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Anjom-Shoae J, Feinle-Bisset C, Horowitz M. Impacts of dietary animal and plant protein on weight and glycemic control in health, obesity and type 2 diabetes: friend or foe? Front Endocrinol (Lausanne) 2024; 15:1412182. [PMID: 39145315 PMCID: PMC11321983 DOI: 10.3389/fendo.2024.1412182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024] Open
Abstract
It is well established that high-protein diets (i.e. ~25-30% of energy intake from protein) provide benefits for achieving weight loss, and subsequent weight maintenance, in individuals with obesity, and improve glycemic control in type 2 diabetes (T2D). These effects may be attributable to the superior satiating property of protein, at least in part, through stimulation of both gastrointestinal (GI) mechanisms by protein, involving GI hormone release and slowing of gastric emptying, as well as post-absorptive mechanisms facilitated by circulating amino acids. In contrast, there is evidence that the beneficial effects of greater protein intake on body weight and glycemia may only be sustained for 6-12 months. While both suboptimal dietary compliance and metabolic adaptation, as well as substantial limitations in the design of longer-term studies are all likely to contribute to this contradiction, the source of dietary protein (i.e. animal vs. plant) has received inappropriately little attention. This issue has been highlighted by outcomes of recent epidemiological studies indicating that long-term consumption of animal-based protein may have adverse effects in relation to the development of obesity and T2D, while plant-based protein showed either protective or neutral effects. This review examines information relating to the effects of dietary protein on appetite, energy intake and postprandial glycemia, and the relevant GI functions, as reported in acute, intermediate- and long-term studies in humans. We also evaluate knowledge relating to the relevance of the dietary protein source, specifically animal or plant, to the prevention, and management, of obesity and T2D.
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Affiliation(s)
- Javad Anjom-Shoae
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, SA, Australia
| | - Christine Feinle-Bisset
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, SA, Australia
| | - Michael Horowitz
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, SA, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
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Chinese Guidelines for Medical Nutrition Therapy for Patients with Diabetes (2022 Edition). Asia Pac J Clin Nutr 2024; 33:118-152. [PMID: 38794974 PMCID: PMC11170023 DOI: 10.6133/apjcn.202406_33(2).0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/05/2024] [Indexed: 05/27/2024]
Abstract
Medical nutrition therapy (MNT) is the foundation of the comprehensive treatment of patients with diabetes. In 2010, the Chinese Clinical Nutritionist Center of the Chinese Medical Doctor Association developed the first Chinese guideline on MNT for patients with diabetes, and it was updated in 2015. Since then, new evidence has emerged in the field of MNT and metabolic therapy in patients with diabetes. The Nutrition and Metabolic Management Branch of the China International Exchange and Promotive Association for Medical and Health Care organized a team of experts from related institutions, including the Clinical Nutrition Branch of the Chinese Nutrition Society, Chinese Diabetes Society, Chinese Society for Parenteral and Enteral Nutri-tion, and Chinese Clinical Nutritionist Center of the Chinese Medical Doctor Association. Their task was to develop the Chinese Guidelines of Medical Nutrition Therapy in Diabetes (2022 Edition) in accordance with the requirements of the Guidelines for the Formulation/Revision of Clinical Guidelines in China (2022 Edition) by combining the questions raised and evidence gathered in clinical practices in China, to guide and standardize the clinical MNT.
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Lee I, Mitsumoto H, Lee S, Kasarskis E, Rosenbaum M, Factor-Litvak P, Nieves JW. Higher Glycemic Index and Glycemic Load Diet Is Associated with Slower Disease Progression in Amyotrophic Lateral Sclerosis. Ann Neurol 2024; 95:217-229. [PMID: 37975189 PMCID: PMC10842093 DOI: 10.1002/ana.26825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/23/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE High-caloric diets may slow the progression of amyotrophic lateral sclerosis; however, key macronutrients have not been identified. We examined whether dietary macronutrients are associated with the rate of progression and length of survival among the prospective cohort study participants. METHODS Participants with a confirmed diagnosis of sporadic amyotrophic lateral sclerosis enrolled in the Multicenter Cohort Study of Oxidative Stress were included (n = 304). We evaluated baseline macronutrient intake assessed by food frequency questionnaire in relation to change in revised amyotrophic lateral sclerosis functional rating scale total-score, and tracheostomy-free survival using linear regression and Cox proportional hazard models. Baseline age, sex, disease duration, diagnostic certainty, body mass index, bulbar onset, revised amyotrophic lateral sclerosis functional rating scale total-score, and forced vital capacity were included as covariates. RESULTS Baseline higher glycemic index and load were associated with less decline of revised amyotrophic lateral sclerosis functional rating scale total score at 3-month follow-up (β = -0.13, 95% CI -0.2, -0.01, p = 0.03) and (β = -0.01, 95% CI -0.03, -0.0007, p = 0.04), respectively. Glycemic index second-quartile, third-quartile, and fourth-quartile groups were associated with less decline at 3 months by 1.9 (95% CI -3.3, -0.5, p = 0.008), 2.0 (95% CI -3.3, -0.6, p = 0.006), and 1.6 (95% CI -3.0, -0.2, p = 0.03) points compared with the first-quartile group; the glycemic load fourth-quartile group had 1.4 points less decline compared with the first-quartile group (95% CI -2.8, 0.1, p = 0.07). Higher glycemic index was associated with a trend toward longer tracheostomy-free survival (HR 0.97, 95% CI 0.93, 1.00, p = 0.07). INTERPRETATION Higher dietary glycemic index and load are associated with slower disease progression in amyotrophic lateral sclerosis. ANN NEUROL 2024;95:217-229.
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Affiliation(s)
- Ikjae Lee
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Hiroshi Mitsumoto
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Seonjoo Lee
- Department of Biostatistics and Psychiatry, Columbia University, New York, NY, USA
- Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA
| | - Edward Kasarskis
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Michael Rosenbaum
- Department of Pediatrics and Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Pam Factor-Litvak
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jeri W Nieves
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Dingena CF, Mahendra A, Holmes MJ, Clement NS, Scott EM, Zulyniak MA. Protocol for the INFORMED (Individualised Patient Care and Treatment for Maternal Diabetes) Study: a randomised controlled trial embedded within routine care. BMJ Open 2023; 13:e065388. [PMID: 36849210 PMCID: PMC9972421 DOI: 10.1136/bmjopen-2022-065388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION Diabetes in pregnancy presents a unique physiological challenge to manage glycaemia while maintaining adequate nourishment for the growing fetus. Women with diabetes who become pregnant are at greater risk of adverse maternal and newborn outcomes, compared with women without diabetes. Evidence suggests that control of (postprandial) glycaemia is key to manage maternal and offspring health but it is not yet clear (1) how diet and lifestyle moderate these shifts across the full duration of pregnancy or (2) what aspects of maternal and offspring health are associated with dysglycaemia. METHODS AND ANALYSIS To investigate these gaps, a cross-over randomised clinical trial has been embedded within routine clinical care. Seventy-six pregnant women in their first trimester with type 1 or type 2 diabetes (with or without medication) attending their routine antenatal appointments at National Health Service (NHS) Leeds Teaching Hospitals will be recruited. Following informed consent, data on women's health, glycaemia, pregnancy and delivery will be shared by the NHS with researchers. At each visit in the first (10-12 weeks), second (18-20 weeks) and third (28-34 weeks) trimester, participants will be asked for consent to: (1) lifestyle and diet questionnaires, (2) blood for research purposes and (3) analysis of urine collected at clinical visits. Additionally, participants will be asked to consume two blinded meals in duplicate in second and third trimester. Glycaemia will be assessed by continuous glucose monitoring as part of routine care. The primary outcome is the effect of experimental meals (high vs low protein) on postprandial glycaemia. Secondary outcomes include (1) the association between dysglycaemia and maternal and newborn health, and (2) the association between maternal metabolic profiles in early pregnancy with dysglycaemia in later pregnancy. ETHICS AND DISSEMINATION The Leeds East Research Ethics Committee and NHS (REC: 21/NE/0196) approved the study. Results will be published in peer-reviewed journals and disseminated to participants and the wider public. TRIAL REGISTRATION NUMBER ISRCTN57579163.
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Affiliation(s)
| | | | | | | | - Eleanor M Scott
- Division of Clinical and Population Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Monnard C, Rytz A, Tudorica CM, Fiore GL, Do TAL, Bhaskaran K, Macé K, Shahkhalili Y. Nutritional Composition of Infant Cereal Prototypes Can Precisely Predict Their Glycemic Index. Nutrients 2022; 14:nu14183702. [PMID: 36145078 PMCID: PMC9504606 DOI: 10.3390/nu14183702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Designing cereal-based products with appropriate metabolic responses is of high interest to the food industry in view of the potential health impact of the product. The objective of this study was to test whether a model that used the nutrient composition of breakfast cereals to predict their glycemic index (GI) and glycemic load (GL) could also accurately predict the GI and GL for complete (containing protein, reconstituted in water) infant cereal prototypes. Four independent studies measured the postprandial glucose response of 20 complete infant cereal prototypes (51−76 g/100 g glycemic carbohydrates) in healthy adults. The predictions were strongly correlated with the measured values for both the GI (r = 0.93, p-value < 0.01) and GL (r = 0.98, p-value < 0.01). The in vivo incremental area under the curve (iAUC) for glucose showed a strong linear relationship with the predicted GL (r = 0.99, p < 0.01). In summary, the model previously developed to predict the GI and GL of breakfast cereals was both accurate and precise for infant cereals and could be considered a simple tool to support nutritionally responsible product development.
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Affiliation(s)
- Cathriona Monnard
- Nestlé Institute of Health Sciences, Société des Produits Nestlé S.A., 1015 Lausanne, Switzerland
- Correspondence:
| | - Andreas Rytz
- Nestlé Research Center, 1000 Lausanne, Switzerland
| | | | | | - Tram Anh Line Do
- Nestlé Product Technology Center, Société des Produits Nestlé S.A., Route de Chavornay 3, 1350 Orbe, Switzerland
| | - Kalpana Bhaskaran
- Centre for Applied Nutrition Services, Glycemic Index Research Unit, School of Applied Science, Temasek Polytechnic, Singapore 529757, Singapore
| | | | - Yasaman Shahkhalili
- Nestlé Institute of Health Sciences, Société des Produits Nestlé S.A., 1015 Lausanne, Switzerland
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Fernández-González E, Martínez-González MÁ, Bes-Rastrollo M, Suescun-Elizalde D, Basterra-Gortari FJ, Santiago S, Gea A. Association between pre-conceptional carbohydrate quality index and the incidence of gestational diabetes: the SUN cohort study. Br J Nutr 2022; 129:1-11. [PMID: 35591757 PMCID: PMC9899572 DOI: 10.1017/s000711452200157x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/17/2022] [Accepted: 05/05/2022] [Indexed: 11/07/2022]
Abstract
The aim of the study was to investigate the association between pre-gestational carbohydrate quality index (CQI) and the incidence of gestational diabetes mellitus (GDM). Data from the 'Seguimiento Universidad de Navarra' (SUN) cohort were used, which includes 3827 women who notified at least one pregnancy between December 1999 and December 2019. We used a validated semi-quantitative 136-item FFQ to evaluate dietary exposures at baseline and at 10-year follow-up. The CQI was defined by four criteria: glycaemic index, whole-grain/total-grain carbohydrate, dietary fibre intake and solid/total carbohydrate ratio. We fitted generalised estimating equations with repeated measurements of the CQI to assess its relationship with incident GDM. A total of 6869 pregnancies and 202 new cases of incident GDM were identified. The inverse association between the global quality of carbohydrate and the development of GDM was not statistically significant: OR the highest v. the lowest CQI category: 0·67, 95 % CI (0·40, 1·10), Pfor trend = 0·10. Participants at the highest CQI category and with daily carbohydrate amounts ≥50 % of total energy intake had the lowest incidence of GDM (OR = 0·29 (95 % CI (0·09, 0·89)) compared with those with the lowest quality (lowest CQI) and quantity (≤40 %). Further studies are needed to overcome the limitations of our study. Those studies should jointly consider the quality and the quantity of dietary carbohydrates, as the quality might be of importance, especially in women with a higher intake of carbohydrates.
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Affiliation(s)
- Elena Fernández-González
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, 31008, Spain
- Department of Endocrinology and Clinical Nutrition, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid
| | - Miguel Á. Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, 31008, Spain
- IdisNA, Pamplona, Spain
- Biomedical Research Network Center for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
- Harvard TH Chan School of Public Health, Department of Nutrition, Boston, USA
| | - Maira Bes-Rastrollo
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, 31008, Spain
- IdisNA, Pamplona, Spain
- Biomedical Research Network Center for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
| | - David Suescun-Elizalde
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, 31008, Spain
| | - Francisco Javier Basterra-Gortari
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, 31008, Spain
- IdisNA, Pamplona, Spain
- Complejo Hospitalario de Navarra, Department of Endocrinology and Nutrition, Pamplona, Spain
| | - Susana Santiago
- University of Navarra, Department of Food Sciences and Nutrition, Pamplona, Spain
| | - Alfredo Gea
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, 31008, Spain
- IdisNA, Pamplona, Spain
- Biomedical Research Network Center for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
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Jun S, Lee S, Lee J, Kim J. Diets high in glycemic index and glycemic load are associated with an increased risk of metabolic syndrome among Korean women. Nutr Metab Cardiovasc Dis 2022; 32:1154-1164. [PMID: 35256231 DOI: 10.1016/j.numecd.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Accurate estimation of the glycemic index (GI) and glycemic load (GL) of diets is essential when assessing health implications of dietary GI and GL. The present study aimed to estimate dietary GI and GL utilizing the updated GI tables with a large number of new, reliable GI values and assess their associations with metabolic syndrome among Korean adults. METHODS AND RESULTS We analyzed data from 3317 men and 6191 women for this cross-sectional study. Dietary intake was assessed with a validated food frequency questionnaire. Metabolic syndrome and its components were defined based on the harmonized criteria with Korean-specific cutoffs for waist circumference. Multivariate logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Compared with women in the lowest quintiles of energy-adjusted dietary GI and GL, women in the highest quintiles had significantly greater risks of metabolic syndrome (GI, OR = 1.56, 95% CI = 1.18-2.06; GL, OR = 1.80, 95% CI = 1.27-2.57), elevated blood pressure, reduced high-density lipoprotein cholesterol (HDL-C, both GI and GL), elevated triglycerides (GI only), elevated waist circumference, and elevated fasting glucose (GL only). Among men, no significant association was noted except for a higher risk of reduced HDL-C (OR = 1.59, 95% CI = 1.01-2.29) in the highest quintile of energy-adjusted dietary GI than in the lowest quintile. CONCLUSION Our findings suggest that dietary GI and GL are positively associated with metabolic syndrome risk among women, but not men, in Korea.
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Affiliation(s)
- Shinyoung Jun
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang-si, Republic of Korea
| | - Seohyun Lee
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang-si, Republic of Korea
| | - Jeonghee Lee
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang-si, Republic of Korea
| | - Jeongseon Kim
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang-si, Republic of Korea.
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Complete nutrition drink with retrograded starch is low glycemic, and the individual glucose response to the low glycemic complete nutrition drink depends on fasting insulin levels and HOMA-IR in a randomized cross-over control trial. J Nutr Sci 2022; 11:e25. [PMID: 35462880 PMCID: PMC9003636 DOI: 10.1017/jns.2022.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022] Open
Abstract
Complete nutrition drinks with a low glycemic index (GI) provide nutritional support and prevent hyperglycaemia. The present study identified GI and factors predicting individual glucose response to a new complete nutrition drink. A randomised cross-over controlled trial was conducted in eighteen healthy volunteers (FPG < 100 mg/dl). Complete nutrition drinks containing retrograded starch, glucose solution and white bread were assigned in a random sequence with 14-day wash-out intervals. Plasma glucose and insulin levels were measured from baseline to 180 min after consuming each food. Results show the adjusted GIs of the drink was 48.2 ± 10.4 and 46.7 ± 12.7 with glucose and white bread as the reference, respectively. While the drink has low GI (<55), the individual glucose responses varied (GI: 7–149). Comparing characters in individual GI < 55 (n = 12) and GI ≥ 55 (n = 6) groups revealed significantly higher baseline insulin in the low GI group (14.86 ± 16.51 μIU/ml v. 4.9 ± 3.4 μIU/ml, P < 0·05). The correlation matrix confirms only two predictive factors for having individual GI <55 were baseline insulin (r = 0·5, P = 0·03) and HOMA-IR (r = 0·55, P = 0·02). ROC curve reveals fasting insulin above 1.6 μIU/ml and HOMA-IR above 1.05 as the cut-off values. The findings suggest that the complete nutrition drink has a low GI, but there was wide variability in individual responses partly explained by fasting insulin levels and HOMA-IR. Screening for fasting insulin and HOMA-IR may be encouraged to maximise the functional benefit of the drink.
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Drozdowska A, Sinningen K, Falkenstein M, Rudolf H, Libuda L, Buyken AE, Lücke T, Kersting M. Impact of lunch with carbohydrates differing in glycemic index on children's cognitive functioning in the late postprandial phase: a randomized crossover study. Eur J Nutr 2021; 61:1637-1647. [PMID: 34902050 PMCID: PMC8921027 DOI: 10.1007/s00394-021-02766-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/30/2021] [Indexed: 12/01/2022]
Abstract
Purpose Studies about effects of lunch dietary Glycemic Index (GI) on cognition of schoolchildren are scarce. Our previous CogniDo GI study found no changes of cognition in the early postprandial phase after consumption of two rice types with medium vs. high dietary GI for lunch (i.e., 45 min after starting lunch). This study investigated whether the dietary GI of lunch has an impact on cognition of schoolchildren in the late postprandial phase, 90 min after lunch. Methods A randomized, 2 × 2 crossover intervention study was conducted at a comprehensive school with 5th and 6th grade students. Participants (n = 212) were randomly assigned to either sequence 1 or 2. In the first period, participants of sequence 1 received a dish with high GI rice (GI: 79), those of sequence 2 with medium GI rice (GI: 64)—in the second period, 1 week later, vice versa. Computer-based cognitive testing was performed 90 min after lunch examining tonic alertness, visual search and task switching, and working memory. Treatment effects and treatment effects adjusted for estimated lunch glycemic load (GL) were analyzed using a linear mixed model. Results The selected cognitive parameters were not affected by the GI of lunch 90 min after lunch, neither after intention-to-treat nor in the per-protocol analysis. Adjustment for GL also did not change results. Conclusion The present study revealed no notable differences after the consumption of two rice types with medium vs. high dietary GI for lunch in children’s cognitive function in the late postprandial phase, 90 min after lunch. Clinical trial registration German Clinical Trials Register (DRKS00013597); date of registration: 16/04/2018, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-021-02766-y.
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Affiliation(s)
- Alina Drozdowska
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
| | - Kathrin Sinningen
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany.
| | | | - Henrik Rudolf
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Lars Libuda
- Paderborn University, Faculty of Natural Sciences, Institute of Nutrition, Consumption and Health, Nutrition Sciences, 33098, Paderborn, Germany
| | - Anette E Buyken
- Paderborn University, Faculty of Natural Sciences, Institute of Nutrition, Consumption and Health, Public Health Nutrition, 33098, Paderborn, Germany
| | - Thomas Lücke
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
| | - Mathilde Kersting
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
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Nilsen I, Andersson A, Laurenius A, Osterberg J, Sundbom M, Haenni A. Lower Interstitial Glucose Concentrations but Higher Glucose Variability during Low-Energy Diet Compared to Regular Diet-An Observational Study in Females with Obesity. Nutrients 2021; 13:3687. [PMID: 34835943 PMCID: PMC8623427 DOI: 10.3390/nu13113687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
This is an observational study of interstitial glucose (IG) concentrations, IG variability and dietary intake under free-living conditions in 46 females with obesity but without diabetes. We used continuous glucose monitoring, open-ended food recording and step monitoring during regular dietary intake followed by a low-energy diet (LED). Thirty-nine participants completed both study periods. The mean BMI at baseline was 43.6 ± 6.2 kg/m2. Three weeks of LED resulted in a mean weight loss of 5.2% with a significant reduction in diurnal IG concentration but with greater glycemic variability observed during LED. The mean 24 h IG concentration decreased from 5.8 ± 0.5 mmol/L during the regular diet period to 5.4 ± 0.5 mmol/L (p < 0.001) during LED, while the mean amplitude of glycemic excursion increased from 1.5 ± 0.7 to 1.7 ± 0.7 mmol/L (p = 0.031). The positive incremental area under the curve at breakfast was significantly larger for LED compared to regular diet. The daily fiber intake and the glycemic index of breakfast meals were significantly associated with the glycemic variability during regular dietary intake. In conclusion, the 24 h mean IG concentration was lower but with more pronounced glycemic variability during LED compared to a regular diet.
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Affiliation(s)
- Inger Nilsen
- Department of Dietetics and Speech Therapy, Mora Hospital, SE-792 51 Mora, Sweden
- Center for Clinical Research Dalarna, Region Dalarna, SE-791 82 Falun, Sweden
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, SE-751 22 Uppsala, Sweden;
| | - Agneta Andersson
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, SE-751 22 Uppsala, Sweden;
| | - Anna Laurenius
- Department of Surgery, University of Gothenburg, SE-413 45 Gothenburg, Sweden;
| | - Johanna Osterberg
- Department of Surgery, Mora Hospital, SE-792 51 Mora, Sweden;
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, SE-171 77 Stockholm, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden;
| | - Arvo Haenni
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, SE-751 85 Uppsala, Sweden;
- Department of Surgery, Bariatric Unit, Falun Hospital, SE-791 31 Falun, Sweden
- Department of Diabetes, Endocrinology, University Hospital, SE-750 85 Uppsala, Sweden
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Bland JS. COVID-19 Risk: Clinical Tools for Assessing and Personalizing Immunity. Integr Med (Encinitas) 2021; 20:18-23. [PMID: 34393672 PMCID: PMC8352418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Researchers and clinicians all over the world are struggling to bring the spread of SARS-CoV-2 under control. Whether we refer to COVID-19 as a pandemic (a widely used word) or a syndemic (a new emerging term), we now know that specific immunotypes have been linked to both risk to infection and presentation of this disease. Application of assessment tools that support a fuller understanding of individual immune system status is next-level care that providers must prepare for and deliver. Commonly used biometric devices already gather data that can be relevant and useful to a phenotypic evaluation of immune function. These variables include pulse rate, blood oxygenation, sleep cycles, respiration rate, heart rate variability, continuous blood glucose monitoring, and ambulatory blood pressure. When coupled with traditional blood analytes and measurements of nutrient status, a more complete picture of immunological function may be revealed. Innovative questionnaires and algorithms can also be helpful additions to a clinician's toolkit. In a therapeutic relationship between provider and patient, this approach may lead to options for personalized immune intervention using diet, medical nutrition, and lifestyle medicine.
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Wu T, Hsu FC, Pierce JP. Increased Acid-Producing Diet and Past Smoking Intensity Are Associated with Worse Prognoses Among Breast Cancer Survivors: A Prospective Cohort Study. J Clin Med 2020; 9:jcm9061817. [PMID: 32545214 PMCID: PMC7355548 DOI: 10.3390/jcm9061817] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/25/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
Current dietary guidelines do not consider cancer survivors’ and past smokers’ low capacity to regulate their acid–base balance. People with a low capacity to regulate their acid–base balance are more susceptible to acid-producing diets. We studied a cohort of 2950 early stage breast cancer survivors who provided dietary information at baseline and during follow-up. We assessed the intakes of acid-producing diets via two commonly used dietary acid load scores: potential renal acid load (PRAL) and net endogenous acid production (NEAP). We assessed past smoking intensity by pack-years of smoking. After an average of 7.3 years of follow-up, there were 295 total deaths, 249 breast cancer-specific deaths, and 490 cases of recurrent breast cancer. Increased intakes of dietary acid load and pack-years of smoking were each independently and jointly associated with increased total mortality and breast cancer-specific mortality; tests for trends and overall associations were statistically significant for NEAP and marginally significant for PRAL. Compared to women in the lowest tertile of NEAP and pack-year of smoking = 0, women in the highest tertile of NEAP and pack-years of smoking >15 had the greatest increased risk of total mortality (HR = 3.23, 95%CI 1.99–5.26). Further, dietary acid scores were associated with increased breast cancer recurrence among women with pack-years of smoking >0 but not in those with pack-years of smoking = 0 (p values for interactions <0.05). Our study provides valuable evidence for adding dietary acid load scores to dietary guidelines for breast cancer survivors and developing specific guidelines for past smokers among these survivors.
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Affiliation(s)
- Tianying Wu
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA
- Moores Cancer Center, School of Medicine, University of California, San Diego, CA 92093, USA;
- Correspondence:
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - John P. Pierce
- Moores Cancer Center, School of Medicine, University of California, San Diego, CA 92093, USA;
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The Role of Glycemic Index and Glycemic Load in the Development of Real-Time Postprandial Glycemic Response Prediction Models for Patients With Gestational Diabetes. Nutrients 2020; 12:nu12020302. [PMID: 31979294 PMCID: PMC7071209 DOI: 10.3390/nu12020302] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 12/21/2022] Open
Abstract
The incorporation of glycemic index (GI) and glycemic load (GL) is a promising way to improve the accuracy of postprandial glycemic response (PPGR) prediction for personalized treatment of gestational diabetes (GDM). Our aim was to assess the prediction accuracy for PPGR prediction models with and without GI data in women with GDM and healthy pregnant women. The GI values were sourced from University of Sydney’s database and assigned to a food database used in the mobile app DiaCompanion. Weekly continuous glucose monitoring (CGM) data for 124 pregnant women (90 GDM and 34 control) were analyzed together with records of 1489 food intakes. Pearson correlation (R) was used to quantify the accuracy of predicted PPGRs from the model relative to those obtained from CGM. The final model for incremental area under glucose curve (iAUC120) prediction chosen by stepwise multiple linear regression had an R of 0.705 when GI/GL was included among input variables and an R of 0.700 when GI/GL was not included. In linear regression with coefficients acquired using regularization methods, which was tested on the data of new patients, R was 0.584 for both models (with and without inclusion of GI/GL). In conclusion, the incorporation of GI and GL only slightly improved the accuracy of PPGR prediction models when used in remote monitoring.
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The Effect of a Low GI Diet on Truncal Fat Mass and Glycated Hemoglobin in South Indians with Type 2 Diabetes-A Single Centre Randomized Prospective Study. Nutrients 2020; 12:nu12010179. [PMID: 31936428 PMCID: PMC7019781 DOI: 10.3390/nu12010179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 01/15/2023] Open
Abstract
Background: There has been no previous study that has investigated the effect of a low glycemic index (LGI) diet with local recipes of South Indian cuisine on the body fat composition using dual-energy X-ray absorptiometry (DXA). Truncal obesity has been associated with the risk of metabolic disorders and cardiovascular diseases. Aim: The aim of this study was to examine the effect of a low GI diet on glycemic control and body composition in people with type 2 diabetes in South India. Method: This was a prospective and randomized controlled study that was conducted over a period of 24 weeks. A total of 40 participants were recruited from the Department of Endocrinology and Diabetes Outpatient in Kerala, South India. All the patients had type 2 diabetes and were randomly assigned and given advice and instructions to follow either a low GI diet plan (n = 18) or their usual diet, which served as control (n = 18). The advice was reinforced throughout the study period. Dietary compliance was evaluated based on a 24 h dietary recall at weeks 3, 11, 12, 18, 23, and 24. The age of the subjects ranged from 35 to 65 years. Anthropometric, body composition, and cardio-metabolic parameters were measured according to standard procedures. T-tests were conducted to compare differences between intervention and control groups and the Pearson correlation coefficient was used to evaluate associations between the variables. Results: There were significant reductions (p < 0.05) in the low GI diet compared to the control group with respect to weight, body mass index (BMI), and triceps skinfold thickness. Similarly, significant reductions were observed in the low GI diet group with respect to region, total fat, android, and gynoid fat mass and the differences between the groups were significant at p < 0.05. There was also a positive correlation between BMI and android fat mass (r = 0.745), total fat mass (r = 0.661), total truncal mass (r = 0.821), and truncal fat (r = 0.707). There was a significant reduction in glycated hemoglobin in the low GI diet group compared to the control group at p < 0.05. Conclusion: This study has demonstrated that there was a significant reduction (p < 0.05) of truncal obesity and glycated hemoglobin in patients with type 2 diabetes on a local diet of South Indian cuisine with low GI compared with the control.
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Armaghanian N, Atkinson F, Taylor N, Kench A, Brand-Miller J, Markovic T, Steinbeck K. Dietary intake in cystic fibrosis and its role in glucose metabolism. Clin Nutr 2019; 39:2495-2500. [PMID: 31818530 DOI: 10.1016/j.clnu.2019.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/05/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dietary intervention in cystic fibrosis (CF) has historically focused on high-energy diets to address malnutrition, with little attention on diet quality. With increased survival, CF complications such as impaired glucose tolerance (IGT) and cystic fibrosis related diabetes (CFRD) have increased in prevalence. In the absence of consensus on the management of IGT, the role of dietary intake, specifically carbohydrate quality, requires consideration. AIMS The aims of this study were to: 1) determine nutritional quality of dietary intake at an adult CF clinic and compare this to the Australian Dietary Guidelines 2) explore relationships between dietary intake, including glycaemic index (GI) and glycaemic load (GL), and glucose response variables using continuous glucose monitoring (CGM). METHODS Adults attending a Sydney hospital were recruited to undergo CGM for five-seven days and record dietary intake using a food record over the CGM period. The relationship between variables of dietary intake, including GI and GL and variables of glycaemic response, including mean amplitude of glycaemic excursions (MAGE), percentage of time in hyperglycaemic and euglycaemic range, were determined. RESULTS Eighteen participants completed the study with 87 full days of dietary and CGM data. Dietary intake was higher than recommendations in the Australian Dietary Guidelines in relation to grains and protein foods and only slightly higher in saturated fat. Bivariate correlations showed dietary GI was significantly positively associated with percentage of time in hyperglycaemic range. Dietary GL was significantly associated with SD, MAGE and percentage of time in euglycaemic range on CGM. Results remained significant when controlled for energy intake in partial correlation analyses. CONCLUSIONS This study suggests GI and GL may be important dietary factors influencing glucose metabolism in CF. Further studies exploring low GI or GL diets as a dietary intervention in CF are the next step.
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Affiliation(s)
- Natasha Armaghanian
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Australia; Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia.
| | - Fiona Atkinson
- Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney, Australia
| | - Nicole Taylor
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Andrea Kench
- Nutrition and Dietetics Department, Children's Hospital at Westmead, Westmead, Australia; Department of Respiratory Medicine, Children's Hospital at Westmead, Westmead, Australia
| | - Jennie Brand-Miller
- Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney, Australia
| | - Tania Markovic
- The Boden Institute, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia; Metabolism & Obesity Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kate Steinbeck
- Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Westmead, Australia
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Lin YH, Huang YY, Chen HY, Hsieh SH, Sun JH, Chen ST, Lin CH. Impact of Carbohydrate on Glucose Variability in Patients with Type 1 Diabetes Assessed Through Professional Continuous Glucose Monitoring: A Retrospective Study. Diabetes Ther 2019; 10:2289-2304. [PMID: 31659627 PMCID: PMC6848334 DOI: 10.1007/s13300-019-00707-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The aim of this study was to objectively analyze the correlation between dietary components and blood glucose variation by means of continuous glucose monitoring (CGM). METHODS Patients with type 1 diabetes mellitus (T1DM) who received CGM to manage their blood glucose levels were enrolled into the study, and the components of their total caloric intake were analyzed. Glycemic variation parameters were calculated, and dietary components, including percentages of carbohydrate, protein and fat in the total dietary intake, were analyzed by a dietitian. The interaction between parameters of glycemic variability and dietary components was analyzed. RESULTS Sixty-one patients with T1DM (33 females, 28 males) were enrolled. The mean age of the participants was 34.7 years, and the average duration of diabetes was 14 years. Glycated hemoglobin before CGM was 8.54%. Participants with a carbohydrate intake that accounted for < 50% of their total caloric intake had a longer DM duration and a higher protein and fat intake than did those with a carbohydrate intake that accounted for ≥ 50% of total caloric intake, but there was no between-group difference in total caloric intake per day. The group with a carbohydrate intake that accounted for < 50% of their total caloric intake also had lower nocturnal continuous overlapping net glycemic action (CONGA) 1, - 2 and - 4 values. The percentage of protein intake had a slightly negative correlation with mean amplitude of glycemic excursions (MAGE) (r = - 0.286, p < 0.05) and a moderately negative correlation with coefficient of variation (CV) (r = 0.289, p < 0.05). One additional percentage of protein calories of total calories per day decreased the MAGE to 4.25 mg/dL and CV to 0.012 (p < 0.05). The optimal dietary protein percentage for MAGE < 140 mg/dL was 15.13%. The performance of predictive models revealed the beneficial effect of adequate carbohydrate intake on glucose variation when combined with protein consumption. CONCLUSIONS Adequate carbohydrate consumption-but not more than half the daily total calories-combined with protein calories that amount to approximately 15% of the daily caloric intake is important for glucose stability and beneficial for patients with T1DM.
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Affiliation(s)
- Yi-Hsuan Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsin-Yun Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Sheng-Hwu Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jui-Hung Sun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.
- Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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The Effect of Dietary Glycaemic Index on Glycaemia in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2018; 10:nu10030373. [PMID: 29562676 PMCID: PMC5872791 DOI: 10.3390/nu10030373] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/07/2018] [Accepted: 03/15/2018] [Indexed: 01/12/2023] Open
Abstract
Background: The increasing prevalence of diabetes in the United Kingdom and worldwide calls for new approaches to its management, and diets with low glycaemic index have been proposed as a useful means for managing glucose response. However, there are conflicting reports and differences in the results of studies in terms of their effectiveness. Furthermore, the impact of low-glycaemic index diets and their long-term use in patients with type 2 diabetes remains unclear. Objectives: The objective of this study was to conduct a systematic review and meta-analysis of the effect of low-glycaemic index diets in patients with type 2 diabetes. Methods: Search methods: Randomised controlled studies were selected from a number of databases (EBSCOHost with links to Health Research databases, PubMed, and grey literature) based on the Population, Intervention, Comparator, Outcomes and Study designs (PICOS) framework. The search terms included synonyms and Medical Subject Headings (MeSH) and involved the use of Boolean operators (AND/OR) which allowed the combination of words and search terms. Selection criteria: As per the selection criteria, the following types of articles were selected: studies on randomised controlled trials, with year of publication between 2008 and 2018, including patients with type 2 diabetes. Thus, studies involving patients with gestational and type 1 diabetes were excluded, as were observational studies. Nine articles which met the inclusion criteria were selected for the systematic review, whereas only six articles which met the criteria were included in the meta-analysis. Data collection and analysis: Studies were evaluated for quality and risk of bias. In addition, heterogeneity, meta-analysis, and sensitivity tests of the extracted data were carried out using Review Manager 5.3 (Review Manager, 2014). Results: The findings of the systematic review showed that the low-glycaemic index (low-GI) diet resulted in a significant improvement (<0.05) in glycated haemoglobin (HbA1c) in two studies: low-GI diet Δ = −0.5% (95% CI, −0.61% to −0.39%) vs. high-cereal fibre diet Δ = −0.18% (95% CI, −0.29% to −0.07%); and low-GI legume diet Δ = −0.5% (95%, −0.6% to −0.4%) vs. high-wheat fibre diet Δ = −0.3% (95% Cl, −0.4 to −0.2%). There was a slight improvement in one study (low glycaemic response = 6.5% (6.3–7.1) vs. control = 6.6% (6.3–7.0) and no significant difference (p > 0.05) in four studies compared with the control diet. Four studies showed improvements in fasting blood glucose in low-GI diets compared to higher-GI diets or control: low-GI diet = 150.8 ± 8.7 vs. higher-GI diet = 157.8 ± 10.4 mg/dL, mean ± SD p = 0.43; low-GI diet = 127.7 vs. high-cereal fibre diet = 136.8 mg/dL, p = 0.02; low-GI diet = 6.5 (5.6–8.4) vs. standard diabetic diet = 6.7 (6.1–7.5) mmol/L, median and interquartile range p > 0.05; and low-GI diet = 7.3 ± 0.3 vs. conventional carbohydrate exchange diet = 7.7 ± 0.4 mmol/L, mean ± SEM (Standard Error of Mean) p < 0.05. The results of the meta-analysis and sensitivity tests demonstrated significant differences (p < 0.001 and p < 0.001, respectively) between the low-GI diet and the higher-GI diet or control diet in relation to glycated haemoglobin. Differences between the low-GI diet and higher-GI diet or control were significant (p < 0.05) with respect to the fasting blood glucose following meta-analysis. Conclusion: The low-GI diet is more effective in controlling glycated haemoglobin and fasting blood glucose compared with a higher-GI diet or control in patients with type 2 diabetes.
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Camps SG, Kaur B, Quek RYC, Henry CJ. Does the ingestion of a 24 hour low glycaemic index Asian mixed meal diet improve glycaemic response and promote fat oxidation? A controlled, randomized cross-over study. Nutr J 2017; 16:43. [PMID: 28701162 PMCID: PMC5508658 DOI: 10.1186/s12937-017-0258-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/24/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The health benefits of consuming a low glycaemic index (GI) diet to reduce the risk of type 2 Diabetes are well recognized. In recent years the GI values of various foods have been determined. Their efficacy in constructing and consuming a low GI diet over 24 h in modulating glycaemic response has not been fully documented. The translation of using single-point GI values of foods to develop a 24 h mixed meal diet can provide valuable information to consumers, researchers and dietitians to optimize food choice for glycaemic control. By using GI values of foods to develop mixed meals, our study is the first to determine how both blood glucose and substrate oxidation may be modulated over 24 h. METHODS The study included 11 Asian men with a BMI between 17-24 kg/m2 who followed both a 1-day low GI and 1-day high GI diet in a randomized, controlled cross-over design. Test meals included breakfast, lunch, snack and dinner. Glycaemic response was measured continuously for over 24 h and postprandial substrate oxidation for 10 h inside a whole body calorimeter. RESULTS The low GI diet resulted in lower 24 h glucose iAUC (860 ± 440 vs 1329 ± 614 mmol/L.min; p = 0.014) with lower postprandial glucose iAUC after breakfast (p < 0.001), lunch (p = 0.009), snack (p = 0.012) and dinner (p = 0.003). Moreover, 24 h mean amplitude of glycaemic excursion was lower during the low GI vs high GI diet (1.44 ± 0.63 vs 2.33 ± 0.82 mmol/L; p < 0.001). Simultaneously, decrease in 10 h fat oxidation was less during the low vs high GI diet (-0.033 ± 0.021 vs -0.050 ± 0.017 g/min; p < 0.001), specifically after breakfast (p < 0.001) and lunch (p < 0.001). CONCLUSIONS Our study corroborates that using low GI local foods to construct a 24 h low GI diet, is able to reduce glycaemic response and variability as recorded by continuous glucose monitoring. Our observations also confirm that a low GI diet promotes fat oxidation over carbohydrate oxidation when compared to a high GI diet. These observations provide public health support for the encouragement of healthier nutrition choices by consuming low GI foods. TRIAL REGISTRATION NCT 02631083 (Clinicaltrials.gov).
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Affiliation(s)
- Stefan Gerardus Camps
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) and National University Health System, Centre for Translational Medicine, Yong Loo Lin School of Medicine, 14 Medical Drive #07-02, MD 6 Building, Singapore, 117599, Singapore.
| | - Bhupinder Kaur
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) and National University Health System, Centre for Translational Medicine, Yong Loo Lin School of Medicine, 14 Medical Drive #07-02, MD 6 Building, Singapore, 117599, Singapore
| | - Rina Yu Chin Quek
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) and National University Health System, Centre for Translational Medicine, Yong Loo Lin School of Medicine, 14 Medical Drive #07-02, MD 6 Building, Singapore, 117599, Singapore
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) and National University Health System, Centre for Translational Medicine, Yong Loo Lin School of Medicine, 14 Medical Drive #07-02, MD 6 Building, Singapore, 117599, Singapore.,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, S14 Level 5, Science Drive 2, Singapore, 117543, Singapore
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Diederichs T, Herder C, Roßbach S, Roden M, Wudy SA, Nöthlings U, Alexy U, Buyken AE. Carbohydrates from Sources with a Higher Glycemic Index during Adolescence: Is Evening Rather than Morning Intake Relevant for Risk Markers of Type 2 Diabetes in Young Adulthood? Nutrients 2017; 9:nu9060591. [PMID: 28604592 PMCID: PMC5490570 DOI: 10.3390/nu9060591] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/02/2017] [Accepted: 06/07/2017] [Indexed: 12/19/2022] Open
Abstract
Background: This study investigated whether glycemic index (GI) or glycemic load (GL) of morning or evening intake and morning or evening carbohydrate intake from low- or higher-GI food sources (low-GI-CHO, higher-GI-CHO) during adolescence are relevant for risk markers of type 2 diabetes in young adulthood. Methods: Analyses included DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study participants who had provided at least two 3-day weighed dietary records (median: 7 records) during adolescence and one blood sample in young adulthood. Using multivariable linear regression analyses, estimated morning and evening GI, GL, low-GI-CHO (GI < 55) and higher-GI-CHO (GI ≥ 55) were related to insulin sensitivity (N = 252), hepatic steatosis index (HSI), fatty liver index (FLI) (both N = 253), and a pro-inflammatory-score (N = 249). Results: Morning intakes during adolescence were not associated with any of the adult risk markers. A higher evening GI during adolescence was related to an increased HSI in young adulthood (p = 0.003). A higher consumption of higher-GI-CHO in the evening was associated with lower insulin sensitivity (p = 0.046) and an increased HSI (p = 0.006), while a higher evening intake of low-GI-CHO was related to a lower HSI (p = 0.009). Evening intakes were not related to FLI or the pro-inflammatory-score (all p > 0.1). Conclusion: Avoidance of large amounts of carbohydrates from higher-GI sources in the evening should be considered in preventive strategies to reduce the risk of type 2 diabetes in adulthood.
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Affiliation(s)
- Tanja Diederichs
- IEL-Nutritional Epidemiology, DONALD Study, Rheinische Friedrich-Wilhelms-University Bonn, Heinstueck 11, 44225 Dortmund, Germany.
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Ingolstädter Landstr. 1, 85764 München-Neuherberg, Germany.
| | - Sarah Roßbach
- IEL-Nutritional Epidemiology, DONALD Study, Rheinische Friedrich-Wilhelms-University Bonn, Heinstueck 11, 44225 Dortmund, Germany.
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Ingolstädter Landstr. 1, 85764 München-Neuherberg, Germany.
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Stefan A Wudy
- Pediatric Endocrinology and Diabetology, Laboratory for Translational Hormone Analytics, Peptide Hormone Research Unit, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Feulgenstraße 10-12, 35392 Gießen, Germany.
| | - Ute Nöthlings
- IEL-Nutritional Epidemiology, DONALD Study, Rheinische Friedrich-Wilhelms-University Bonn, Heinstueck 11, 44225 Dortmund, Germany.
| | - Ute Alexy
- IEL-Nutritional Epidemiology, DONALD Study, Rheinische Friedrich-Wilhelms-University Bonn, Heinstueck 11, 44225 Dortmund, Germany.
| | - Anette E Buyken
- IEL-Nutritional Epidemiology, DONALD Study, Rheinische Friedrich-Wilhelms-University Bonn, Heinstueck 11, 44225 Dortmund, Germany.
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, University Paderborn, Warburger Straße 100, 33098 Paderborn, Germany.
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Cheng G, Xue H, Luo J, Jia H, Zhang L, Dai J, Buyken AE. Relevance of the dietary glycemic index, glycemic load and genetic predisposition for the glucose homeostasis of Chinese adults without diabetes. Sci Rep 2017; 7:400. [PMID: 28341844 PMCID: PMC5428428 DOI: 10.1038/s41598-017-00453-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/27/2017] [Indexed: 01/19/2023] Open
Abstract
Type 2 diabetes (T2DM) and pre-diabetes have become a major public health problem in China. We examined whether a higher dietary glycemic index (GI) or glycemic load (GL) was associated with a less favorable glucose homeostasis among Chinese adults and whether these associations were modified by their genetic predisposition or whether combined effects exist with their cereal fiber intake. Multivariable regression analyses were performed in 3918 adults aged 23-69 years for whom three 24-hour dietary recalls and information on glucose homeostasis, genetic background and potential confounders was available. Adults in the highest GI (GL) tertile had an approximately 9% (5%) higher fasting plasma glucose, 11% (3%) higher glycated haemoglobin, 12% (7%) higher insulin level, and 28% (22%) higher hepatic insulin resistance compared to those in the lowest tertile (adjusted pfor-trend ≤ 0.04). Moreover, a higher dietary GI or GL was associated with higher odds of pre-diabetes (pfor-trend = 0.03). These associations were more pronounced among persons with a high T2DM genetic risk score (pfor-interaction ≤ 0.06) or a low cereal fiber intake (pfor-interaction ≤ 0.05). In conclusion, our study indicates that the dietary GI or GL is of relevance for glucose homeostasis among Chinese adults, particularly among individuals genetically predisposed to T2DM.
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Affiliation(s)
- Guo Cheng
- West China School of Public Health and State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, P.R. China.
| | - Hongmei Xue
- West China School of Public Health, Sichuan University, Chengdu, P.R. China
| | - Jiao Luo
- West China School of Public Health, Sichuan University, Chengdu, P.R. China
| | - Hong Jia
- Department of Epidemiology and Biostatistics, School of Public Health, Southwest Medical University, Luzhou, China
| | - Lishi Zhang
- West China School of Public Health, Sichuan University, Chengdu, P.R. China
| | - Junbiao Dai
- MOE Key Laboratory of Bioinformatics and Center for Synthetic and Systems Biology, School of Life Sciences, Tsinghua University, Beijing, China
| | - Anette E Buyken
- IEL-Nutritional Epidemiology, University of Bonn, DONALD Study, Dortmund, Germany
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de Mello Fontanelli M, Sales CH, Carioca AAF, Marchioni DM, Fisberg RM. The relationship between carbohydrate quality and the prevalence of metabolic syndrome: challenges of glycemic index and glycemic load. Eur J Nutr 2017; 57:1197-1205. [DOI: 10.1007/s00394-017-1402-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/10/2017] [Indexed: 12/11/2022]
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Kizirian NV, Goletzke J, Brodie S, Atkinson FS, Markovic TP, Ross GP, Buyken A, Brand-Miller JC. Lower glycemic load meals reduce diurnal glycemic oscillations in women with risk factors for gestational diabetes. BMJ Open Diabetes Res Care 2017; 5:e000351. [PMID: 28405345 PMCID: PMC5372136 DOI: 10.1136/bmjdrc-2016-000351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/15/2017] [Accepted: 03/09/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Maternal glycemia plays a key role in fetal growth. We hypothesized that lower glycemic load (GL) meals (lower glycemic index, modestly lower carbohydrate) would substantially reduce day-long glucose variability in women at risk of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS A crossover study of 17 women (mean±SD age 34.8±4 years; gestational weeks 29.3±1.3; body mass index 23.8±4.7 kg/m2) who consumed a low GL or a high GL diet in random order, 1-day each, over 2 consecutive days. Diets were energy-matched and fiber-matched with 5 meals per 24 hours. All food was provided. Continuous glucose monitoring was used to assess diurnal glycemia. RESULTS Maternal glucose levels were 51% lower on the low GL day with lower incremental area under the curve (iAUC±SEM 549±109 vs 1120±198 mmol/L min, p=0.015). Glycemic variability was significantly lower on the low GL day, as demonstrated by a lower average SD (0.7±0.1 vs 0.9±0.1, p<0.001) and lower mean amplitude of glycemic excursions (2.1±0.2 vs 2.7±0.2 mmol/L, p<0.001). CONCLUSIONS A lower GL meal plan in pregnancy acutely halves day-long maternal glucose levels and reduces glucose variability, providing further evidence to support the utility of a low GL diet in pregnancy.
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Affiliation(s)
- Nathalie V Kizirian
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Janina Goletzke
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
- IEL-Nutritional Epidemiology, University of Bonn, DONALD Study, Dortmund, Germany
| | - Shannon Brodie
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona S Atkinson
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Tania P Markovic
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Glynis P Ross
- Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anette Buyken
- IEL-Nutritional Epidemiology, University of Bonn, DONALD Study, Dortmund, Germany
| | - Jennie C Brand-Miller
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
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Accuracy of Continuous Glucose Monitoring Measurements in Normo-Glycemic Individuals. PLoS One 2015; 10:e0139973. [PMID: 26445499 PMCID: PMC4596806 DOI: 10.1371/journal.pone.0139973] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/18/2015] [Indexed: 11/23/2022] Open
Abstract
Background The validity of continuous glucose monitoring (CGM) is well established in diabetic patients. CGM is also increasingly used for research purposes in normo-glycemic individuals, but the CGM validity in such individuals is unknown. We studied the accuracy of CGM measurements in normo-glycemic individuals by comparing CGM-derived versus venous blood-derived glucose levels and measures of glycemia and glycemic variability. Methods In 34 healthy participants (mean age 65.7 years), glucose was simultaneously measured every 10 minutes, via both an Enlite® CGM sensor, and in venous blood sampled over a 24-hour period. Validity of CGM-derived individual glucose measurements, calculated measures of glycemia over daytime (09:00h-23:00h) and nighttime (23:00h-09:00h), and calculated measures of glycemic variability (e.g. 24h standard deviation [SD]) were assessed by Pearson correlation coefficients, mean absolute relative difference (MARD) and paired t-tests. Results The median correlation coefficient between CGM and venous glucose measurements per participant was 0.68 (interquartile range: 0.40–0.78), and the MARD was 17.6% (SD = 17%). Compared with venous sampling, the calculated measure of glycemia during daytime was 0.22 mmol/L higher when derived from CGM, but no difference was observed during nighttime. Most measures of glycemic variability were lower with CGM than with venous blood sampling (e.g., 24h SD: 1.07 with CGM and 1.26 with venous blood; p-value = 0.004). Conclusion In normo-glycemic individuals, CGM-derived glucose measurements had good agreement with venous glucose levels. However, the measure of glycemia was higher during the day and most measures of glycemic variability were lower when derived from CGM.
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Bozzetto L, Giorgini M, Alderisio A, Costagliola L, Giacco A, Riccardi G, Rivellese AA, Annuzzi G. Glycaemic load versus carbohydrate counting for insulin bolus calculation in patients with type 1 diabetes on insulin pump. Acta Diabetol 2015; 52:865-71. [PMID: 25697600 DOI: 10.1007/s00592-015-0716-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/23/2015] [Indexed: 11/28/2022]
Abstract
AIMS To evaluate feasibility and effectiveness on short-term blood glucose control of using glycaemic load counting (GLC) versus carbohydrate counting (CC) for prandial insulin dosing in patients with type 1 diabetes (T1D). METHODS Nine T1D patients on insulin pump, aged 26-58 years, HbA1c 7.7 ± 0.8 % (61 ± 8.7 mmol/mol), participated in this real-life setting study. By a crossover design, patients were randomised to calculate their pre-meal insulin dose based on the insulin/glycaemic load ratio (GLC period) or the insulin/carbohydrate ratio (CC period) for 1 week, shifting to the alternate method for the next week, when participants duplicated their first week food plan. Over either week, a blind subcutaneous continuous glucose monitoring was performed, and a 7-day food record was filled in. RESULTS Total daily insulin doses (45 ± 10 vs. 44 ± 9 I.U.; M ± SD, p = 0.386) and basal infusion (26 ± 7 vs. 26 ± 8 I.U., p = 0.516) were not different during GLC and CC periods, respectively. However, the range of insulin doses (difference between highest and lowest insulin dose) was wider during GLC, with statistical significance at dinner (8.4 ± 6.2 vs. 6.0 ± 3.9 I.U., p = 0.041). Blood glucose iAUC after lunch was lower, albeit not significantly, during GLC than CC period (0.6 ± 8.6 vs. 3.4 ± 8.2 mmol/l∙3 h, p = 0.059). Postprandial glucose variability, evaluated as the maximal amplitude after meal (highest minus lowest glucose value), was significantly lower during GLC than CC period at lunch (4.22 ± 0.28 vs. 5.47 ± 0.39 mmol/l, p = 0.002) and dinner (3.89 ± 0.33 vs. 4.89 ± 0.33, p = 0.026). CONCLUSIONS Calculating prandial insulin bolus based on glycaemic load counting is feasible in a real-life setting and may improve postprandial glucose control in people with T1D.
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Affiliation(s)
- L Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini, 5, 80131, Naples, Italy
| | - M Giorgini
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini, 5, 80131, Naples, Italy
| | - A Alderisio
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini, 5, 80131, Naples, Italy
| | - L Costagliola
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini, 5, 80131, Naples, Italy
| | - A Giacco
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini, 5, 80131, Naples, Italy
| | - G Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini, 5, 80131, Naples, Italy
| | - A A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini, 5, 80131, Naples, Italy.
| | - G Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, Via Pansini, 5, 80131, Naples, Italy
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Augustin LSA, Kendall CWC, Jenkins DJA, Willett WC, Astrup A, Barclay AW, Björck I, Brand-Miller JC, Brighenti F, Buyken AE, Ceriello A, La Vecchia C, Livesey G, Liu S, Riccardi G, Rizkalla SW, Sievenpiper JL, Trichopoulou A, Wolever TMS, Baer-Sinnott S, Poli A. Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC). Nutr Metab Cardiovasc Dis 2015; 25:795-815. [PMID: 26160327 DOI: 10.1016/j.numecd.2015.05.005] [Citation(s) in RCA: 387] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 05/08/2015] [Accepted: 05/08/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS The positive and negative health effects of dietary carbohydrates are of interest to both researchers and consumers. METHODS International experts on carbohydrate research held a scientific summit in Stresa, Italy, in June 2013 to discuss controversies surrounding the utility of the glycemic index (GI), glycemic load (GL) and glycemic response (GR). RESULTS The outcome was a scientific consensus statement which recognized the importance of postprandial glycemia in overall health, and the GI as a valid and reproducible method of classifying carbohydrate foods for this purpose. There was consensus that diets low in GI and GL were relevant to the prevention and management of diabetes and coronary heart disease, and probably obesity. Moderate to weak associations were observed for selected cancers. The group affirmed that diets low in GI and GL should always be considered in the context of diets otherwise understood as healthy, complementing additional ways of characterizing carbohydrate foods, such as fiber and whole grain content. Diets of low GI and GL were considered particularly important in individuals with insulin resistance. CONCLUSIONS Given the high prevalence of diabetes and pre-diabetes worldwide and the consistency of the scientific evidence reviewed, the expert panel confirmed an urgent need to communicate information on GI and GL to the general public and health professionals, through channels such as national dietary guidelines, food composition tables and food labels.
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Affiliation(s)
- L S A Augustin
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.
| | - C W C Kendall
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Science, University of Toronto, Toronto, Canada; University of Saskatchewan, Saskatoon, Canada
| | - D J A Jenkins
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Science, University of Toronto, Toronto, Canada
| | - W C Willett
- Department of Nutrition, Harvard School of Public Health, Boston, USA
| | - A Astrup
- Department of Nutrition, Exercise and Sports (NEXS), Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - A W Barclay
- Glycemic Index Foundation, Sydney, Australia
| | - I Björck
- Food for Health Science Centre, Lund University, Lund, Sweden
| | - J C Brand-Miller
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia
| | - F Brighenti
- Department of Food Sciences, University of Parma, Parma, Italy
| | - A E Buyken
- Department of Nutritional Epidemiology, University of Bonn, Bonn, Germany
| | - A Ceriello
- Institut d' Investigación Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Spain
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - G Livesey
- Independent Nutrition Logic, Wymondham, UK
| | - S Liu
- Department of Epidemiology and Medicine, Brown University, Providence, USA
| | - G Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - S W Rizkalla
- Institute Cardiometabolism and Nutrition (ICAN), University Pierre et Marie Curie, Pitié Salpêtrière Hospital, Paris, France; National Institute of Health and Medical Research (INSERM), University Pierre et Marie Curie and Pitié Salpêtrière Hospital, Paris, France
| | - J L Sievenpiper
- Department of Nutritional Science, University of Toronto, Toronto, Canada
| | - A Trichopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - T M S Wolever
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Science, University of Toronto, Toronto, Canada
| | | | - A Poli
- Nutrition Foundation of Italy, Milan, Italy
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Tay J, Thompson CH, Brinkworth GD. Glycemic Variability: Assessing Glycemia Differently and the Implications for Dietary Management of Diabetes. Annu Rev Nutr 2015; 35:389-424. [PMID: 25974701 DOI: 10.1146/annurev-nutr-121214-104422] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The primary therapeutic target for diabetes management is the achievement of good glycemic control, of which glycated hemoglobin (HbA1c) remains the standard clinical marker. However, glycemic variability (GV; the amplitude, frequency, and duration of glycemic fluctuations around mean blood glucose) is an emerging target for blood glucose control. A growing body of evidence supports GV as an independent risk factor for diabetes complications. Several techniques have been developed to assess and quantify intraday and interday GV. Additionally, GV can be influenced by several nutritional factors, including carbohydrate quality, quantity; and distribution; protein intake; and fiber intake. These factors have important implications for clinical nutrition practice and for optimizing blood glucose control for diabetes management. This review discusses the available evidence for GV as a marker of glycemic control and risk factor for diabetes complications. GV quantification techniques and the influence of nutritional considerations for diabetes management are also discussed.
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Affiliation(s)
- Jeannie Tay
- Commonwealth Scientific and Industrial Research Organisation (CSIRO)-Food and Nutrition Flagship, Adelaide, South Australia 5000, Australia;
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27
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Glade MJ, Smith K. A glance at… glycemic index. Nutrition 2015; 31:539-41. [DOI: 10.1016/j.nut.2014.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/24/2014] [Indexed: 01/26/2023]
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Sacks FM, Carey VJ, Anderson CAM, Miller ER, Copeland T, Charleston J, Harshfield BJ, Laranjo N, McCarron P, Swain J, White K, Yee K, Appel LJ. Effects of high vs low glycemic index of dietary carbohydrate on cardiovascular disease risk factors and insulin sensitivity: the OmniCarb randomized clinical trial. JAMA 2014; 312:2531-41. [PMID: 25514303 PMCID: PMC4370345 DOI: 10.1001/jama.2014.16658] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Foods that have similar carbohydrate content can differ in the amount they raise blood glucose. The effects of this property, called the glycemic index, on risk factors for cardiovascular disease and diabetes are not well understood. OBJECTIVE To determine the effect of glycemic index and amount of total dietary carbohydrate on risk factors for cardiovascular disease and diabetes. DESIGN, SETTING, AND PARTICIPANTS Randomized crossover-controlled feeding trial conducted in research units in academic medical centers, in which 163 overweight adults (systolic blood pressure, 120-159 mm Hg) were given 4 complete diets that contained all of their meals, snacks, and calorie-containing beverages, each for 5 weeks, and completed at least 2 study diets. The first participant was enrolled April 1, 2008; the last participant finished December 22, 2010. For any pair of the 4 diets, there were 135 to 150 participants contributing at least 1 primary outcome measure. INTERVENTIONS (1) A high-glycemic index (65% on the glucose scale), high-carbohydrate diet (58% energy); (2) a low-glycemic index (40%), high-carbohydrate diet; (3) a high-glycemic index, low-carbohydrate diet (40% energy); and (4) a low-glycemic index, low-carbohydrate diet. Each diet was based on a healthful DASH-type diet. MAIN OUTCOMES AND MEASURES The 5 primary outcomes were insulin sensitivity, determined from the areas under the curves of glucose and insulin levels during an oral glucose tolerance test; levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides; and systolic blood pressure. RESULTS At high dietary carbohydrate content, the low- compared with high-glycemic index level decreased insulin sensitivity from 8.9 to 7.1 units (-20%, P = .002); increased LDL cholesterol from 139 to 147 mg/dL (6%, P ≤ .001); and did not affect levels of HDL cholesterol, triglycerides, or blood pressure. At low carbohydrate content, the low- compared with high-glycemic index level did not affect the outcomes except for decreasing triglycerides from 91 to 86 mg/dL (-5%, P = .02). In the primary diet contrast, the low-glycemic index, low-carbohydrate diet, compared with the high-glycemic index, high-carbohydrate diet, did not affect insulin sensitivity, systolic blood pressure, LDL cholesterol, or HDL cholesterol but did lower triglycerides from 111 to 86 mg/dL (-23%, P ≤ .001). CONCLUSIONS AND RELEVANCE In this 5-week controlled feeding study, diets with low glycemic index of dietary carbohydrate, compared with high glycemic index of dietary carbohydrate, did not result in improvements in insulin sensitivity, lipid levels, or systolic blood pressure. In the context of an overall DASH-type diet, using glycemic index to select specific foods may not improve cardiovascular risk factors or insulin resistance. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00608049.
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Affiliation(s)
- Frank M Sacks
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts2Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Vincent J Carey
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Cheryl A M Anderson
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland7Department of Family and Preventive Medicine, University of California, San Diego
| | - Edgar R Miller
- Division of General Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland5Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Trisha Copeland
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Jeanne Charleston
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland4Division of General Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland5Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopk
| | - Benjamin J Harshfield
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Nancy Laranjo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Phyllis McCarron
- Division of General Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Janis Swain
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Karen White
- Division of General Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Karen Yee
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lawrence J Appel
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland4Division of General Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland5Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopk
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van Baak MA. 24-hour glucose profiles on diets varying in protein content and glycemic index. Nutrients 2014; 6:3050-61. [PMID: 25093276 PMCID: PMC4145294 DOI: 10.3390/nu6083050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 07/11/2014] [Accepted: 07/14/2014] [Indexed: 11/16/2022] Open
Abstract
Evidence is increasing that the postprandial state is an important factor contributing to the risk of chronic diseases. Not only mean glycemia, but also glycemic variability has been implicated in this effect. In this exploratory study, we measured 24-h glucose profiles in 25 overweight participants in a long-term diet intervention study (DIOGENES study on Diet, Obesity and Genes), which had been randomized to four different diet groups consuming diets varying in protein content and glycemic index. In addition, we compared 24-h glucose profiles in a more controlled fashion, where nine other subjects followed in random order the same four diets differing in carbohydrate content by 10 energy% and glycemic index by 20 units during three days. Meals were provided in the lab and had to be eaten at fixed times during the day. No differences in mean glucose concentration or glucose variability (SD) were found between diet groups in the DIOGENES study. In the more controlled lab study, mean 24-h glucose concentrations were also not different. Glucose variability (SD and CONGA1), however, was lower on the diet combining a lower carbohydrate content and GI compared to the diet combining a higher carbohydrate content and GI. These data suggest that diets with moderate differences in carbohydrate content and GI do not affect mean 24-h or daytime glucose concentrations, but may result in differences in the variability of the glucose level in healthy normal weight and overweight individuals.
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Affiliation(s)
- Marleen A van Baak
- Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, P.O. Box 616, 6200MD Maastricht, The Netherlands.
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George R, Garcia AL, Edwards CA. Glycaemic responses of staple South Asian foods alone and combined with curried chicken as a mixed meal. J Hum Nutr Diet 2014; 28:283-91. [PMID: 24661372 DOI: 10.1111/jhn.12232] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The glycaemic responses of staples differ when eaten as mixed meals. We determined the glycaemic responses and glycaemic index (GI) values for common South Asian carbohydrate rich foods and the effect of adding curried chicken to them as mixed meals. METHODS The GI and glycaemic response to staples (basmati rice, pilau rice and chapatti) and mixed meals (pilau rice with chicken curry and chapatti with chicken curry) were measured in healthy volunteers. Paired comparisons in each subject were carried out for staples and their equivalent mixed meals (n = 9). RESULTS GI values for the mixed meals were significantly lower than the staples alone (41 and 60 for pilau rice with chicken curry and pilau rice alone, P = 0.001; 45 and 68 for chapatti with chicken curry and chapatti alone, P = 0.004). Both, pilau rice and chapatti with chicken curry had a significantly lower glycaemic response than their equivalent staples alone: incremental area under the blood glucose response curves (IAUC) 111.9 mmol min(-1 ) L(-1) for pilau rice with curry versus 162.4 mmol min(-1 ) L(-1) for pilau rice alone (P = 0.001) and IAUC 110.1 mmol min(-1 ) L(-1) for chapatti with chicken curry versus 183.6 mmol min(-1 ) L(-1) for chapatti alone (P = 0.002). CONCLUSIONS Adding fat and protein-containing curries as part of a mixed meal to carbohydrate rich staple foods reduced glycaemic responses, and also changed the GI category.
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Affiliation(s)
- R George
- Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - A L Garcia
- Human Nutrition, School of Medicine, College of Medical, Veterinary & Life Sciences,, University of Glasgow, Glasgow, UK
| | - C A Edwards
- Human Nutrition, School of Medicine, College of Medical, Veterinary & Life Sciences,, University of Glasgow, Glasgow, UK
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Goletzke J, Herder C, Joslowski G, Bolzenius K, Remer T, Wudy SA, Roden M, Rathmann W, Buyken AE. Habitually higher dietary glycemic index during puberty is prospectively related to increased risk markers of type 2 diabetes in younger adulthood. Diabetes Care 2013; 36:1870-6. [PMID: 23349549 PMCID: PMC3687320 DOI: 10.2337/dc12-2063] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Carbohydrate nutrition during periods of physiological insulin resistance such as puberty may affect future risk of type 2 diabetes. This study examined whether the amount or the quality (dietary glycemic index [GI], glycemic load [GL], and added sugar, fiber, and whole-grain intake) of carbohydrates during puberty is associated with risk markers of type 2 diabetes in younger adulthood. RESEARCH DESIGN AND METHODS The analysis was based on 226 participants (121 girls and 105 boys) from the Dortmund Nutritional and Anthropometric Longitudinally Designed Study (DONALD) with an average of five 3-day weighed dietary records (range 2-6) during puberty (girls, age 9-14 years; boys, age 10-15 years) and fasting blood samples in younger adulthood (age 18-36 years) (average duration of follow-up 12.6 years). Multivariable linear regression was used to analyze the associations between carbohydrate nutrition and homeostasis model assessment-insulin resistance (HOMA-IR) as well as the liver enzymes alanine aminotransferase (ALT) and γ-glutamyltransferase (GGT) (n = 214). RESULTS A higher dietary GI was prospectively related to greater values of HOMA-IR (P(trend) = 0.03), ALT (P(trend) = 0.02), and GGT (P(trend) = 0.04). After adjustment for sex, adult age, baseline BMI, and early life and socioeconomic factors as well as protein and fiber intake, predicted mean HOMA-IR values in energy-adjusted tertiles of GI were 2.37 (95% CI 2.16-2.60), 2.47 (2.26-2.71), and 2.59 (2.35-2.85). The amount of carbohydrates, GL, and added sugar, fiber, and whole-grain intake were not related to the analyzed markers. CONCLUSIONS Our data indicate that a habitually higher dietary GI during puberty may adversely affect risk markers of type 2 diabetes in younger adulthood.
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Affiliation(s)
- Janina Goletzke
- IEL-Nutritional Epidemiology, University of Bonn, DONALD Study at the Research Institute of Child Nutrition, Dortmund, Germany.
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Effects of hypocaloric diets with different glycemic indexes on endothelial function and glycemic variability in overweight and in obese adult patients at increased cardiovascular risk. Clin Nutr 2013; 32:346-52. [DOI: 10.1016/j.clnu.2012.10.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 09/25/2012] [Accepted: 10/12/2012] [Indexed: 12/13/2022]
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Abstract
Inadequate dietary fiber intake is common in modern diets, especially in children. Epidemiological and experimental evidence point to a significant association between a lack of fiber intake and ischemic heart disease, stroke atherosclerosis, type 2 diabetes, overweight and obesity, insulin resistance, hypertension, dyslipidemia, as well as gastrointestinal disorders such as diverticulosis, irritable bowel disease, colon cancer, and cholelithiasis. The physiological effects of fiber relate to the physical properties of volume, viscosity, and water-holding capacity that the fiber imparts to food leading to important influences over the energy density of food. Beyond these physical properties, fiber directly impacts a complex array of microbiological, biochemical, and neurohormonal effects directly through modification of the kinetics of digestion and through its metabolism into constituents such as short chain fatty acids, which are both energy substrates and important enteroendocrine ligands. Of particular interest to clinicians is the important role dietary fiber plays in glucoregulation, appetite, and satiety. Supplementation of the diet with highly functional fibers may prove to play an important role in long-term obesity management.
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Affiliation(s)
- Michael R. Lyon
- Canadian Center for Functional Medicine, 1550 United Boulevard, Coquitlam, BC Canada V3K 6Y2
- Food, Nutrition and Health Program, University of British Columbia, 1550 United Boulevard, Coquitlam, BC Canada V3K 6Y2
| | - Veronica Kacinik
- Canadian Center for Functional Medicine, 1550 United Boulevard, Coquitlam, BC Canada V3K 6Y2
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