High dietary glycemic load is associated with higher concentrations of urinary advanced glycation endproducts: the Cohort on Diabetes and Atherosclerosis Maastricht (CODAM) Study

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Background: Advanced glycation endproducts (AGEs) and their precursors (dicarbonyls) are associated with the progression of diseases such as diabetes and cardiovascular disease. Plasma concentrations of dicarbonyls methylglyoxal (MGO), glyoxal (GO), and 3-deoxyglucosone (3-DG) are increased after an oral glucose load indicating that consumption of diets high in carbo hydrates may induce the endogenous formation of dicarbonyls and AGEs.

Objective: To examine the associations of dietary glycemic index (GI) and glycemic load (GL) with concentrations of dicarbonyls and AGEs in plasma and urine.

Methods: Cross-sectional analyses were performed in a human observational cohort [Cohort on Diabetes and Atherosclerosis Maastricht (CODAM), n = 494, 59 +/- 7 y, 25% type 2 diabetes]. GI and GL were derived from FFQs. Dicarbonyls and AGEs were measured in the fasting state by ultra-performance liquid chromatography-tandem MS. MGO, GO, and 3-DG and protein-bound N-epsilon-(carboxymethyl)lysine (CML), N-epsilon-(1-carboxyethyl)lysine (CEL), and pentosidine were measured in plasma. Free forms of CML, CEL, and N-delta-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) were measured in both plasma and urine. Multiple linear regression was performed with dicarbonyls and AGEs as dependent variables, and dietary GI or GL as main independent variables (all standardized). Models were adjusted for health and lifestyle factors, dietary factors, and reciprocally for GI and GL. As this was an explorative study, we did not adjust for multiple testing.

Results: GI was not associated with any of the dicarbonyls or AGEs. GL was positively associated with free urinary MG-H1 (beta = 0.34; 95% CI: 0.12, 0.55). Furthermore, GL was positively associated with free plasma MG-H1 and free urinary CML (beta = 0.23; 95% CI: 0.02, 0.43; and beta = 0.28; 95% CI: 0.06, 0.50), but these associations were not independent of dietary AGE intake.

Conclusions: A habitual diet higher in GL is associated with higher concentrations of free urinary MG-H1. This urinary AGE is most likely a reflection of AGE accumulation and degradation in tissues, where they may be involved in tissue dysfunction.

Original languageEnglish
Pages (from-to)358-366
Number of pages9
JournalAmerican Journal of Clinical Nutrition
Issue number2
Publication statusPublished - Aug 2019


  • glycemic load
  • glycemic index
  • advanced glycation endproducts
  • dicarbonyls
  • type 2 diabetes
  • cardiovascular complications
  • glycation
  • glycotoxin
  • nutrition
  • diet
  • AGE
  • FOOD

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