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Original Research Communications |
1 From the Departments of Epidemiology and Nutrition, the Harvard School of Public Health; the Channing Laboratory; and the Division of Preventive Medicine, the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston.
Background: Little is known about the effects of the amount and type of carbohydrates on risk of coronary heart disease (CHD).
Objective: The objective of this study was to prospectively evaluate the relations of the amount and type of carbohydrates with risk of CHD.
Design: A cohort of 75521 women aged 38–63 y with no previous diagnosis of diabetes mellitus, myocardial infarction, angina, stroke, or other cardiovascular diseases in 1984 was followed for 10 y. Each participant's dietary glycemic load was calculated as a function of glycemic index, carbohydrate content, and frequency of intake of individual foods reported on a validated food-frequency questionnaire at baseline. All dietary variables were updated in 1986 and 1990.
Results: During 10 y of follow-up (729472 person-years), 761 cases of CHD (208 fatal and 553 nonfatal) were documented. Dietary glycemic load was directly associated with risk of CHD after adjustment for age, smoking status, total energy intake, and other coronary disease risk factors. The relative risks from the lowest to highest quintiles of glycemic load were 1.00, 1.01, 1.25, 1.51, and 1.98 (95% CI: 1.41, 2.77 for the highest quintile; P for trend < 0.0001). Carbohydrate classified by glycemic index, as opposed to its traditional classification as either simple or complex, was a better predictor of CHD risk. The association between dietary glycemic load and CHD risk was most evident among women with body weights above average [ie, body mass index (in kg/m2) 
23].
Conclusion: These epidemiologic data suggest that a high dietary glycemic load from refined carbohydrates increases the risk of CHD, independent of known coronary disease risk factors.
Key Words: Diet • carbohydrate • fiber • glycemic load • glycemic index • coronary heart disease • Nurses' Health Study • women
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A. Slyper, J. Jurva, J. Pleuss, R. Hoffmann, and D. Gutterman Influence of glycemic load on HDL cholesterol in youth Am. J. Clinical Nutrition, February 1, 2005; 81(2): 376 - 379. [Abstract] [Full Text] [PDF]
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K. Oh, F. B. Hu, E. Cho, K. M. Rexrode, M. J. Stampfer, J. E. Manson, S. Liu, and W. C. Willett Carbohydrate Intake, Glycemic Index, Glycemic Load, and Dietary Fiber in Relation to Risk of Stroke in Women Am. J. Epidemiol., January 15, 2005; 161(2): 161 - 169. [Abstract] [Full Text] [PDF]
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 C. K. Roberts and R. J. Barnard Effects of exercise and diet on chronic disease J Appl Physiol, January 1, 2005; 98(1): 3 - 30. [Abstract] [Full Text] [PDF]
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D. S. Michaud, C. S. Fuchs, S. Liu, W. C. Willett, G. A. Colditz, and E. Giovannucci Dietary Glycemic Load, Carbohydrate, Sugar, and Colorectal Cancer Risk in Men and Women Cancer Epidemiol. Biomarkers Prev., January 1, 2005; 14(1): 138 - 147. [Abstract] [Full Text] [PDF]
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M. A. Pereira, J. Swain, A. B. Goldfine, N. Rifai, and D. S. Ludwig Effects of a Low-Glycemic Load Diet on Resting Energy Expenditure and Heart Disease Risk Factors During Weight Loss JAMA, November 24, 2004; 292(20): 2482 - 2490. [Abstract] [Full Text] [PDF]
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A. Harbis, S. Perdreau, S. Vincent-Baudry, M. Charbonnier, M.-C. Bernard, D. Raccah, M. Senft, A.-M. Lorec, C. Defoort, H. Portugal, et al. Glycemic and insulinemic meal responses modulate postprandial hepatic and intestinal lipoprotein accumulation in obese, insulin-resistant subjects Am. J. Clinical Nutrition, October 1, 2004; 80(4): 896 - 902. [Abstract] [Full Text] [PDF]
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K. Hoffmann, B.-C. Zyriax, H. Boeing, and E. Windler A dietary pattern derived to explain biomarker variation is strongly associated with the risk of coronary artery disease Am. J. Clinical Nutrition, September 1, 2004; 80(3): 633 - 640. [Abstract] [Full Text] [PDF]
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B. Sloth, I. Krog-Mikkelsen, A. Flint, I. Tetens, I. Bjorck, S. Vinoy, H. Elmstahl, A. Astrup, V. Lang, and A. Raben 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. Clinical Nutrition, August 1, 2004; 80(2): 337 - 347. [Abstract] [Full Text] [PDF]
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D. A Schaumberg, S. Liu, J. M Seddon, W. C Willett, and S. E Hankinson Dietary glycemic load and risk of age-related cataract Am. J. Clinical Nutrition, August 1, 2004; 80(2): 489 - 495. [Abstract] [Full Text] [PDF]
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S. W. Rizkalla, L. Taghrid, M. Laromiguiere, D. Huet, J. Boillot, A. Rigoir, F. Elgrably, and G. Slama 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, August 1, 2004; 27(8): 1866 - 1872. [Abstract] [Full Text] [PDF]
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K. Oh, W. C. Willett, C. S. Fuchs, and E. L. Giovannucci Glycemic Index, Glycemic Load, and Carbohydrate Intake in Relation to Risk of Distal Colorectal Adenoma in Women Cancer Epidemiol. Biomarkers Prev., July 1, 2004; 13(7): 1192 - 1198. [Abstract] [Full Text] [PDF]
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D. J. Jenkins, C. W. Kendall, A. Marchie, and L. S. Augustin Too much sugar, too much carbohydrate, or just too much? Am. J. Clinical Nutrition, May 1, 2004; 79(5): 711 - 712. [Full Text] [PDF]
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L. S Gross, L. Li, E. S Ford, and S. Liu Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment Am. J. Clinical Nutrition, May 1, 2004; 79(5): 774 - 779. [Abstract] [Full Text] [PDF]
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 R. J. Norman, M. Noakes, R. Wu, M. J. Davies, L. Moran, and J. X. Wang Improving reproductive performance in overweight/obese women with effective weight management Hum. Reprod. Update, May 1, 2004; 10(3): 267 - 280. [Abstract] [Full Text] [PDF]
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M. D. Holmes, S. Liu, S. E. Hankinson, G. A. Colditz, D. J. Hunter, and W. C. Willett Dietary Carbohydrates, Fiber, and Breast Cancer Risk Am. J. Epidemiol., April 15, 2004; 159(8): 732 - 739. [Abstract] [Full Text] [PDF]
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P. Nestel, M. Cehun, and A. Chronopoulos Effects of long-term consumption and single meals of chickpeas on plasma glucose, insulin, and triacylglycerol concentrations Am. J. Clinical Nutrition, March 1, 2004; 79(3): 390 - 395. [Abstract] [Full Text] [PDF]
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T. O. Scholl, X. Chen, C. S. Khoo, and C. Lenders The Dietary Glycemic Index during Pregnancy: Influence on Infant Birth Weight, Fetal Growth, and Biomarkers of Carbohydrate Metabolism Am. J. Epidemiol., March 1, 2004; 159(5): 467 - 474. [Abstract] [Full Text] [PDF]
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M. A. Pereira, E. O'Reilly, K. Augustsson, G. E. Fraser, U. Goldbourt, B. L. Heitmann, G. Hallmans, P. Knekt, S. Liu, P. Pietinen, et al. Dietary Fiber and Risk of Coronary Heart Disease: A Pooled Analysis of Cohort Studies Arch Intern Med, February 23, 2004; 164(4): 370 - 376. [Abstract] [Full Text] [PDF]
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 S. Higginbotham, Z.-F. Zhang, I-M. Lee, N. R. Cook, E. Giovannucci, J. E. Buring, and S. Liu Dietary Glycemic Load and Risk of Colorectal Cancer in the Women's Health Study J Natl Cancer Inst, February 4, 2004; 96(3): 229 - 233. [Abstract] [Full Text] [PDF]
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J. W. Anderson, K. M. Randles, C. W. C. Kendall, and D. J. A. Jenkins Carbohydrate and Fiber Recommendations for Individuals with Diabetes: A Quantitative Assessment and Meta-Analysis of the Evidence J. Am. Coll. Nutr., February 1, 2004; 23(1): 5 - 17. [Abstract] [Full Text] [PDF]
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N. M. McKeown, J. B. Meigs, S. Liu, E. Saltzman, P. W.F. Wilson, and P. F. Jacques Carbohydrate Nutrition, Insulin Resistance, and the Prevalence of the Metabolic Syndrome in the Framingham Offspring Cohort Diabetes Care, February 1, 2004; 27(2): 538 - 546. [Abstract] [Full Text] [PDF]
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S. Higginbotham, Z.-F. Zhang, I-M. Lee, N. R. Cook, J. E. Buring, and S. Liu Dietary Glycemic Load and Breast Cancer Risk in the Women's Health Study Cancer Epidemiol. Biomarkers Prev., January 1, 2004; 13(1): 65 - 70. [Abstract] [Full Text] [PDF]
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S. Liu, W. C Willett, J. E Manson, F. B Hu, B. Rosner, and G. Colditz Relation between changes in intakes of dietary fiber and grain products and changes in weight and development of obesity among middle-aged women Am. J. Clinical Nutrition, November 1, 2003; 78(5): 920 - 927. [Abstract] [Full Text] [PDF]
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E. Cho, D. Spiegelman, D. J. Hunter, W. Y. Chen, G. A. Colditz, and W. C. Willett Premenopausal Dietary Carbohydrate, Glycemic Index, Glycemic Load, and Fiber in Relation to Risk of Breast Cancer Cancer Epidemiol. Biomarkers Prev., November 1, 2003; 12(11): 1153 - 1158. [Abstract] [Full Text]
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