1. Dietary Glycemic Index, Glycemic Load, and Risk of Stroke: A Large, Prospective Cohort Study among Chinese Women Danxia Yu 1, Xiao-Ou Shu 1, Honglan Li 2, Gong Yang 1, Ding Ding 3, Zhen Hong 3, Yu-Tang Gao 2, Wei Zheng 1, and Xianglan Zhang 1 1 Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA; 2 Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China; 3 Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China. Introduction Chinese people habitually consume a high-carbohydrate diet. During the recent nutrition transitions, refined grains have become the predominant source of carbohydrates in the Chinese diet. Methods Subjects included 64,320 women (aged 40-70 years) living in urban communities of Shanghai, China, having no history of diabetes, cardiovascular disease, or cancer at baseline (1997-2000). Dietary intakes were assessed using a validated food frequency questionnaire via in-person interviews and were adjusted for total energy by the residual method. During a mean follow-up of 10 years, 3,075 incident stroke cases were identified and confirmed by medical records, including 2,815 ischemic stroke and 260 hemorrhagic stroke cases. Cox regression model was used to evaluate the association and adjusted for age, income, education, physical activity, cigarette smoking, alcohol drinking, menopausal status, use of hormone therapy, history of hypertension, use of aspirin, family history of stroke, body mass index, waist-to-hip ratio, and intakes of total energy, protein, and saturated fat. Results High dietary GL and GI, but not total carbohydrate intake, were associated with increased risk of stroke in middle-aged and older Chinese women in Shanghai. The associations were more evident for GL, which reflects both carbohydrate quality and quantity, and for hemorrhagic stroke. The GL-stroke association may be modified by age, menopause, and abdominal adiposity. SubgroupsHR (95% CI)P trend P inter Age < 60 years1.75 (1.24, 2.45)0.006 0.001 Age ≥ 60 years1.03 (0.76, 1.38)0.82 Pre-menopause1.89 (1.12, 3.21)0.07 0.06 Post-menopause1.18 (0.92, 1.51)0.18 Waist/Hip < 0.81.66 (1.11, 2.49)0.08 0.05 Waist/Hip ≥ 0.81.13 (0.87, 1.48)0.23 No hypertension1.32 (0.98, 1.78)0.19 0.28 Hypertension1.28 (0.92, 1.78)0.10 Stratified analyses for risk of total stroke by dietary GL (the highest vs. lowest quintile) High intake of refined carbohydrates, and a high dietary glycemic index (GI) and glycemic load (GL), have been shown to be associated with higher risks of cardiovascular and metabolic diseases. Among Chinese adults, high carbohydrate intake, mainly from white rice, and high dietary GL have been associated with increased risks of coronary heart disease and type 2 diabetes. Objective: To prospectively examine carbohydrate intake, dietary GI, and GL in relation to ischemic and hemorrhagic stroke risk among middle-aged and older Chinese women in the Shanghai Women’s Health Study. Results Conclusion Funding & Contact info. The present study is supported by NIH grants R01 HL095931 to X. Zhang, and R37 CA070867 and UM1 CA182910 to W. Zheng. The content is solely the responsibility of the authors and does not necessarily represent official views of the NIH. The authors declare no conflict of interest. Dr. Xianglan Zhang, xianglan.zhang@vanderbilt.edu Dr. Danxia Yu, danxia.yu@vanderbilt.edu Risk of Total StrokeQuintiles P- trend 12345 Glycemic Load Median173196210224245 Cases, n395485590614 991 Age- and energy- adjusted model 1 (ref) 1.09 (0.96, 1.25) 1.22 (1.07, 1.38) 1.10 (0.97, 1.25) 1.38 (1.23, 1.55) <0.0001 Multivariate model 1 (ref) 1.08 (0.93, 1.25) 1.19 (1.01, 1.40) 1.07 (0.89, 1.29) 1.30 (1.04, 1.62) 0.04 Glycemic Index Median69.573.375.677.580.0 Cases, n404535549672 915 Age- and energy- adjusted model 1 (ref) 1.17 (1.03, 1.34) 1.11 (0.98, 1.27) 1.25 (1.10, 1.41) 1.35 (1.20, 1.52) <0.0001 Multivariate model 1 (ref) 1.10 (0.97, 1.26) 1.03 (0.91, 1.18) 1.12 (0.98, 1.28) 1.16 (1.01, 1.33) 0.04 Carbohydrates Median, g/day246268282296314 Cases, n452491550643 939 Age- and energy- adjusted model 1 (ref) 0.97 (0.86, 1.11) 1.02 (0.90, 1.15) 1.05 (0.93, 1.19) 1.23 (1.10, 1.37) <0.0001 Multivariate model 1 (ref) 0.93 (0.79, 1.08) 0.93 (0.78, 1.12) 0.92 (0.75, 1.14) 0.99 (0.76, 1.30) 0.97 Risk of Ischemic Stroke Glycemic load 1 (ref) 1.06 (0.91, 1.24) 1.14 (0.96, 1.35) 1.04 (0.86, 1.26) 1.21 (0.95, 1.52) 0.17 Glycemic index 1 (ref) 1.12 (0.98, 1.29) 1.04 (0.90, 1.19) 1.13 (0.99, 1.30) 1.12 (0.98, 1.30) 0.14 Carbohydrates 1 (ref) 0.92 (0.78, 1.07) 0.90 (0.75, 1.09) 0.90 (0.72, 1.12) 0.94 (0.71, 1.25) 0.75 Risk of Hemorrhagic Stroke Glycemic load 1 (ref) 1.32 (0.79, 2.21) 1.85 (1.07, 3.21) 1.36 (0.72, 2.60) 2.70 (1.28, 5.67) 0.01 Glycemic index 1 (ref) 0.93 (0.59, 1.46) 0.99 (0.63, 1.56) 0.96 (0.61, 1.52) 1.55 (0.99, 2.42) 0.05 Carbohydrates 1 (ref) 1.01 (0.60, 1.71) 1.32 (0.73, 2.41) 1.18 (0.58, 2.39) 1.63 (0.68, 3.91) 0.25