Dietary glycemic index, dietary glycemic load, sugar drink intake, and risk of all-cause and cause-specific mortality

概要

［課程－２］
審査の結果の要旨
氏名 ホン

シラン

The research question of this study was to examine the association of dietary glycemic
index (GI), glycemic load (GL) and sugary drink consumption with the risks of
mortality. The three main objectives of this study were 1) to quantify the association
between dietary GI, GL, and sugary drink consumption and risk of death from all
causes; 2) to examine the association between dietary GI, GL, and sugary drink
consumption and cause-specific mortality; and 3) to perform sex-stratified analysis to
examine whether there are gender differences in the associations. The data from The
Japan Public Health Center-based Prospective Study were used for the analysis.
The key findings of this study are as follows:
1. For the dietary GI and GL analysis, during a mean follow-up of 17.1 years,
7,535 deaths among men and 4,913 among women were documented. Of these,
4,964 deaths were due to cancer, 2,941 to circulatory system diseases, 1,501 to
heart disease, 1,157 to cerebrovascular disease, 919 to respiratory diseases, and
459 to digestive diseases.
2. As compared with the lowest quartile, the multivariable hazard ratio (HR) for
those who had the highest quartile of GI was 1.13 (95%CI, 1.07–1.19). The HRs
for death comparing the highest with the lowest quartile were 1.26 (1.13–1.40)
for circulatory system diseases, 1.32 (1.13–1.54) for heart disease, 1.27 (1.07–
1.51) for cerebrovascular disease, and 1.39 (1.14–1.70) for respiratory diseases.
3. The associations between dietary GI and total and cause-specific mortality risk
were not modified by sex, except for circulatory system disease mortality and
heart disease mortality.
4. Dietary GL showed a null association with all-cause mortality. Among those
who had the highest GL, HRs for death from circulatory system diseases was
1.23 (1.04–1.44) and cerebrovascular disease was 1.30 (1.01–1.69) as compared
with the lowest quartile.
5. The associations between dietary GL and total and cause-specific mortality risk
were not modified by sex.
6. For the sugary drink analysis, during a mean follow-up of 17.1 years, 7,118
deaths among men and 4,693 among women were documented. Of these, 4,713

deaths were due to cancer, 1,088 to cerebrovascular disease, 2,766 to circulatory
system diseases, 1,412 to heart disease, 888 to respiratory diseases, and 433 to
digestive diseases.
7. Sugary drink consumption was associated with higher total mortality, with
multivariate HR of 1.06 (1.00–1.13) for quintile 3, 1.07 (1.01–1.13) for quintile
4, and 1.15 (1.09–1.22) for quintile 5, compared with the quintile 1.
Additionally, positive associations with cause-specific mortality were observed,
including death from circulatory system diseases and heart disease diseases.
8. The associations between sugary drinks and total and cause-specific mortality
risk were not modified by sex.
The results of this study suggest that dietary GI and sugary drink consumption were
associated with a greater risk of total and cause-specific mortality. The findings did not
support a positive association between dietary GL with overall mortality, but dietary GL
was associated with cause-specific mortality, especially with circulatory system disease
and cerebrovascular disease mortality.
This study is the largest Asian-based analysis of the association between dietary GI/GL,
sugary drinks, and mortality outcomes to date. The findings of this study provide new
perspectives and further evidence to support public health actions in Japan to raise
public awareness of healthier food choices. Given the reasons above, the committee
considers that this thesis is worthy of a doctoral degree.
よって本論文は博士（ 保健 学 ）の学位請求論文として合格と認められる。