Carbohydrate quality and human health: a series of systematic reviews and meta-analyses

Reynolds, Andrew; Mann, Jim; Cummings, John H.; Winter, Nicola; Mete, Evelyn; Morenga, Lisa Te

doi:10.1016/s0140-6736(18)31809-9

Cited by 986 publications

(656 citation statements)

References 36 publications

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“…Although only marginally significant, such 12% increased risk was not in contrast with the WCRF result, thought the different methods of analyses (i.e., dose-response versus extreme quantile), inclusion criteria (e.g., only cohort versus both cohort and case-control studies) and search updates do not allow a direct comparison. A positive association between high GL (but not GI) and the risk of endometrial cancer was reported in other previous meta-analyses [57,60,61], while a recent high profile publication by Reynold et al, which provided systematic reviews and meta-analyses of prospective studies on the relationship between the most widely studied indicators of carbohydrate quality and incidence of, and mortality from, a wide range of non-communicable diseases, did not find any relation with GI and GL, both in dose-response and extreme quantile analyses [7]. In that report, high GI was associated with a marginally significant 10% increased risk of colorectal cancer (summary RR 1.10, 95% CI, 0.99–1.22), and each 10 units/day of GI to a 5% increased risk of borderline significance (summary RR 1.05, 95% CI, 1.00–1.10), while no association was reported for GL [7].…”

Section: Discussionmentioning

confidence: 86%

“…A positive association between high GL (but not GI) and the risk of endometrial cancer was reported in other previous meta-analyses [57,60,61], while a recent high profile publication by Reynold et al, which provided systematic reviews and meta-analyses of prospective studies on the relationship between the most widely studied indicators of carbohydrate quality and incidence of, and mortality from, a wide range of non-communicable diseases, did not find any relation with GI and GL, both in dose-response and extreme quantile analyses [7]. In that report, high GI was associated with a marginally significant 10% increased risk of colorectal cancer (summary RR 1.10, 95% CI, 0.99–1.22), and each 10 units/day of GI to a 5% increased risk of borderline significance (summary RR 1.05, 95% CI, 1.00–1.10), while no association was reported for GL [7]. Excess risks of colorectal cancer less than 10% for high versus low GI were found in previous meta-analyses of prospective studies [57,62].…”

Section: Discussionmentioning

confidence: 86%

“…In particular, no associations with stomach [37], prostate [7,38,39], and pancreatic cancers [56,57,58] were reported by others. A meta-analysis on kidney cancer based on the same study sample yielded essentially identical results [36], i.e., a positive, but weak, significant association with high GI and no association with GL.…”

Section: Discussionmentioning

confidence: 99%

“…A possible role in the development of selected cancers has been also suggested [6], but the evidence is yet weak [7]. Long-term consumption of a high GI/GL diet results in chronically high blood glucose, and hence, to chronically elevated insulin concentration.…”

Section: Introductionmentioning

confidence: 99%

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Glycemic Index, Glycemic Load and Cancer Risk: An Updated Meta-Analysis

et al. 2019

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Diets high in glycemic index (GI) and glycemic load (GL) have been related to an increased risk of selected cancers, but additional quantification is required. We updated a systematic review and meta-analysis published in 2015 to May 2019 to provide quantitative information on GI/GL and cancer risk. Relative risks (RR) and the corresponding 95 % confidence intervals (CI) for the highest versus the lowest categories of GI and GL were extracted from selected studies and pooled using random-effects models. Twenty reports (>22,000 cancer cases) have become available after January 2015, and 15 were added to the meta-analyses by cancer sites, which considered a total of 88 investigations. The five additional reports were reviewed, but not included in the meta-analyses, since data were inadequate to be pooled. For hormone-related cancers, summary RRs for the highest versus lowest GI and GL intakes were moderately increased. They ranged from 1.04 (breast) to 1.12 (endometrium) for GI and from 1.03 (prostate) to 1.22 (ovary) for GL, of borderline significance. High GI was associated with small increased risks of colorectal (summary RR for GI: 1.20, 95% CI, 1.07–1.34—GL: 1.09, 95% CI, 0.97–1.22, 19 studies), bladder (GI: 1.25, 95% CI, 1.11–1.41—GL: 1.10, 95% CI, 0.85–1.42, four studies) and kidney cancers (GI: 1.16, 95% CI, 1.02–1.32—GL: 1.14, 95% CI, 0.81–1.60, five studies). GL was not significantly related to those cancer sites. Stomach, prostate and lung cancers were not associated with GI and GL. The present analysis, based on an updated comprehensive evaluation of the epidemiological literature, indicates moderate unfavorable effects of high versus low GI on colorectal, and possibly bladder and kidney cancers, and a possible moderate positive association between GL and endometrial cancer.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Glycemic Index, Glycemic Load and Cancer Risk: An Updated Meta-Analysis

et al. 2019

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“…People consuming high levels of dietary fibre and whole grains have lower risk of all cause and cardiovascular mortality and incidence of common non-communicable diseases, including coronary heart disease and type 2 diabetes, than those eating less fibre, a series of systematic reviews and meta-analyses1 has found.…”

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confidence: 99%

Eating more fibre linked to reduced risk of non-communicable diseases and death, review finds

Mayor¹

2019

BMJ

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Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016

Shan

Rehm

Rogers

et al. 2019

JAMA

329

224

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IMPORTANCE Changes in the economy, nutrition policies, and food processing methods can affect dietary macronutrient intake and diet quality. It is essential to evaluate trends in dietary intake, food sources, and diet quality to inform policy makers.OBJECTIVE To investigate trends in dietary macronutrient intake, food sources, and diet quality among US adults.DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional analysis of the US nationally representative 24-hour dietary recall data from 9 National Health and Nutrition Examination Survey cycles (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) among adults aged 20 years or older. EXPOSURE Survey cycle.MAIN OUTCOMES AND MEASURES Dietary intake of macronutrients and their subtypes, food sources, and the Healthy Eating Index 2015 (range, 0-100; higher scores indicate better diet quality; a minimal clinically important difference has not been defined).RESULTS There were 43 996 respondents (weighted mean age, 46.9 years; 51.9% women). From 1999 to 2016, the estimated energy from total carbohydrates declined from 52.5% to 50.5% (difference, −2.02%; 95% CI, −2.41% to −1.63%), whereas that of total protein and total fat increased from 15.5% to 16.4% (difference, 0.82%; 95% CI, 0.67%-0.97%) and from 32.0% to 33.2% (difference, 1.20%; 95% CI, 0.84%-1.55%), respectively (all P < .001 for trend). Estimated energy from low-quality carbohydrates decreased by 3.25% (95% CI, 2.74%-3.75%; P < .001 for trend) from 45.1% to 41.8%. Increases were observed in estimated energy from high-quality carbohydrates (by 1.23% [95% CI, 0.84%-1.61%] from 7.42% to 8.65%), plant protein (by 0.38% [95% CI, 0.28%-0.49%] from 5.38% to 5.76%), saturated fatty acids (by 0.36% [95% CI, 0.20%-0.51%] from 11.5% to 11.9%), and polyunsaturated fatty acids (by 0.65% [95% CI, 0.56%-0.74%] from 7.58% to 8.23%) (all P < .001 for trend). The estimated overall Healthy Eating Index 2015 increased from 55.7 to 57.7 (difference, 2.01; 95% CI, 0.86-3.16; P < .001 for trend). Trends in high-and low-quality carbohydrates primarily reflected higher estimated energy from whole grains (0.65%) and reduced estimated energy from added sugars (−2.00%), respectively. Trends in plant protein were predominantly due to higher estimated intake of whole grains (0.12%) and nuts (0.09%).CONCLUSIONS AND RELEVANCE From 1999 to 2016, US adults experienced a significant decrease in percentage of energy intake from low-quality carbohydrates and significant increases in percentage of energy intake from high-quality carbohydrates, plant protein, and polyunsaturated fat. Despite improvements in macronutrient composition and diet quality, continued high intake of low-quality carbohydrates and saturated fat remained.

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Carbohydrate quality and human health: a series of systematic reviews and meta-analyses

Cited by 986 publications

References 36 publications

Glycemic Index, Glycemic Load and Cancer Risk: An Updated Meta-Analysis

Glycemic Index, Glycemic Load and Cancer Risk: An Updated Meta-Analysis

Eating more fibre linked to reduced risk of non-communicable diseases and death, review finds

Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016

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