Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes: A Systematic Review and Updated Meta-Analyses of Prospective Cohort Studies

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Published meta-analyses indicate significant but inconsistent incident type-2 diabetes(T2D)-dietary glycemic index (GI) and glycemic load (GL) risk ratios or risk relations (RR). It is nowover a decade ago that a published meta-analysis used a predefined standard to identify validstudies. Considering valid studies only, and using random effects dose-response meta-analysis(DRM) while withdrawing spurious results (p < 0.05), we ascertained whether these relationswould support nutrition guidance, specifically for an RR > 1.20 with a lower 95% confidence limit>1.10 across typical intakes (approximately 10th to 90th percentiles of population intakes). Thecombined T2D-GI RR was 1.27 (1.15-1.40) (p < 0.001, n = 10 studies) per 10 units GI, while that forthe T2D-GL RR was 1.26 (1.15-1.37) (p < 0.001, n = 15) per 80 g/d GL in a 2000 kcal (8400 kJ) diet.The corresponding global DRM using restricted cubic splines were 1.87 (1.56-2.25) (p < 0.001, n =10) and 1.89 (1.66-2.16) (p < 0.001, n = 15) from 47.6 to 76.1 units GI and 73 to 257 g/d GL in a 2000kcal diet, respectively. In conclusion, among adults initially in good health, diets higher in GI or GLwere robustly associated with incident T2D. Together with mechanistic and other data, thissupports that consideration should be given to these dietary risk factors in nutrition advice.Concerning the public health relevance at the global level, our evidence indicates that GI and GLare substantial food markers predicting the development of T2D worldwide, for persons ofEuropean ancestry and of East Asian ancestry.


  • Geoffrey Livesey
  • Richard Taylor
  • Helen F. Livesey
  • Anette E. Buyken
  • David J.A. Jenkins
  • Livia S.A. Augustin
  • John L. Sievenpiper
  • Alan W. Barclay
  • Simin Liu
  • Thomas M.S. Wolever
  • Walter C. Willett
  • Furio Brighenti
  • Jordi Salas-Salvadó
  • Inger Björck
  • Salwa W. Rizkalla
  • Gabriele Riccardi
  • Carlo La Vecchia
  • Antonio Ceriello
  • Antonia Trichopoulou
  • Andrea Poli
  • And 5 others
  • Arne Astrup
  • Cyril W.C. Kendall
  • Marie Ann Ha
  • Sara Baer-Sinnott
  • Jennie C. Brand-Miller
External organisations
  • University of Paderborn
  • University of Toronto
  • St. Michael's Hospital
  • Istituto Nazionale Tumori IRCCS - Fondazione G Pascale, Napoli
  • Brown University
  • Harvard University
  • University of Parma
  • Institut d'Investigació Sanitària Pere Virgili
  • Carlos III Health Institute
  • Pitié Salpetriere University Paris
  • University of Naples Federico II
  • University of Milan
  • IRCCS Multimedica
  • Hellenic Health Foundation, Athens
  • University of Copenhagen
  • University of Saskatchewan
  • University of Sydney
  • Independent Nutrition Logic Ltd
  • Glycemic Index Foundation
  • Nutrition Foundation of Italy
  • Oldways
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Nutrition and Dietetics


  • alcohol, cohort studies, dietary fiber, epidemiology, glycemic index, glycemic load, meta-analysis, protein, type 2 diabetes
Original languageEnglish
Article number1280
Issue number6
Publication statusPublished - 2019
Publication categoryResearch