Elsevier

Metabolism

Volume 59, Issue 11, November 2010, Pages 1574-1582
Metabolism

Dietary glycemic index, glycemic load, and intake of carbohydrate and rice in relation to risk of mortality from stroke and its subtypes in Japanese men and women

https://doi.org/10.1016/j.metabol.2010.02.004Get rights and content

Abstract

We assessed the relationship of the dietary glycemic index (GI), glycemic load (GL), and intake of carbohydrate and rice, and risk of mortality from stroke and its subtypes. The cohort consisted of 12 561 men and 15 301 women residing in Takayama, Japan, in 1992. At the baseline, a food frequency questionnaire was administered; and the dietary GI, GL, and intake of carbohydrates and rice were estimated. Deaths from stroke occurring in the cohort were prospectively noted until 1999 with data from the office of the National Vital Statistics. The risk of mortality from stroke was assessed with a Cox proportional hazard model after adjusting for age; body mass index; smoking status; physical activity; history of hypertension; education; and intake of total energy, alcohol, dietary fiber, salt, and total fat. The risk of stroke subtypes was assessed in the age-adjusted model. The hazard ratios of total stroke comparing the highest vs the lowest quartiles of the dietary GI were 0.78 (95% confidence interval [CI], 0.41-1.47) with Ptrend = .50 in men and 2.09 (95% CI, 1.01-4.31) with Ptrend = .10 in women. Among women, the association was also significant with the risk of ischemic stroke (hazard ratio = 2.45; 95% CI, 1.01-5.92; Ptrend = .03); and a significant positive trend was also observed between dietary GL and mortality from hemorrhagic stroke (Ptrend = .05). The current study implies that diets with a high dietary GI increase the risk of mortality from stroke among Japanese women.

Introduction

Stroke is a common condition in Japan, and risk of death due to stroke was about twice of that in the United States and other Western countries from 1950 through 1987 [1]. Mortality from stroke has been declining in following years, but it is still the third leading cause of death in Japan [2]. Prospective epidemiologic studies have provided little information concerning the relationship among the dietary glycemic index (GI), glycemic load (GL), and risk of stroke. A few studies have evaluated the association and suggested that the dietary GL increases the risk of stroke [3], [4], [5]. These studies were conducted in Western countries, and no report has yet been published concerning Asian populations. Carbohydrate consumption is high in Japan; and its major source is white rice, which is high in dietary GI. Research into the potential health effects of GI, GL, carbohydrates, and rice is of particular interest in this population.

We therefore conducted a prospective study among Japanese men and women in a community-based cohort to obtain information on the relationship of the dietary GI, GL, intake of carbohydrates and rice, and the risk of stroke. It might be beneficial to study the specific types of stroke because each subtype of stroke has its own risk factors [6], [7]. We also assessed the risk of subtypes of stroke in the current study.

Section snippets

Study participants

The data were provided by the Takayama study in Japan. The details of the Takayama study have been described elsewhere [8], [9], [10]. Briefly, the study population was men and women residing in Takayama City who were 35 years or older in 1992. At the baseline, a self-administered questionnaire was conducted to the 36 990 residents to collect information on the baseline characteristics of the study cohort such as age, height, weight, and length of education. Physician diagnoses of major

Results

The characteristics of the study participants at the baseline are presented in Table 1. Participants in higher quartiles of dietary GI were more likely to have lower alcohol consumption and were less likely to be current cigarette smokers. Women in the highest dietary GI were more likely to be older and less likely to be educated. With regard to daily food and dietary intake, participants in higher quartiles of dietary GI were more likely to have lower total calorie intake in line with lowered

Discussion

To our knowledge, the current study is the first prospective cohort study that suggests an association between the dietary GI and the risk of stroke. Among Japanese women in this population, the dietary GI was significantly associated with an increasing risk of mortality from stroke. Such association was not observed among men.

In previous studies, diets high in GI have been linked with an increased risk of diabetes and glucose intolerance [19], [20], [21], [22]. The association of the dietary

Summary

In conclusion, we found a positive relationship between the dietary GI and risk of mortality from stroke among women in a community-based cohort in Japan, where a high risk of stroke is still observed. The results of the study also suggest that the risk of mortality from ischemic stroke is increased with increased level of the dietary GI among women, and a positive trend is also suggested between dietary GL and mortality from hemorrhagic stroke among women. Conducting further studies that

Acknowledgment

This study was supported in part by grants from the Ministry of Education, Science, Sports, and Culture, Japan.

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