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Original Research Communication |
1 From the Center of Cardiovascular Prevention, the Divisions of Preventive Medicine (SL, JEM, JEB, and PMR) and Cardiology (PMR) and the Channing Laboratory (JEM, MJS, and WCW), Harvard Medical School, Boston; the Department of Medicine, Brigham and Women's Hospital, and the Department of Ambulatory Care and Prevention, Harvard Medical School, Boston (JEB); and the Departments of Epidemiology (JEM, JEB, MJS, and WCW) and Nutrition (SL and WCW), the Harvard School of Public Health, Boston.
Background: Recent prospective data suggest that intake of rapidly digested and absorbed carbohydrates with a high dietary glycemic load is associated with an increased risk of ischemic heart disease.
Objective: We examined whether a high dietary glycemic load was associated with elevated hs-CRP concentrations and whether this association was modified by body mass index (BMI; in kg/m2).
Design: In 244 apparently healthy women, we measured plasma hs-CRP concentrations and determined average dietary glycemic loads with a validated semiquantitative food-frequency questionnaire. Using multiple regression models, we evaluated the association between dietary glycemic load and plasma hs-CRP after adjusting for age; treatment status; smoking status; BMI; physical activity level; parental history of myocardial infarction; history of hypertension, diabetes, and high cholesterol; postmenopausal hormone use; alcohol intake; and other dietary variables.
Results: We found a strong and statistically significant positive association between dietary glycemic load and plasma hs-CRP. The median hs-CRP concentration for the lowest quintile of dietary glycemic load was 1.9 mg/L and for the highest quintile was 3.7 mg/L; corresponding multivariate-adjusted geometric means were 1.4 and 3.8 mg/L, respectively (P for trend < 0.01). This association was significantly modified by BMI. Among women with a BMI 
25, the multivariate-adjusted geometric mean hs-CRP concentration in the lowest quintile was 1.6 mg/L and in the highest quintile was 5.0 mg/L; however, among women with a BMI < 25, the corresponding means were 1.1 and 3.1 mg/L, respectively (P = 0.01 for interaction).
Conclusions: Dietary glycemic load is significantly and positively associated with plasma hs-CRP in healthy middle-aged women, independent of conventional risk factors for ischemic heart disease. Exacerbation of the proinflammatory process may be a mechanism whereby a high intake of rapidly digested and absorbed carbohydrates increases the risk of ischemic heart disease, especially in overweight women prone to insulin resistance.
Key Words: Dietary carbohydrate • glycemic index • glycemic load • high-sensitivity C-reactive protein • obesity • ischemic heart disease • middle-aged women • Women's Health Study
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