Dietary Insulin Index and Dietary Insulin Load in Relation to Metabolic Syndrome: The Shahedieh Cohort Study

Are dietary factors associated with cardiometabolic risk factors in patients with non-alcoholic fatty liver disease?

Background

Non-alcoholic fatty liver disease (NAFLD) is intricately linked with dietary patterns and metabolic homeostasis. Therefore, the present study focused to investigate the relation between dietary patterns and cardiometabolic risk factors related to fatty liver in NAFLD patients.

Methods

This cross-sectional study included 117 individuals whose body mass index (BMI) threshold of 25 or above diagnosed with NAFLD by magnetic resonance imaging. The hospital database was used to review the patients' medical records such as lipid parameters, and fasting blood sugar. Anthropometric measurements and body composition were measured by researchers. Likewise, data from 24-h dietary recalls of individuals were collected to analyze their energy and nutrient intakes besides calculating dietary insulin index (DII), dietary insulin load (DIL), dietary glycemic index (DGI), and dietary glycemic load (DGL).

Results

Participants consuming diets with distinct levels of DII, DIL, DGI, and DGL exhibited variations in dietary energy and nutrient intake. Specifically, differences were noted in carbohydrate intake across quartiles of DII, DIL, DGI, and DGL, while fructose consumption showed variability in DGL quartiles (p ≤ 0.05). Moreover, sucrose intake demonstrated distinctions in both DII and DGL quartiles (p ≤ 0.05). No statistical difference was found in biochemical parameters and the fatty liver index among different levels of DII, DIL, DGI, and DGL (p > 0.05). After adjusting for potential confounders, participants with a higher DGI had four times greater odds of developing metabolic syndrome compared to those in the bottom quartile (OR, 4.32; 95% CI [1.42-13.11]).

Conclusion

This study provides initial evidence of the intricate association between dietary factors and NAFLD, emphasizing the necessity for further research including prospective designs with larger sample sizes, to garner additional insights.

The High-Dietary Insulin Load Score Is Associated With Elevated Level of Fasting Blood Sugar in Iranian Adult Men: Results From Fasa PERSIAN Cohort Study

Aim: The potential of different foods to induce postprandial hyperinsulinemia may be involved in the development of metabolic syndrome (MetS). We aimed to evaluate the association between dietary insulin indices and MetS in a large population of adults in Iran. Methods: A total of 6356 adults aged 35-70 years were included in the present cross-sectional study. A validated block-format 125-item semiquantitative food frequency questionnaire (FFQ) was used to obtain usual food intakes, and MetS was defined according to the International Diabetes Federation (IDF) and American Heart Association (AHA)/National Heart, Lung, and Blood Institute (NHLBI) criteria. Results: MetS was prevalent in 13.8% of participants. Mean age of the study participants was 46.58 ± 8.82 years, and mean body mass index (BMI) was 25.02 ± 4.60 kg/m2. Mean dietary insulin index (DII) and dietary insulin load (DIL) were 63.15 ± 7.57 and 168.253 ± 52.09, respectively. In the crude model, men in the highest DIL quartile were more likely to have hyperglycemia than those in the lowest quartile (OR: 1.75, 95% CI: 1.12-2.73, p trend = 0.04). This association remained significant and was even stronger after adjusting for potential confounders in model I (OR: 3.64, 95% CI: 1.57-8.47, p trend = 0.005) and further adjustment for BMI in model II (OR: 3.61, 95% CI: 1.55-8.44, p trend = 0.006). Conclusions: In healthy men, adherence to a high-DIL diet may be associated with a greater likelihood of having hyperglycemia. No statistically significant association was observed between insulin indices and the odds of having MetS.

Association between dietary insulin index and postmenopausal osteoporosis in Iranian women: a case-control study

BACKGROUND

The relationship between the dietary insulin index (DII) and the disease's risk is unknown, despite the fact that hyperinsulinemia is presumed to contribute to osteoporosis. The insulin response of various diets determines the DII. This study aimed to investigate the connection between postmenopausal Iranian women's adherence to a diet with a higher insulinemic potential and osteoporosis.

METHODS

A total of 380 postmenopausal women were included in the current case-control study. A 168-item food frequency questionnaire (FFQ) with established validity and reliability was used to evaluate individuals' daily calorie intake. The standard formula was employed to determine the dietary insulin load of each product. Subsequently, the calculation of DII was performed by dividing the dietary insulin load by the total energy consumed for each individual. In order to investigate the relationship between osteoporosis and DII, logistic regression was implemented.

RESULTS

The results of the current study demonstrated a substantial inverse relationship between osteoporosis and the DII, even after accounting for confounding variables (OR = 0.927; 95% CI = 0.888-0.967). The mean scores of DII (P < 0.001) was significantly higher in control group (36.82 ± 8.98) compared to the case group (33.53 ± 6.28).

CONCLUSIONS

Our findings suggest that keeping a diet high in insulin index and low in foods that are insulinogenic may improve bone mass density. Consequently, it may be essential for postmenopausal women to consume nutrients that stimulate insulin production in order to prevent osteoporosis.

The association between dietary insulin index and dietary insulin load with rheumatoid arthritis

This study was designed to assess the relationship between dietary insulin index (DII) and dietary insulin load (DIL) and rheumatoid arthritis (RA) risk in a case-control study. This study enrolled ninety-five newly diagnosed RA patients and 200 age- and sex-matched healthy controls. Dietary intakes were assessed using a validated 168-item semi-quantitative FFQ. DII and DIL were calculated using food insulin index values from previously published data. In the unadjusted model, individuals in the highest DIL tertile had the significantly higher odds of RA than those in the lowest tertile of the DIL scores (OR = 1·32, 95 % CI (1·15, 1·78), Pfor trend = 0·009). After adjusting for confounders, the risk of RA was 2·73 times higher for participants in the highest tertile of DIL than for those in the lowest tertile (OR = 2·73, 95 % CI (1·22, 3·95), Pfor trend < 0·001). In addition, patients in the highest DII tertile had higher risk of RA than those in the first tertile (OR = 2·22, 95 % CI (1·48, 3·95), Pfor trend = 0·008). This association persisted after adjusting for potential confounders (OR = 3·75, 95 % CI (3·18, 6·78), Pfor trend = 0·002). Our findings suggest that diets high in DII and DIL may increase the risk of developing RA, independent of other potential confounders. These findings can be verified by more research, particularly with a prospective design.

The Application of the Food Insulin Index in the Prevention and Management of Insulin Resistance and Diabetes: A Scoping Review

The food insulin index (FII) is a novel algorithm used to determine insulin responses of carbohydrates, proteins, and fats. This scoping review aimed to provide an overview of all scientifically relevant information presented on the application of the FII in the prevention and management of insulin resistance and diabetes. The Arksey and O'Malley framework and the PRISMA Extension for Scoping Reviews 22-item checklist were used to ensure that all areas were covered in the scoping review. Our search identified 394 articles, of which 25 articles were included. Three main themes emerged from the included articles: 1. the association of FII with the development of metabolic syndrome, insulin resistance, and diabetes, 2. the comparison of FII with carbohydrate counting (CC) for the prediction of postprandial insulin response, and 3. the effect of metabolic status on the FII. Studies indicated that the FII can predict postprandial insulin response more accurately than CC, and that a high DII and DIL diet is associated with the development of metabolic syndrome, insulin resistance, and diabetes. The FII could be a valuable tool to use in the prevention and management of T1DM, insulin resistance, and T2DM, but more research is needed in this field.

Dietary Insulin Index (DII) and Dietary Insulin load (DIL) and Caveolin gene variant interaction on cardiometabolic risk factors among overweight and obese women: a cross-sectional study

BACKGROUND AND OBJECTIVE

Studies have shown that Caveolin gene polymorphisms (CAV-1) are involved in chronic diseases, such as metabolic syndrome. Moreover, the dietary insulin index (DII) and dietary insulin load (DIL) have been shown to potentially elicit favorable effects on cardiovascular disease (CVD) risk. Therefore, this study sought to investigate the effect of DII DIL and CAV-1 interaction on CVD risk factors.

METHODS

This cross-sectional study consisted of 333 overweight and obese women aged 18-48 years. Dietary intakes, DII, and DIL were evaluated using the 147-item food frequency questionnaire (FFQ). Serum profiles were measured by standard protocols. The CAV-1 rs 3,807,992 and anthropometric data were measured by the PCR-RFLP method and bioelectrical impedance analysis (BIA), respectively. Participants were also divided into three groups based on DII, DIL score, and rs3807992 genotype.

RESULTS

This comparative cross-sectional study was conducted on 333 women classified as overweight or obese. Participants with A allele for the caveolin genotype and higher DII score showed significant interactions with high-density lipoprotein (HDL) (P for AA = 0.006 and P for AG = 0.019) and CRI-I (P for AA < 0.001 and P for AG = 0.024). In participants with AA genotype and greater DII score, interactions were observed in weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, CRI-II, fat-free mass (FFM), and skeletal muscle mass (SMM) (P < 0.079). Those with higher DIL scores and AA genotype had higher weight (P = 0.033), FFM (P = 0.022), and SMM (P = 0.024). In addition, DIL interactions for waist/hip ratio (WHR), waist circumference (WC), triglyceride (TG), CRI-I, and body fat mass (BFM) among individuals with AA genotype, while an HDL interaction was observed in individuals with AG and AA (P < 0.066).

CONCLUSION

The findings of the present study indicate that people who carry the caveolin rs3807992 (A) allele and have greater DII and DIL scores are at higher risk for several cardiovascular disease and metabolic syndrome biomarkers. These results highlight that diet, gene variants, and their interaction, should be considered in the risk evaluation of developing CVD.

Dietary insulin index, dietary insulin load and dietary patterns and the risk of metabolic syndrome in Hoveyzeh Cohort Study

Postprandial insulin secretion has been associated with metabolic disorders such as hyperlipidemia and type 2 diabetes. Therefore, we aimed to explore the relationship between dietary insulin indices and dietary pattern with the risk of Metabolic Syndrome (MetS). The participants of the present cross-sectional study were included among the individuals who participated in the Hoveyzeh Cohort Study (HCS). A total of 3905 Iranian adults, aged 35-70 years, are included in the current analysis. The Food Frequency Questionnaire (FFQ) is used to calculate the dietary Insulin Index (DII), Insulin Load (DIL), and dietary pattern. Dietary pattern was derived using Reduced-Rank Regression (RRR) based on intake of protein (g/day), fiber (g/day), fat (g/day), magnesium (mg/day), and dietary insulin index were considered as response variables. The Generalized Linear Model was used to obtain the odds ratio (OR) and 95% confidence interval (CI) for MetS based on gender, while considering quartiles of DIL, DII scores, and dietary pattern, adjusted for potential confounders. The mean ± SD of age and BMI of the participants in the top quartile of DIL were 45.72 ± 8.05 years and 28.25 ± 5.02 kg/m2, respectively. The mean ± SD of DII was 40.53 ± 4.06 and the mean ± SD of DIL was 117,986.1 ± 30,714.06. A significant positive association was observed between DIL and MetS in women after adjusting for confounding factors (OR: 1.51; 95% CI 1.16; 1.96). No significant association was seen between DIL, DII, and MetS among men. A derived dietary pattern characterized by high intakes of fruits, sugar, sweet deserts, Whole Grains, and dairy was associated with an increased risk of MetS in adjusted model2 among women (OR: 1.41; 95% CI 1.13; 1.75) and men in the same model (OR: 2.09; 95% CI 1.35; 3.21).However, the final model was significant just for men (OR: 2.08; 95% CI 1.35; 3.21) and not for women (OR: 1.24; 95% CI 0.96; 1.60). Our findings showed that adherence to a diet with a high insulin load can increase the risk of MetS in women. In addition, a derived dietary pattern by RRR indicated that a diet rich in fruits, sugar, sweet deserts, whole Grains, and dairy is related to increased risk of MetS in both men and women.

Association between dietary insulin index and load with cardiometabolic risk factors and risk of metabolic syndrome among the patients with type 2 diabetes: a cross-sectional study

BACKGROUND

This study aims to investigate the association between dietary insulin index (DII) and load (DIL) with cardiometabolic risk factors and the risk of developing metabolic syndrome (MetS) among patients with type 2 diabetes (T2DM).

METHODS

A cross-sectional study was conducted among 500 T2DM patients. Dietary intake was assessed using a validated food frequency questionnaire, and DII and DIL were calculated based on insulin response and energy content. Logistic regression analyses were performed to determine the odds ratios (ORs) for MetS.

RESULTS

Participants in the highest quartile of DIL had significantly higher odds of MetS (OR: 2.16; 95% CI: 1.02-4.25, P = 0.039) and hyperglycemia (OR: 1.69; 95% CI: 1.08-4.96, P = 0.032). We also discovered that patients in the highest quartile of DII had higher odds of MetS (OR: 1.69; 95% CI: 1.08-4.96, P = 0.034) and hyperglycemia (OR: 1.39; 95% CI: 1.04-4.12, P = 0.019). Furthermore, participants in the highest quartile of DIL (OR: 1.64; 95% CI: 1.00-2.59, P = 0.03) and DII (OR: 1.42; 95% CI: 1.05-1.95, P = 0.026) had higher odds of high waist circumference. When it came to hypertriglyceridemia, we found a significant association between DII and DIL only in the crude model, not the fully adjusted model. However, we didn't observe any significant association between DII and DIL with hypercholesteremia, Low HDL, and high blood pressure (P > 0.05).

CONCLUSION

Our study provides evidence suggesting that a higher DII and DIL may be associated with an increased risk of cardiometabolic risk factors and MetS in patients with T2DM.

Association between dietary insulin index and load with brain derived neurotrophic factor, adropin and metabolic health status in Iranian adults

The associations of high potential insulinogenic foods with metabolic health (MH) status and brain-derived neurotrophic factor (BDNF) and adropin were not investigated quite enough. We examined the relationship between dietary insulin load (DIL) and dietary insulin index (DII) with MH and serum levels of BDNF and adropin among Iranian adults. This cross-sectional investigation accomplished among 527 Iranian middle-aged adults (54.3% men). Dietary information was obtained by a validated food frequency questionnaire. Anthropometric indices and blood pressure were assessed. For measuring lipid and glycemic profile and serum levels of BDNF and adropin, blood samples were assembled after 12 h of fasting. MH was defined based on lipid and glycemic profile, high blood pressure, insulin resistance and chronic inflammation. After adjustments all confounders, participants in the highest tertile of DII compared to the lowest one had a 115% increased odds for metabolic unhealthy (MU) profile (ORT3 vs. T1 = 2.15, 95% CI 1.03-4.49). However, DIL was not related to MU. Higher DII was additionally associated with high blood pressure, in maximally-adjusted model (ORT3 vs. T1 = 3.57, 95% CI 1.61-7.92). Moreover, moderate DIL was significantly associated with hypertriglyceridemia (ORT2 vs. T1 = 2.56, 95% CI 1.01-6.45). Each tertile increase in DII or DIL was not significantly associated with serum BDNF or adropin values. Greater DII was associated with higher chance of MU and hypertension in Iranian adults; but no association was found between DIL and metabolic health. DIL or DII was not related to circulating BDNF or adropin. To confirm these findings, additional prospective investigations are required.

The Possible Mediatory Role of Inflammatory Markers on the Association of Dietary Insulin Index and Insulin Load with Metabolic Syndrome in Women with Overweight and Obesity: A Cross-Sectional Study

Background

Metabolic syndrome (MetS) is associated with increased inflammation. Diet plays an important role in the prevention and management of MetS, while some dietary factors can also increase or decrease markers of systemic inflammation. In this study, we aimed to determine the mediated association of inflammatory markers induced by dietary insulin index (DII) and dietary insulin load (DIL) with MetS and its components.

Methods

This cross-sectional study was conducted with 219 women aged 18-28 years. Dietary intake was assessed by a 147-item food frequency questionnaire (FFQ). DII and DIL were calculated using the standard formula. The guidelines of the National Cholesterol Education Program's Adult Treatment Panel III were used to define MetS. Biochemical parameters and anthropometric and blood pressure measures were evaluated by standard protocols.

Results

After the adjustment for potential confounders, a marginally significant association was found between DII and MetS (OR = 2.11; 95% CI = 0.93-4.82; P = 0.06). However, we did not find a significant association between DIL and MetS. Furthermore, DII was significantly associated with waist circumference (WC) (OR = 1.67; 95% CI = 1.09- 4.03; P = 0.03) and marginally associated with triglyceride (TG) (OR = 1.10; 95% CI = 0.92-2.33; P = 0.07) and systolic blood pressure/diastolic blood pressure (SBP/DBP) (OR = 1.84; 95% CI = 0.85-3.99; P = 0.07). Moreover, there was a significant association between DIL and SBP/DBP (OR = 1.74; 95% CI = 1.54-5.61; P = 0.04). Also, we found that MCP-1 may have a mediatory role in the association between DII and DIL with MetS and several components of MetS. Hs-CRP did not have mediatory role in the association between DII and MetS. However, hs-CRP had a mediatory role in several MetS components. Furthermore, hs-CRP may have a mediatory role in the association of DIL with MetS and with some of its components.

Conclusions

A higher DII score may increase the odds of MetS and its components. DIL was not significantly associated with the odds of MetS, but the association of DIL and SBP/DBP was significant. MCP-1 may have a mediatory role in associations between DII and DIL with MetS. In addition, hs-CRP may have a mediatory role in the association between DIL and MetS.

Glycemic index, glycemic load, dietary insulin index, and dietary insulin load in relation to cardiometabolic risk factors among participants with atherosclerosis: a cross-sectional study

BACKGROUND

We examined the cross-sectional associations of dietary Glycemic Index (GI), Glycemic Load (GL), Dietary Insulin Index (DII), and Dietary Insulin Load (DIL) with cardiovascular disease (CVD) factors in subjects with atherosclerosis.

METHODS

The present cross-sectional study was conducted on subjects with atherosclerosis. Regular dietary intake was assessed using a 168-item semi-quantitative food frequency questionnaire (FFQ) and GI, GL, DIL, and DII were also calculated. Odds Ratio (OR) and 95% Confidence Intervals (CIs) were estimated for general and central obesity according to the GI, GL, DII, and DIL.

RESULTS

According to the continuous score of GL, there was a significant positive association between GL and central obesity for women in all models. Regarding the association between DIL score and biochemical variables, there was a significant positive association between Na and Aspartate transaminase (AST) with DII. Moreover, there was a significant positive association between LDL-c(p = 0.03) and AST (p = 0.04)with DIL score in all 3 models.

CONCLUSION

In this study, GL was associated with greater odds of central obesity in women, but not in men. Neither dietary DII nor DIL was associated with BMI and central obesity. GI, GL, DII, and DIL were significantly associated with some CVD risk biomarkers in subjects with atherosclerosis.

Association of major dietary patterns with advanced glycation end products and high-sensitivity C-reactive protein in people with type 1 diabetes mellitus

BACKGROUND

The associations of diet with serum levels of advanced glycation end products (AGEs) and high-sensitivity C-reactive protein (hs-CRP) have been examined in patients with type 2 diabetes mellitus (T2DM). However, data on patients with type 1 diabetes mellitus (T1DM) are limited. Therefore, this study was conducted to investigate the associations of major dietary patterns with serum levels of AGEs and hs-CRP among patients with T1DM.

METHODS

A total of 229 patients with T1DM participated in this current cross-sectional study. We collected dietary data using a validated food frequency questionnaire (FFQ). The factor analysis approach was used to determine major dietary patterns. A fasting blood sample was collected from each participant to assess serum levels of AGEs and hs-CRP. The associations of dietary patterns with elevated levels of AGEs and hs-CRP were assessed using binary logistic regression.

RESULTS

Patients with T1DM in the highest tertile of a Western dietary pattern had 4.32 times higher odds of having elevated AGEs than those in the lowest tertile (OR: 4.32, 95% CI: 1.86-10.05). Additionally, adherence to the Western diet was associated with 2.97 times greater odds of having elevated hs-CRP (> 3 mg/L) (OR: 2.97, 95% CI: 1.22-7.24) in these patients. Such positive associations were not observed for unhealthy and traditional dietary patterns. Moreover, higher adherence to a semi-healthy diet (characterized by high consumption of white meat, whole grains, processed meat, and a low salt intake) was associated with 87% lower odds of having elevated hs-CRP (OR: 0.13, 95% CI: 0.05-0.35). However, we found no significant association between the semi-healthy diet and AGEs levels.

CONCLUSION

We found that adherence to a Western dietary pattern was associated with elevated levels of AGEs/hs-CRP in patients with T1DM. Also, we discovered a significant inverse association between adherence to a semi-healthy diet and hs-CRP levels.

Dietary insulin index and load and cardiometabolic risk factors among people with obesity: a cross-sectional study

BACKGROUND

The hypothesis of the effect of the insulinogenic effects of diet on the development of cardiometabolic disorders has been suggested, but limited data are available for adults with obesity. This study aimed to determine the association of dietary insulin index (DII) and dietary insulin load (DIL) with cardiometabolic risk factors among Iranian adults with obesity.

METHODS

The study was conducted with a total of 347 adults aged 20-50 years in Tabriz, Iran. Usual dietary intake was assessed through a validated 147-item food frequency questionnaire (FFQ). DIL was computed using published food insulin index (FII) data. DII was calculated by dividing DIL by the total energy intake of each participant. Multinational logistic regression analysis was performed to evaluate the association between DII and DIL and cardiometabolic risk factors.

RESULTS

Mean age of participants was 40.78 ± 9.23 y, and mean body mass index (BMI) was 32.62 ± 4.80 kg/m2. Mean of DII and DIL was 73.15 ± 37.60 and 196,242 ± 100,181. Participants with higher DII had higher BMI, weight, waist circumference (WC), and blood concentrations of triglyceride (TG) and Homeostasis model assessment insulin resistance index (HOMA-IR) (P < 0.05). After taking potential confounders into account, DIL was positively associated with MetS (OR: 2.58; 95% CI: 1.03-6.46), and high blood pressure (OR: 1.61; 95% CI: 1.13-6.56). Moreover, after adjustment for potential confounders, moderate DII was associated with increased odds of MetS (OR: 1.54, 95% CI: 1.36-4.21), high TG (OR, 1.25; 95% CI, 1.17-5.02), and high blood pressure (OR: 1.88; 95% CI: 1.06-7.86).

CONCLUSION

This population-based study revealed that adults with higher DII and DIL associated with cardiometabolic risk factors and consequently, replacement of high with low DII and DIL may have reduce the risk of cardiometabolic disorders. Further studies with longitudinal design are required to confirm these findings.

Associations between Insulin Index and dietary insulin load with cardiometabolic phenotype in the AZAR cohort population in north-western Iran: a cross-sectionalstudy

OBJECTIVES

Hyperinsulinaemia and insulin resistance are proposed as contributors to the incidence of cardiometabolic phenotypes (CMPs) with unhealthy metabolic status. This study analysed the association between dietary insulin load (DIL) and Dietary Insulin Index (DII) with CMPs in the AZAR cohort population.

DESIGN

This study was a cross-sectional analysis of the AZAR Cohort Study, beginning in 2014 and continuing to this date.

SETTING

The AZAR cohort is a part of an Iranian screening programme named the Persian cohort and involves participants living in the Shabestar region, Iran for at least 9 months.

PARTICIPANTS

A total of 15 006 participants agreed to partake in the study. We excluded participants with missing data (n=15), daily energy intake lower than 800 kcal (n=7) or higher than 8000 kcal (n=17), and cancer (n=85). Finally, 14 882 individuals remained.

PRIMARY AND SECONDARY OUTCOME MEASURES

The gathered information included the participants' demographic, dietary, anthropometric and physical activity data.

RESULTS

The frequency of DIL and DII significantly decreased from the first to fourth quartiles in metabolically unhealthy participants (p≤0.001). The mean values of DIL and DII were greater in metabolically healthy participants than in unhealthy ones (p<0.001). The results of the unadjusted model showed that the risks of unhealthy phenotypes in the fourth DIL quartile decreased by 0.21 (0.14-0.32) and 0.37 (0.33-0.43), respectively, compared with the first quartile. The same model showed the same risks for DII decreased by 0.18 (0.11-0.28) and 0.39 (0.34-0.45), respectively. The results in both genders were the same as all participants combined.

CONCLUSIONS

DII and DIL were correlated with a decreased OR of unhealthy phenotypes. We suggest the reason may be either a lifestyle change in metabolically unhealthy participants or elevated insulin secretion not being as detrimental as previously thought. Further studies can confirm these speculations.

Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

How do carbohydrate quality indices influence on bone mass density in postmenopausal women? A case-control study

BACKGROUND

Carbohydrates are the primary energy source in Asian countries, including Iran. An emerging method can be used to measure the quality of carbohydrates, including the carbohydrate quality index (CQI), which includes a variety of components. Low-carbohydrate diet score (LCDS) has been proposed as a new method of scoring micronutrient intake that could provide a reasonable explanation for the link between diet and the risk of chronic diseases.

OBJECTIVE

This study aimed to investigate the relationship between CQI, LCDS, glycemic index (GI), glycemic load (GL), insulin load (IL), and insulin index (II) with bone mass density (BMD) in postmenopausal women.

METHOD

In this case-control study, 131 postmenopausal women with osteoporosis/osteopenia and 131 healthy postmenopausal women aged 45-65 participated. The dual-energy X-ray absorptiometry (DEXA) method measured the BMD of the lumbar vertebrae and femoral neck. A validated semi-quantitative food frequency questionnaire was used to assess dietary intake. Logistic regression were used to evaluate the relation between GI, GL, II, IL, CQI, and LCDS with BMD.

RESULTS

Diets with higher GI increased the risk of osteopenia and osteoporosis, but LCDS and CQI decreased the risk of osteopenia and osteoporosis.

CONCLUSION

These findings suggest that a higher intake of fruits and vegetables and receiving various dietary vitamins, minerals, and antioxidant compounds may be a useful way to prevent osteopenia in Iranian women.

Dietary insulin index and load in relation to cardiometabolic risk factors in patients with type 2 diabetes mellitus: A cross-sectional study on the RaNCD cohort study

OBJECTIVES

The aim of the present study was to evaluate the link between the dietary insulin index (DII) and dietary insulin load (DIL) and cardiometabolic risk factors in patients with type 2 diabetes mellitus (T2DM).

METHOD

In this cross-sectional population-based study, 827 participants with diabetes were included based on the RaNCD (Ravansar Non-Communicable Disease) cohort study baseline data. DII and DIL were calculated based on standard formulas using food insulin index values published earlier. Logistic regression analysis was used to determine the association of DII and DIL with cardiovascular risk factors.

RESULTS

A significantly direct association was shown between DII and metabolic syndrome (MetS; odds ratio [OR], 1.32; 95% confidence interval [CI], 1.05-2.50). The odds of developing abdominal obesity in patients with the highest DII were almost twice as high as those with the lowest DII (OR, 2.06; 95% CI, 1.02-4.99). Patients in the top quintile of DIL had twice the odds of being obese than those in the bottom quintile. Furthermore, positive associations were found between DIL and both MetS (OR, 1.98; 95% CI, 1.10-4.21) and waist circumference (OR, 2.90; 95% CI, 1.10-7.20).

CONCLUSION

Higher DII and DIL were positively related to greater risks for both MetS and abdominal obesity among patients with T2DM. Additionally, higher DIL was associated with a higher risk for obesity in the Ravansar population. However, further prospective investigations are needed to clarify the cause-and-effect link between DII, DIL, and cardiovascular risk factors in patients with T2DM.

Relation of dietary insulin index and dietary insulin load to metabolic syndrome depending on the lifestyle factors: Tehran lipid and glucose study

AIM

The hypothesis of the effect of the insulinogenic effects of diet on the development of cardiovascular diseases has been proposed, but the findings of previous studies are very contradictory. We investigated the association between dietary insulin index (DII) and dietary insulin load (DIL), and metabolic syndrome (MetS) risk. Another objective was to examine the extent to which lifestyle (physical activity, smoking status, and weight change) and sex influence the relationship between DII, DIL, and MetS risk.

MATERIALS AND METHODS

We followed 1915 participants in the Tehran Lipid and Glucose Study. DIL and DII were calculated based on a validated food frequency questionnaire. Weight change was measured, and participants were categorized into > 3% weight loss, weight stable (± 3%), and > 3% weight gain. By joint classification, the association between DII and DIL (< median and ≥ median) and risk of MetS was assessed according to weight change, sex, physical activity levels, and smoking status. Cox proportional hazards models were used to estimate the HRs (95% CI), adjusting for potential confounders.

RESULTS

During 8.9 years of follow-up, among 1915 participants, we documented 591 new cases of MetS. DII and DIL were not associated with MetS risk in the crude and adjusted models. However, DIL and DII were associated with weight gain (≥ 3%). In the crude model, DIL and DII were associated with a higher risk of weight gain [HR: 1.74: 95% CI 1.50-2.03, and 1.70 (1.46-1.98), respectively]. These associations remained significant after further adjustment for confounders. The HRs were 1.61 (1.35-1.92) for DIL and 1.64 (1.39-1.93) for DII. Among men, women, participants with low physical activity levels, and smokers, the risk of MetS, independent of DIL and DII, only increased in a participant with weight gain. In women with weight stability, DIL and DII, higher than the median, were positively associated with MetS risk.

CONCLUSION

Our findings suggest that the association between MetS risk and a hyperinsulinemic diet depended on weight change.

The relationship between low-carbohydrate diet score, dietary insulin index and load with obesity in healthy adults

PURPOSE

Carbohydrate intake and insulinemic potential of diet are suggested to be correlated with the development of different chronic diseases. Considering the limited research on obesity, this study aimed to investigate the association of dietary insulin index (DII), dietary insulin load (DIL), and low-carbohydrate diet score (LCDS) with body weight and obesity in healthy adults.

METHODS

In this cross-sectional study, DII, DIL, and LCDS were calculated using relevant formulas based on dietary intakes obtained by a valid 168-item food frequency questionnaire, in 393 otherwise healthy adults of either normal-weight, overweight, or obese.

RESULTS

Individuals in the highest tertile of DIL and DII had respectively 73% (OR: 0.27, 95% CI 0.08-0.94, p = 0.049) and 50% (OR: 0.5, 95% CI 0.26-0.96, p = 0.038) lower odds of being overweight compared to the lowest tertile, after adjusting the effects of age, sex, and dietary energy intake. Participants in the highest tertile of DIL had 92% greater odds of being obese compared to the lowest tertile, but this association did not remain significant after adjusting the effect of energy intake. Individuals in the highest tertile of LCDS had about 2 times odds of being overweight compared with those in the lowest tertile (OR: 2.04, 95% CI 1.04-4.01, p = 0.049). There was no relationship between being obese and tertiles of LCDS.

CONCLUSION

Higher dietary carbohydrate intake and insulinemic potential of diet could not be considered independent dietary risk factors for overweight or obesity.

LEVEL OF EVIDENCE

Level III: evidence obtained from an observational study.

Dietary insulin index and insulin load in relation to hypertriglyceridemic waist phenotype and low brain derived neurotrophic factor in adults

Background

The evidence about the relation of the insulinemic potential of food with visceral obesity and brain-derived neurotrophic factor (BDNF) was limited. We aimed to investigate the relation of dietary insulin index (DII) and dietary insulin load (DIL) with hypertriglyceridemic waist phenotype (HTGW) and serum BDNF in Iranian adults.

Methods

This cross-sectional study included 528 middle-aged adults (45.6% women), using a multistage cluster random-sampling method. Dietary intakes were assessed using a validated semi-quantitative 168-item food frequency questionnaire. Blood samples were collected after 12 h of fasting for assessing the serum BDNF and triglyceride concentrations. HTGW was defined as triacylglycerol ≥ 150 mg/dL plus enlarged waist circumference. The values less than the first decile of serum BDNF were considered as the low level.

Results

Individuals in the top tertile of DIL, in comparison to those in the bottom tertile, had higher odds of HTGW in both crude (OR = 1.96, 95% CI: 1.14–3.37) and fully adjusted model (OR = 6.10, 95% CI: 1.58–23.53). However, the relation between DII and odds of HTGW was statistically insignificant in crude (OR = 1.30, 95% CI: 0.78–2.16) and maximally adjusted model (OR = 1.25, 95% CI: 0.65–2.40). After considering confounders, participants in the top tertile of DIL had marginally higher odds of having low BDNF values (OR = 2.00, 95% CI: 0.95–4.21). Nevertheless, the association between DII and odds of low BDNF values was statistically insignificant.

Conclusion

This population-based study demonstrated that adults with higher DIL had significantly higher chance of HTGW phenotype and slightly higher chance for low BDNF level. DII was not associated with HTGW phenotype or BDNF values.

A Personalized Diet Approach Study: Interaction between PPAR-γ Pro12Ala and Dietary Insulin Indices on Metabolic Markers in Diabetic Patients

BACKGROUND

The objectives were to investigate the effect of the interaction between peroxisome proliferator-activated receptor gamma (PPAR-γ) Pro12Ala polymorphisms and dietary insulin load and insulin index (DIL and DII) on Cardio-metabolic Markers among diabetic patients.

METHODS

This cross-sectional study was conducted on 393 diabetic patients. Food-frequency questionnaire (FFQ) was used for DIL and DII calculation. PPAR-γ Pro12Ala was genotyped by the PCR-RFLP method. Biochemical markers including TC, LDL, HDL, TG, SOD, CRP, TAC, PTX3, PGF2α. IL18, leptin and ghrelin were measured by standard protocol.

RESULT

Risk-allele carriers (CG, GG) had higher obesity indices WC (P _interaction =0.04), BMI (P _interaction =0.006) and, WC (P _interaction =0.04) compared with individuals with the CC genotype when they consumed a diet with higher DIL and DII respectively. Besides, carriers of the G allele who were in the highest tertile of DIL, had lower HDL (P _interaction =0.04) and higher PGF2α (P _interaction =0.03) and PTX3 (P _interaction =0.03). Moreover, the highest tertile of the DII, showed an increase in IL18 (P _interaction =0.01) and lower SOD (P _interaction =0.03) for risk allele carriers compared to those with CC homozygotes.

CONCLUSION

We revealed PPAR-γ Pro12Ala polymorphism was able to intensify the effect of DIL and DII on CVD risk factors; risk-allele carriers who consumed a diet with high DIL and DII score have more likely to be obese and have higher inflammatory markers. Also, protective factor against CVD risk factors were reduced significantly in this group compared to CC homozygotes. This article is protected by copyright. All rights reserved.

Association of Dietary Glycemic Index, Glycemic Load, Insulin Index, and Insulin Load with Bacterial Vaginosis in Iranian Women: A Case-Control Study

Background

Inconsistent findings have been reported for associations between dietary indices and bacterial vaginosis (BV). The aim of this study was to examine the association of dietary glycemic index (DGI), glycemic load (DGL), insulin index (DII), and insulin load (DIL) with BV among Iranian women.

Methods

The current case-control study consisted of 144 new cases of BV and 151 controls. The diagnosis of BV was made based on the Amsel criterion in hospital clinics in Tehran, Iran, from November 2020 until June 2021. DGI, DGL, DII, and DIL were calculated from a validated semiquantitative food frequency questionnaire. The association between dietary carbohydrate indices and odds of BV were assessed adjusting for potential confounders through an estimation of two multivariate regression models.

Results

The multivariate adjusted odds ratio (OR) comparing the highest tertile of dietary DGI and DGL with the lower tertile was 2.99 (95% confidence interval (CI): 1.47–6.81; P_trend = 0.003) and 4.01 (95% CI: 1.22–5.91; P_trend = 0.029), respectively. In a fully adjusted model, the top tertile of dietary fiber compared to the bottom was associated with 88% (95% CI: 0.14-0.33) lower odds of BV (P_trend < 0.001). DII and DIL were not significantly associated with odds of BV in both crude and adjusted regression models.

Conclusion

The findings support the hypothesis of moderate, direct associations between DGI or DGL and BV. Also, a diet high in fiber decreases odds of BV.

Association of Dietary Insulin Index and Dietary Insulin Load With Metabolic Health Status in Iranian Overweight and Obese Adolescents

Background

Limited data are available on the association of dietary insulin load (DIL) and dietary insulin index (DII) with health status in pediatrics. We aimed to investigate the relationship of DIL and DII with metabolic health status in Iranian overweight/obese adolescents.

Methods

In this cross-sectional study, using a multistage cluster random-sampling method, 203 overweight/obese adolescents (aged 12 to <18 years) were included. A validated 147-item food frequency questionnaire (FFQ) was used for a dietary intake assessment. Glycemic and lipid profile, blood pressure (BP), and anthropometric indices were measured. Participants were categorized as metabolically healthy obese (MHO) or metabolically unhealthy obese (MUO) using the two methods of the International Diabetes Federation (IDF) and a combination of IDF with Homeostasis Model Assessment Insulin Resistance (HOMA-IR).

Results

According to IDF and IDF/HOMA-IR strategies, 38.9% (n = 79) and 33.0% (n = 67) of participants belonged to MUO category. After adjustments for potential confounders, subjects in the highest tertile of DIL in comparison with those in the lowest tertile had the odds ratio (OR) values of 8.44 (95% CI: 2.24-31.78) and 5.86 (95% CI: 1.39-24.58) for MUO based on IDF and IDF/HOMA-IR definitions, respectively. Moreover, after considering potential confounders, adolescents in the highest tertile of DII, compared to the lowest tertile, were, respectively, 6.93 (OR: 6.93; 95% CI: 2.59-18.57) and 5.26 (OR: 5.26; 95% CI: 1.85-14.97) times more likely to be MUO, based on IDF and IDF/HOMA-IR definitions. A significant decreasing trend was observed for OR of MUO in tertiles of DIL and DII. The stratified analysis revealed that these associations were stronger in obese participants; in overweight subjects, the association was not independent of confounders.

Conclusion

This population-based study revealed that higher DIL and DII were strongly related to increased OR of MUO in Iranian adolescents, especially in obese participants. Further investigations, especially with a prospective design, are needed to affirm these findings.

Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Dietary insulin index and load with risk of breast cancer in a case-control study

OBJECTIVE

Circulating insulin levels have been positively associated with risk of breast cancer (BrCa); however, it remains unclear whether a diet inducing an elevated insulin response influences Breast risk.

METHODS

In this study, 250 newly diagnosed breast cancer patients and 250 hospitalised controls were recruited using convenience sampling. The dietary insulin index (DII) was calculated by dividing the dietary insulin load by the total energy intake.

RESULTS

Compared with those in the lowest tertiles of DII and dietary insulin load (DIL), subjects in the highest tertile were more likely to be overweight, have a family history of breast and other types of cancer and a history of benign breast diseases. After controlling for multiple potential confounders, a significantly increased BrCa odds was observed in the highest tertiles of DII and DIL score compared with the lowest tertiles (odds ratio (OR): 1.46; 95% CI: 0.67-3.19, P = .006) and (OR: 1.87; 95% CI: 0.92-3.80, P = .038), respectively.

CONCLUSIONS

Our findings suggest that a diet that induces an elevated postprandial insulin response, indicated by higher DII and DIL scores, may increase the odds of BrCa, especially among women.

Higher dietary insulin load and index are not associated with the risk of metabolic syndrome and obesity in Iranian adults

BACKGROUND

Data about the relation between dietary insulin load (DIL) and dietary insulin index (DII) with metabolic syndrome (MetS) and obesity are scarce. Therefore, the present study aimed to examine the association of the insulinemic potential of the diet with MetS and obesity amongst Iranian adults.

METHODS

This cross-sectional study was conducted amongst 850 adults aged 20-59 years. Dietary data were collected using a 168-item food frequency questionnaire. DIL was calculated using a standard formula and DII was obtained by dividing DIL by the total energy intake of each participant. The guidelines of the International Diabetes Federation were used to define MetS. General obesity was considered as body mass index ≥ 30 kg/m² , and abdominal obesity as waist circumference ≥ 94 cm for men and ≥ 80 cm for women.

RESULTS

Mean DIL and DII values were 101 684 ± 54 802 and 49.4 ± 33.4, respectively. The mean age of participants was 44.9 ± 10.7 years and 36.8%, 28.5% and 48.8% of participants were suffering from MetS, general and abdominal obesity, respectively. In contrast with DIL (P = .73), participants in the last quartile of DII (P = .62) had lower odds of MetS than the first quartile. There were non-significant inverse associations between DIL (P = .91, P = .85) and DII (P = .59, P = .53) with odds of general and abdominal obesity before and after the adjustment of confounders, respectively.

CONCLUSIONS

We did not observe any significant association of DIL and DII with the risk of MetS and obesity amongst the Iranian population. Further prospective studies are needed to confirm the findings of this study.

Association of dietary insulinaemic potential and odds of non-alcoholic fatty liver disease among adults: A case-control study

BACKGROUND

Hyperinsulinaemia is considered as a major risk factor for the development of a myriad of chronic diseases. We examined the association between the dietary insulinaemic potential and the odds of non-alcoholic fatty liver disease (NAFLD) among Iranian adults.

METHODS

After being subjected to a liver ultrasound, 166 patients with NAFLD and 200 controls were included in the study. The dietary intakes and the physical activity levels of the participants were evaluated using a validated semi-quantitative food frequency questionnaire and the International Physical Activity Questionnaire (short IPAQ), respectively. The insulinaemic potential of the diet was assessed by computing the scores of the Empirical Dietary Index for Hyperinsulinemia (EDIH) and the Empirical Dietary Index for Insulin Resistance (EDIR).

RESULTS

Compared with the control subjects, patients with NAFLD were significantly older; had higher values for body mass index, fasting blood sugar, triglycerides, low-density lipoprotein cholesterol, total cholesterol and alanine transaminase; and were more likely to smoke. Moreover, NAFLD patients had significant lower levels of high-density lipoprotein cholesterol and were less likely to perform physical activity. The risk of NAFLD was higher in the individuals in the highest tertile of the EDIH (odds ratio [OR] = 2.79; 95% confidence interval [CI] = 1.32-5.90; p value for trend < 0.05) and EDIR (OR = 2.42; 95% CI = 1.22-4.79; p value for trend < 0.05) compared to those in the lowest tertile of these scores.

CONCLUSIONS

Our study indicates that a higher dietary insulinaemic potential is associated with an increased risk of NAFLD.