小美

作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　April 14, 2010 — 根據一項於4月12日發表於內科醫學誌（Archives of Internal Medicine）的義大利大型世代研究結果，高升糖負荷以及從高升糖指數食物獲得的碳水化合物，與女性發生冠狀血管心臟疾病（CHD）有關，而非男性。
　　
　　Sabina Sieri博士與其來自EPICOR研究的同事們表示，升糖負荷（GL）和升糖指數（GI）與心臟血管疾病的關係已經在一些前瞻性研究中取得不一致的結果，特別是在男性身上。目前這項EPICOR研究針對GI與GL及CHD，在原本收納到歐洲前瞻性癌症與營養研究中，一群大型且同質性低的義大利群眾身上的關係。
　　
　　這項研究族群包括47,749位自願者（15,171位男性與32,578位女性），這些自願者完成一份飲食問卷，且追蹤平均達7.9年。研究者以多變項Cox比例危險模式估計CHD校正相對風險（RRs）以及95%信賴區間（CIs）。
　　
　　在後續追蹤確認了463位病患罹患CHD，其中158位是女性，305位是男性。相較於碳水化合物攝取四分位數最低的女性，那些碳水化合物攝取四分位數最高者，發生CHD風險顯著較高（RR為2.00；95% CI為1.16-3.43）。這樣的關係並未在男性身上觀察到（交互作用P值為0.04）。
　　
　　對女性而言，增加攝取來自高升糖指數（GI）食物的碳水化合物，而非低GI的碳水化合物，顯著地與較高的CHD風險有關（RR為1.68；95% CI為1.02-2.75）。對女性，而非男性，那些糖份攝取量四分位數最高者，相較於最低者，CHD風險顯著較高（RR為2.24；95% CI為1.26-3.98；交互作用P值為0.03）。
　　
　　研究作者們寫到，在這一個義大利群眾中，高膳食GL與來自高GI食物的碳水化合物攝取，會增加女性而非男性的CHD風險。
　　
　　這項研究的限制包括使用並非設計以估計膳食升糖指數與的升糖負荷問卷、以及根據單一測試的飲食暴露量，該次測試主要詢問過去一年內的飲食習慣。
　　
　　研究作者們的結論是，我們暫時推測，女性含糖量高的飲食可能透過脂蛋白與葡萄糖代謝在性別上的差異調控其不好的效應，但是仍需要進一步的前瞻性研究來確認男性的高膳食升糖負荷與CVD（心臟血管疾病）沒有這樣的關係。
　　
　　EPICOR研究接受di San Paolo公司的贊助。義大利EPIC聯盟由Italiana per la Ricerca sul Cancro協會贊助。試驗作者表示沒有相關資金上的往來。


Dietary Glycemic Load Linked to Coronary Heart Disease Risk in Women But Not Men

By Laurie Barclay, MD
Medscape Medical News

April 14, 2010 — High dietary glycemic load and carbohydrate intake from high-glycemic index foods are associated with an increased overall risk for coronary heart disease (CHD) in women but not in men, according to the results of a large, Italian cohort study reported in the April 12 issue of Archives of Internal Medicine.

"Dietary glycemic load (GL) and glycemic index (GI) in relation to cardiovascular disease have been investigated in a few prospective studies with inconsistent results, particularly in men," write Sabina Sieri, PhD, and colleagues from the EPICOR study. "The present EPICOR study investigated the association of GI and GL with ...CHD in a large and heterogeneous cohort of Italian men and women originally recruited to the European Prospective Investigation into Cancer and Nutrition study."

The study cohort consisted of 47,749 volunteers (15,171 men and 32,578 women) who completed a dietary questionnaire and were followed up for a median of 7.9 years. The investigators estimated adjusted relative risks (RRs) for CHD and 95% confidence intervals (CIs) using multivariate Cox proportional hazards modeling.

Of 463 patients with CHD identified during follow-up, 158 were women and 305 were men. Compared with women in the lowest quartile of carbohydrate intake, those in the highest carbohydrate intake quartile had a significantly greater risk for CHD (RR, 2.00; 95% CI, 1.16 - 3.43). This association was not observed in men (P for interaction = .04).

In women, increasing intake of carbohydrates from high-glycemic index foods, but not of low-glycemic index carbohydrates, was also significantly associated with greater CHD risk (RR, 1.68; 95% CI, 1.02 - 2.75). For women, but not for men, CHD risk was significantly greater for those in the highest glycemic load quartile vs those in the lowest quartile (RR, 2.24; 95% CI, 1.26 - 3.98; P for interaction =.03).

"In this Italian cohort, high dietary GL and carbohydrate intake from high-GI foods increase the overall risk of CHD in women but not men," the study authors write.

Limitations of this study include use of questionnaires that were not designed to estimate dietary glycemic index and glycemic load, and dietary exposure based on a single assessment in which participants were asked about eating habits during the preceding year.

"We tentatively suggest that the adverse effects of a high glycemic diet in women are mediated by sex-related differences in lipoprotein and glucose metabolism, but further prospective studies are required to verify a lack of association of a high dietary glycemic load with CVD [cardiovascular disease] in men," the study authors conclude.

The EPICOR study is supported by the Compagnia di San Paolo. The Italian EPIC collaboration is supported by the Associazione Italiana per la Ricerca sul Cancro. The study authors have disclosed no relevant financial relationships.

Arch Intern Med. 2010;170:640-647.