrane Database Syst Rev. 2007; https://doi.org/10.1002/14651858
- Nutrition recommendations and interventions for diabetes. A position statement of the American Diabetes Association.Diabetes Care. 2008; 31: S61-S78
- Evidence-based nutrition guidelines for the prevention and management of diabetes.Diabetes UK, London2011
- Management of dyslipidemia in adults with diabetes.Diabetes Care. 1998; 21: 160-178
Article info
Publication history
Published online: July 27, 2012
Accepted:
June 15,
2012
Received in revised form:
June 12,
2012
Received:
January 17,
2012
Identification
Copyright
© 2012 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
