Low-Versus High-Glycemic Index Diets in Women: Effects on Caloric Requirement, Substrate Utilization and Insulin Sensitivity

A Lowly Digestible-Starch Diet after Weaning Enhances Exogenous Glucose Oxidation Rate in Female, but Not in Male, Mice

Starches of low digestibility are associated with improved glucose metabolism. We hypothesise that a lowly digestible-starch diet (LDD) versus a highly digestible-starch diet (HDD) improves the capacity to oxidise starch, and that this is sex-dependent. Mice were fed a LDD or a HDD for 3 weeks directly after weaning. Body weight (BW), body composition (BC), and digestible energy intake (dEI) were determined weekly. At the end of the intervention period, whole-body energy expenditure (EE), respiratory exchange ratio (RER), hydrogen production, and the oxidation of an oral ¹³C-labelled starch bolus were measured by extended indirect calorimetry. Pancreatic amylase activity and total ¹³C hepatic enrichment were determined in females immediately before and 4 h after administration of the starch bolus. For both sexes, BW, BC, and basal EE and RER were not affected by the type of starch, but dEI and hydrogen production were increased by the LDD. Only in females, total carbohydrate oxidation and starch-derived glucose oxidation in response to the starch bolus were higher in LDD versus HDD mice; this was not accompanied by differences in amylase activity or hepatic partitioning of the ¹³C label. These results show that starch digestibility impacts glucose metabolism differently in females versus males.

The effect of dietary glycemic index and glycemic load on inflammatory biomarkers: a systematic review and meta-analysis of randomized clinical trials

Background

To our knowledge, there is no study available that summarizes earlier findings on the effect of dietary glycemic index (GI) and glycemic load (GL) on inflammatory biomarkers.

Objective

This systematic review and meta-analysis was conducted to systematically review the available clinical trials that examined the effects of low-GI (LGI) and low-GL (LGL) diets on several inflammatory biomarkers in adults.

Design

We searched for relevant articles published up to June 2017 through PubMed, Medline, SCOPUS, EMBASE, and Google Scholar with the use of relevant keywords. Clinical trials that examined the effect of dietary GI and GL on inflammation in adults were included.

Results

Overall, 28 randomized controlled trials (RCTs) including 2961 participants (59% women, 41% men) were included in this meta-analysis. By combining findings from 14 studies on high-sensitivity C-reactive protein (hs-CRP) concentrations, we found no significant effect of LGI or LGL diets on serum hs-CRP concentrations compared with the control diet [weighted mean difference (WMD) for dietary GI: -0.05 mg/L (95% CI: -0.21, 0.10 mg/L); and WMD for dietary GL: 0.08 mg/L (95% CI: -0.26, 0.42 mg/L), respectively]. After combining effect sizes from 5 studies, we did not find significant changes in serum tumor necrosis factor α (TNF-α) concentrations comparing control diets with LGI (WMD: -0.18 mg/L; 95% CI: -0.43, 0.06 mg/L) or LGL (WMD: -0.20 mg/L; 95% CI: -0.33, 0.07 mg/L) diets. Significant changes were also not seen in leptin and interleukin 6 (IL-6) concentrations after the consumption of LGI or LGL diets.

Conclusions

We did not find any significant effect of dietary GI or GL on serum concentrations of inflammatory cytokines, including hs-CRP, leptin, IL-6, and TNF-α in adults. Additional RCTs-in particular, feeding trials-are required to shed light on this issue.

Effects of Low Versus Moderate Glycemic Index Diets on Aerobic Capacity in Endurance Runners: Three-Week Randomized Controlled Crossover Trial

The glycemic index (GI) of ingested carbohydrates may influence substrate oxidation during exercise and athletic performance. Therefore, the aim of this study was to assess the effect of low- and moderate-GI three-week diets on aerobic capacity and endurance performance in runners. We conducted a randomized crossover feeding study of matched diets differing only in GI (low vs. moderate) in 21 endurance-trained runners. Each participant consumed both, low- (LGI) and moderate-GI (MGI) high-carbohydrate (~60%) and nutrient-balanced diets for three weeks each. At the beginning and end of each diet, participants had their aerobic capacity and body composition measured and performed a 12-min running test. After LGI, time to exhaustion during incremental cycling test (ICT) and distance covered in the 12-min run were significantly increased. The MGI diet led to an increase in maximal oxygen uptake (V˙O₂max), but no performance benefits were found after the MGI diet. The LGI and MGI diets improved time and workload at gas exchange threshold (GET) during ICT. The results indicate that a three-week high-carbohydrate LGI diet resulted in a small but significant improvement in athletic performance in endurance runners. Observed increase in V˙O₂max on MGI diet did not affect performance.

Exercise training-induced improvement in skeletal muscle PGC-1α-mediated fat metabolism is independent of dietary glycemic index

OBJECTIVE

This study hypothesized that a low-glycemic diet combined with exercise would increase expression of nuclear regulators of fat transport and oxidation in insulin-resistant skeletal muscle.

METHOD

Nineteen subjects (64 ± 1 y; 34 ± 1 kg/m² ) were randomized to receive isocaloric high-glycemic-index (HiGIX; 80 ± 0.6 units, n = 10) or low-glycemic-index (LoGIX; 40 ± 0.3 units, n = 9) diets combined with supervised exercise (1 h/d, 5 d/wk at ∼85% HR_max ) for 12 weeks. Insulin sensitivity was determined by hyperinsulinemic-euglycemic clamp. Skeletal muscle biopsies were obtained before and after the intervention to assess fasting gene and protein expression.

RESULTS

Weight loss was similar for both groups (9.5 ± 1.3 kg). Likewise, improvements in insulin sensitivity (P < 0.002) and PPARγ (P < 0.002), PGC-1α (P = 0.003), CD36 (P = 0.003), FABP3 (mRNA, P = 0.01 and protein, P = 0.02), and CPT1B (mRNA, P = 0.03 and protein, P = 0.008) expression were similar for both interventions. Increased insulin sensitivity correlated with increased PGC-1α expression (P = 0.04), and increased fasting fat oxidation correlated with increased FABP3 (P = 0.04) and CPT1B (P = 0.05) expression.

CONCLUSIONS

An exercise/diet program resulting in 8% to 10% weight loss improved insulin sensitivity and key molecular mechanisms in skeletal muscle that are controlled by PGC-1α. These effects were independent of the glycemic index of the diets.

Effect of glycemic index on obesity control

OBJECTIVE

Evaluate the effect of glycemic index (GI) on biochemical parameters, food intake, energy metabolism, anthropometric measures and body composition in overweight subjects.

MATERIALS AND METHODS

Simple blind study, in which nineteen subjects were randomly assigned to consume in the laboratory two daily low GI (n = 10) or high GI (n = 9) meals, for forty-five consecutive days. Habitual food intake was assessed at baseline. Food intake, anthropometric measures and body composition were assessed at each 15 days. Energy metabolism and biochemical parameters were evaluated at baseline and the end of the study.

RESULTS

Low GI meals increased fat oxidation, and reduced waist circumference and HOMA-IR, while high GI meals increased daily dietary fiber and energy intake compared to baseline. There was a higher reduction on waist circumference and body fat, and a higher increase on postprandial fat oxidation in response to the LGI meals than after high GI meals. High GI meals increased fasting respiratory coefficient compared to baseline and low GI meals.

CONCLUSION

The results of the present study showed that the consumption of two daily low GI meals for forty-five consecutive days has a positive effect on obesity control, whereas, the consumption of high GI meals result has the opposite effect.

Effect of low-glycemic-sugar-sweetened beverages on glucose metabolism and macronutrient oxidation in healthy men

BACKGROUND/OBJECTIVES

Sugar-sweetened-beverages (SSB) provide high amounts of rapidly absorbable sugar and have been shown to impair insulin sensitivity and promote weight gain. We hypothesized that when compared with high-glycemic index (GI) SSB low-GI SSB lead to lower insulin secretion and thus an improved preservation of insulin sensitivity and fat oxidation during an inactive phase.

SUBJECTS/METHODS

In a controlled cross-over dietary intervention 13 healthy men (age: 23.7±2.2 years, body mass index: 23.6±1.9 kg m(-)(2)) consumed low-GI (isomaltulose) or high-GI (75% maltodextrin+25% sucrose, adapted for sweetness) SSBs providing 20% of energy requirement for 7 days. During this phase, participant's habitual high physical activity (11 375±3124 steps per day) was reduced (2363±900 steps per day). The provided ad libitum diet comprised 55% CHO, 30% fat and 15% protein. Glycemic and insulinemic responses were assessed: Day-long (7-day continuous interstitial glucose monitoring, 24-h-urinary c-peptide excretion), during meal test (37 g isomaltulose vs 28 g maltodextrin+9g sucrose) and measures of insulin sensitivity (basal: homeostasis model assessment of insulin resistance (HOMA-IR), postprandial: Matsuda-ISI). Macronutrient oxidation was assessed by non-protein respiratory quotient (npRQ) in the fasted state (npRQfasting) and postprandial as the area under the npRQ-curve during meal test (npRQtAUC-meal).

RESULTS

Day-long glycemia was lower with low-GI compared with high-GI SSB (-5%, P<0.05). Low-GI SSB led to lower insulin secretion during meal test (-28%, P<0.01) and throughout the day (-31%, P<0.01), whereas postprandial glucose levels did not differ between low-GI and high-GI SSBs. Insulin sensitivity deteriorated on inactivity with both SSBs, but was better preserved with low-GI isomaltulose compared with high-GI maltodextrin-sucrose (ΔHOMA-IR: +0.37±0.52 vs +0.85±0.86; ΔMatsuda-ISI: -5.1±5.5 vs -9.6±5.1, both P<0.05). Both, fasting and postprandial fat oxidation declined on inactivity, with no difference between high-GI and low-GI SSBs.

CONCLUSIONS

Compared with high-GI SSB, 7-day consumption of beverages sweetened with low-GI isomaltulose had beneficial effects on inactivity-induced impairment of glucose metabolism without effecting fuel selection.

Carbohydrate intake and glycemic index affect substrate oxidation during a controlled weight cycle in healthy men

BACKGROUND/OBJECTIVES

Because both, glycemic index (GI) and carbohydrate content of the diet increase insulin levels and could thus impair fat oxidation, we hypothesized that refeeding a low GI, moderate-carbohydrate diet facilitates weight maintenance.

SUBJECTS/METHODS

Healthy men (n=32, age 26.0±3.9 years; BMI 23.4±2.0 kg/m(2)) followed 1 week of controlled overfeeding, 3 weeks of caloric restriction and 2 weeks of hypercaloric refeeding (+50, -50 and +50% energy requirement) with low vs high GI (41 vs 74) and moderate vs high CHO intake (50% vs 65% energy). We measured adaptation of fasting macronutrient oxidation and the capacity to supress fat oxidation during an oral glucose tolerance test. Changes in fat mass were measured by quantitative magnetic resonance.

RESULTS

During overfeeding, participants gained 1.9±1.2 kg body weight, followed by a weight loss of -6.3±0.6 kg and weight regain of 2.8±1.0 kg. Subjects with 65% CHO gained more body weight compared with 50% CHO diet (P<0.05) particularly with HGI meals (P<0.01). Refeeding a high-GI diet led to an impaired basal fat oxidation when compared with a low-GI diet (P<0.02), especially at 65% CHO intake. Postprandial metabolic flexibility was unaffected by refeeding at 50% CHO but clearly impaired by 65% CHO diet (P<0.05). Impairment in fasting fat oxidation was associated with regain in fat mass (r=0.43, P<0.05) and body weight (r=0.35; P=0.051).

CONCLUSIONS

Both higher GI and higher carbohydrate content affect substrate oxidation and thus the regain in body weight in healthy men. These results argue in favor of a lower glycemic load diet for weight maintenance after weight loss.

A low-glycemic diet lifestyle intervention improves fat utilization during exercise in older obese humans

OBJECTIVE

To determine the influence of dietary glycemic index on exercise training-induced adaptations in substrate oxidation in obesity.

DESIGN AND METHODS

Twenty older, obese individuals undertook 3 months of fully supervised aerobic exercise and were randomized to low- (LoGIX) or high-glycemic (HiGIX) diets. Changes in indirect calorimetry (VO2 ; VCO2 ) were assessed at rest, during a hyperinsulinemic-euglycemic clamp, and during submaximal exercise (walking: 65% VO2 max, 200 kcal energy expenditure). Intramyocellular lipid (IMCL) was measured by (1) H-magnetic resonance spectroscopy.

RESULTS

Weight loss (-8.6 ± 1.1%) and improvements (P < 0.05) in VO2 max, glycemic control, fasting lipemia, and metabolic flexibility were similar for both LoGIX and HiGIX groups. During submaximal exercise, energy expenditure was higher following the intervention (P < 0.01) in both groups. Respiratory exchange ratio during exercise was unchanged in the LoGIX group but increased in the HiGIX group (P < 0.05). However, fat oxidation during exercise expressed in relation to changes in body weight was increased in the LoGIX group (+10.6 ± 3.6%; P < 0.05). Fasting IMCL was unchanged, however, extramyocellular lipid was reduced (P < 0.05) after LoGIX.

CONCLUSIONS

A LoGIX/exercise weight-loss intervention increased fat utilization during exercise independent of changes in energy expenditure. This highlights the potential therapeutic value of low-glycemic foods for reversing metabolic defects in obesity.

Is glycaemic index (GI) a valid measure of carbohydrate quality?

Recent criticisms of the glycaemic index (GI) focus on its validity with assertions that GI methodology is not valid, GI values are inaccurate and imprecise, GI does not predict what foods are healthy and that whole grain and fibre are better markers of carbohydrate quality than GI. None of the critics provide sound reasons for rejecting GI because some of their arguments are based on flagrant errors in understanding and interpretation while others are not supported by current data or are inconsistent with other nutritional recommendations. This paper addresses current criticisms of GI and outlines reasons why GI is valid: (1) GI methodology is accurate and precise enough for practical use; (2) GI is a property of foods; and (3) GI is biologically meaningful and relevant to virtually everyone. Current dietary guidelines recommend increased consumption of whole grains and dietary fibre but do not mention GI. However, this is illogical because the evidence that GI affects health outcomes is at least as good or better than that for whole grains and fibre. GI is a novel concept from a regulatory point of view and a number of problems need to be addressed to successfully translate GI knowledge into practice. The problems are not insurmountable but no progress can be made until bias and misunderstanding about GI can be overcome and there is better agreement about what is the actual state of knowledge on GI so that the real issues can be identified and addressed.

Coconut-derived D-xylose affects postprandial glucose and insulin responses in healthy individuals

Metabolic alterations including postprandial hyperglycemia have been implicated in the development of obesity-related diseases. Xylose is a sucrase inhibitor suggested to suppress the postprandial glucose surge. The objectives of this study were to assess the inhibitory effects of two different concentrations of xylose on postprandial glucose and insulin responses and to evaluate its efficacy in the presence of other macronutrients. Randomized double-blind cross-over studies were conducted to examine the effect of D-xylose on postprandial glucose and insulin response following the oral glucose tolerance test (OGTT). In study 1, the overnight-fasted study subjects (n = 49) consumed a test sucrose solution (50 g sucrose in 130 ml water) containing 0, 5, or 7.5 g D-xylose powder. In study 2, the overnight-fasted study subjects (n = 50) consumed a test meal (50 g sucrose in a 60 g muffin and 200 ml sucrose-containing solution). The control meal provided 64.5 g of carbohydrates, 4.5 g of fat, and 10 g of protein. The xylose meal was identical to the control meal except 5 g of xylose was added to the muffin mix. In study 1, the 5 g xylose-containing solutions exhibited significantly lower area under the glucose curve (AUCg) and area under the insulin curve (AUCi) values for 0-15 min (P < 0.0001, P < 0.0001), 0-30 min (P < 0.0001, P < 0.0001), 0-45 min (P < 0.0001, P < 0.0001), 0-60 min (P < 0.0001, P < 0.0001), 0-90 min (P < 0.0001, P < 0.0001) and 0-120 min (P = 0.0071, P = 0.0016). In study 2, the test meal exhibited significantly lower AUCg and AUCi values for 0-15 min (P < 0.0001, P < 0.0001), 0-30 min (P < 0.0001, P < 0.0001), 0-45 min (P < 0.0001, P = 0.0005), 0-60 min (P = 0.0002, P = 0.0025), and 0-90 min (P = 0.0396, P = 0.0246). In conclusion, xylose showed an acute suppressive effect on the postprandial glucose and insulin surges.

Dietary macronutrient composition affects β cell responsiveness but not insulin sensitivity

BACKGROUND

Altering dietary carbohydrate or fat content may have chronic effects on insulin secretion and sensitivity, which may vary with individual metabolic phenotype.

OBJECTIVE

The objective was to evaluate the contribution of tightly controlled diets differing in carbohydrate and fat content for 8 wk to insulin sensitivity and β cell responsiveness and whether effects of diet would vary with race, free-living diet, or insulin response.

DESIGN

Healthy overweight men and women (36 European Americans, 33 African Americans) were provided with food for 8 wk and received either a eucaloric standard diet (55% carbohydrate, 27% fat) or a eucaloric reduced-carbohydrate (RedCHO)/higher-fat diet (43% carbohydrate, 39% fat). Insulin sensitivity and β cell responsiveness were assessed at baseline and 8 wk by using a liquid meal tolerance test.

RESULTS

Insulin sensitivity did not change with diet (P = 0.1601). Static β cell response to glucose (ФS) was 28.5% lower after the RedCHO/higher-fat diet. Subgroup analyses indicated that lower ФS with the RedCHO/higher-fat diet occurred primarily among African Americans. A significant inverse association was observed for change in glucose area under the curve compared with change in ФS.

CONCLUSIONS

Consumption of a eucaloric 43% carbohydrate/39% fat diet for 8 wk resulted in down-regulation of β cell responsiveness, which was influenced by baseline phenotypic characteristics. Further study is needed to probe the potential cause-and-effect relation between change in ФS and change in glucose tolerance. This trial is registered at clinicaltrials.gov as NCT00726908.

Effect of a low glycaemic index diet on blood glucose in women with gestational hyperglycaemia

AIM

The objectives of this pilot study were to determine the feasibility and effect on glycaemic control of a low-glycaemic-index (GI) diet in women with gestational diabetes or impaired glucose tolerance of pregnancy.

METHODS

participants, recruited from the Diabetes-in-Pregnancy Clinic of an inner-city teaching hospital serving a predominantly non-Caucasian population, were randomized to a low-GI (n=23) or control (n=24) diet and followed from 28 weeks gestation until delivery. Self-monitored-blood-glucose (SMBG), maternal and infant weight were collected from medical charts. Dietary intakes were assessed using diet records and questionnaires.

RESULTS

diet GI on control (58, 95% CI: 56,60) was significantly higher than on low-GI (49, 95% CI: 47,51; p=0.001). Glycaemic control improved on both diets, but more postprandial glucose values were within target on low-GI (58.4% of n=1891) than control (48.7% of n=1834; p<0.001). SMBG post-breakfast was directly related to pre-pregnancy BMI in the control, but not the low-GI group (BMI*diet interaction; p=0.021). Participants accepted the study foods and were willing to consume them post-intervention.

CONCLUSIONS

a low-GI diet was feasible and acceptable in this sample and facilitated control of postprandial glucose. A larger study is needed to determine the effect of a low-GI diet on maternal and infant outcomes.

Effects of a low-glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial

BACKGROUND

The optimal diet for pregnancy that is complicated by excessive weight is unknown.

OBJECTIVE

We aimed to examine the effects of a low-glycemic load (low-GL) diet in overweight and obese pregnant women.

DESIGN

We randomly assigned 46 overweight or obese pregnant women to receive a low-GL or a low-fat diet. Participants received carbohydrate-rich foods, fats, and snack foods through home delivery or study visits. The primary outcome was birth weight z score. Other endpoints included infant anthropometric measurements, gestational duration, maternal weight gain, and maternal metabolic parameters.

RESULTS

There were no significant differences in birth weight z score or other measures of infant adiposity between groups. However, in the low-GL compared with the low-fat group, gestational duration was longer (mean ± SD: 39.3 ± 1.1 compared with 37.9 ± 3.1 wk; P = 0.05) and fewer deliveries occurred at ≤ 38.0 wk (13% compared with 48%, P = 0.02; with exclusion of planned cesarean deliveries: 5% compared with 53%; P = 0.002). Adjusted head circumference was greater in the low-GL group (35.0 ± 0.8 compared with 34.2 ± 1.3 cm, P = 0.01). Women in the low-GL group had smaller increases in triglycerides [median (interquartile range): 49 (19, 70) compared with 93 (34, 129) mg/dL; P = 0.03] and total cholesterol [13 (0, 36) compared with 33 (22, 56) mg/dL, P = 0.04] and a greater decrease in C-reactive protein [-2.5 (-5.5, -0.7) compared with -0.4 (-1.4, 1.5) mg/dL, P = 0.007].

CONCLUSIONS

A low-GL diet resulted in longer pregnancy duration, greater infant head circumference, and improved maternal cardiovascular risk factors. Large-scale studies are warranted to evaluate whether dietary intervention during pregnancy aimed at lowering GL may be useful in the prevention of prematurity and other adverse maternal and infant outcomes. This trial is registered at clinicaltrials.gov as NCT00364403.

Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome

BACKGROUND

Women with polycystic ovarian syndrome (PCOS) are intrinsically insulin resistant and have a high risk of cardiovascular disease and type 2 diabetes. Weight loss improves risk factors, but the optimal diet composition is unknown. Low-glycemic index (low-GI) diets are recommended without evidence of their clinical effectiveness.

OBJECTIVE

We compared changes in insulin sensitivity and clinical outcomes after similar weight losses after consumption of a low-GI diet compared with a conventional healthy diet in women with PCOS.

DESIGN

We assigned overweight and obese premenopausal women with PCOS (n = 96) to consume either an ad libitum low-GI diet or a macronutrient-matched healthy diet and followed the women for 12 mo or until they achieved a 7% weight loss. We compared changes in whole-body insulin sensitivity, which we assessed using the insulin sensitivity index derived from the oral-glucose-tolerance test (ISI(OGTT)); glucose tolerance; body composition; plasma lipids; reproductive hormones; health-related quality of life; and menstrual cycle regularity.

RESULTS

The attrition rate was high in both groups (49%). Among completers, ISI(OGTT) improved more with the low-GI diet than with the conventional healthy diet (mean +/- SEM: 2.2 +/- 0.7 compared with 0.7 +/- 0.6, respectively; P = 0.03). There was a significant diet-metformin interaction (P = 0.048), with greater improvement in ISI(OGTT) among women prescribed both metformin and the low-GI diet. Compared with women who consumed the conventional healthy diet, more women who consumed the low-GI diet showed improved menstrual cyclicity (95% compared with 63%, respectively; P = 0.03). Among the biochemical measures, only serum fibrinogen concentrations showed significant differences between diets (P < 0.05).

CONCLUSION

To the best of our knowledge, this study provides the first objective evidence to justify the use of low-GI diets in the management of PCOS.

Fructose consumption: considerations for future research on its effects on adipose distribution, lipid metabolism, and insulin sensitivity in humans

Results from a recent study investigating the metabolic effects of consuming fructose-sweetened beverages at 25% of energy requirements for 10 wk demonstrate that a high-fructose diet induces dyslipidemia, decreases insulin sensitivity, and increases visceral adiposity. The purpose of this review is to present aspects of the study design which may be critical for assessment of the metabolic effects of sugar consumption. Collection of postprandial blood samples is required to document the full effects of fructose on lipid metabolism. Fasting triglyceride (TG) concentrations are an unreliable index of fructose-induced dyslipidemia. Differences in the short-term (24-h) and long-term (>2 wk) effects of fructose consumption on TG and apolipoprotein-B demonstrate that acute effects can differ substantially from those occurring after sustained fructose exposure. Investigating the effects of fructose when consumed ad libitum compared with energy-balanced diets suggest that additive effects of fructose-induced de novo lipogenesis and positive energy balance may contribute to dyslipidemia and decreased insulin sensitivity. Increases of intra-abdominal fat observed in subjects consuming fructose, but not glucose, for 10 wk indicate that the 2 sugars have differential effects on regional adipose deposition. However, the increase of fasting glucose, insulin, and homeostasis model assessment-insulin resistance at 2 wk and the lack of increase of 24-h systemic FFA concentrations suggest that fructose decreases insulin sensitivity independently of visceral adiposity and FFA. The lower postprandial glucose and insulin excursions in subjects consuming fructose and increased excursions in those consuming glucose do not support a relationship between dietary glycemic index and the development of dyslipidemia, decreased insulin sensitivity, or increased visceral adiposity.