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Glycemic load, glycemic index, and body mass index in Spanish adults^1,2,3,4

¹ From the Center for Research in Environmental Epidemiology, Municipal Institute of Medical Research (IMIM-Hospital del Mar), Biomedical Research Park, Barcelona, Spain (MAM); the CIBER Epidemiologia y Salud Pública, Spain (MAM and JV); the Cardiovascular Risk and Nutrition Research Group, IMIM-Hospital del Mar, Barcelona, Spain (JM and HS); the CIBER Fisiopatología de la Obesidad y Nutrición, Spain (MIC and HS); and the Program of Research in Inflammatory and Cardiovascular Disorders, Unitat de Lipids I Epidemiologia Cardiovascular, Cardiovascular Epidemiology and Genetics Research Group, IMIM-Hospital del Mar, Barcelona, Spain (JM and JV).

² A full roster of REGICOR investigators and collaborators can be found at www.regicor.org/regicor.inv.

³ Supported by grant 2FD097-0297-CO2-01 from Fondo Europeo de Desarrollo Regional, by grants from Spain's Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III (Red HERACLES RD06/0009) and Fondo de Investigación Sanitaria (ISCIII CP 03/00115), and the European Union Sixth Framework Project EARNEST FOOD-CT-2005-007036 (to MAM). The CIBER Fisiopatología de la Obesidad y Nutrición and CIBER Epidemiologia y Salud Pública, which provided financial support to this project, are initiatives of the Instituto de Salud Carlos III, Madrid, Spain.

⁴ Address reprint requests to H Schröder, Cardiovascular Risk and Nutrition Research Group, IMIM-Hospital del Mar, 88 Dr. Aiguader Street, Barcelona, Spain 08003. E-mail: hschroeder{at}imim.es. Address correspondence to M Mendez, Center for Environmental Epidemiology Research, 88 Dr. Aiguader Street, Barcelona, Spain 08003. E-mail: mmendez{at}creal.cat.

ABSTRACT

Background: Studies on obesity and glycemic index (GI) or glycemic load (GL) have had inconsistent results, perhaps in part because of underreporting or to heterogeneous dietary patterns across food cultures.

Objectives: We examined associations between body mass index (BMI) and GI or GL in a Mediterranean population, accounting for underreporting. We also constructed dietary factors related to GI and GL to better understand food patterns related to these measures.

Design: Cross-sectional data on 8195 Spanish adults aged 35–74 y were analyzed. A validated food-frequency questionnaire was used to estimate GI and GL, with glucose as the reference value. Reduced-rank regression was used to construct dietary patterns that explained variation in GI and GL. Multivariate linear regression was used to estimate associations between BMI and GI, GL, and their respective diet factors with and without adjusting for energy, which may lie on the causal pathway between glycemic quality and obesity. Effects of excluding underreporters (ratio of energy intake:basal metabolic rate < 1.20) were examined.

Results: Food patterns underlying high GI differed substantially from those of high GL, with fruits, vegetables, and legumes related positively to GL but negatively to GI. After excluding underreporters, GL was negatively associated with BMI, adjusting for energy. GI was not associated with BMI in any model.

Conclusions: After adjusting for energy, GL was associated with reduced BMI in this Mediterranean population. Underreporting did not explain this inverse relation, which was observed among subjects with plausible intakes.

Received for publication May 23, 2008. Accepted for publication September 22, 2008.

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