Role of glycemic index and glycemic load in the healthy state, in prediabetes, and in diabetes

ABSTRACT Background The quality of carbohydrate consumed, assessed by the glycemic index (GI), glycemic load (GL), or carbohydrate quality index (CQI), affects the postprandial glycemic and insulinemic responses, which have been implicated in the etiology of several chronic diseases. However, it is unclear whether plasma metabolites involved in different biological pathways could provide functional insights into the role of carbohydrate quality indices in health. Objectives We aimed to identify plasma metabolomic profiles associated with dietary GI, GL, and CQI. Methods The present study is a cross-sectional analysis of 1833 participants with overweight/obesity (mean age = 67 y) from 2 case-cohort studies nested within the PREDIMED (Prevención con Dieta Mediterránea) trial. Data extracted from validated FFQs were used to estimate the GI, GL, and CQI. Plasma concentrations of 385 metabolites were profiled with LC coupled to MS and associations of these metabolites with those indices were assessed with elastic net regression analyses. Results A total of 58, 18, and 57 metabolites were selected for GI, GL, and CQI, respectively. Choline, cotinine, γ-butyrobetaine, and 36:3 phosphatidylserine plasmalogen were positively associated with GI and GL, whereas they were negatively associated with CQI. Fructose-glucose-galactose was negatively and positively associated with GI/GL and CQI, respectively. Consistent associations of 21 metabolites with both GI and CQI were found but in opposite directions. Negative associations of kynurenic acid, 22:1 sphingomyelin, and 38:6 phosphatidylethanolamine, as well as positive associations of 32:1 phosphatidylcholine with GI and GL were also observed. Pearson correlation coefficients between GI, GL, and CQI and the metabolomic profiles were 0.30, 0.22, and 0.27, respectively. Conclusions The GI, GL, and CQI were associated with specific metabolomic profiles in a Mediterranean population at high cardiovascular disease risk. Our findings may help in understanding the role of dietary carbohydrate indices in the development of cardiometabolic disorders. This trial was registered at isrctn.com as ISRCTN35739639.

Download Full-text

Abstract P140: Glycemic Index, Glycemic Load, and Risk of Type 2 Diabetes: Results from 3 Large US Cohorts and an Updated Meta-analysis

Circulation ◽

10.1161/circ.129.suppl_1.p140 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Shilpa N Bhupathiraju ◽

Deidre K Tobias ◽

Vasanti S Malik ◽

An Pan ◽

Adela Hruby ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycemic Index ◽

Meta Analysis ◽

Glycemic Load ◽

Health Study ◽

Validated Questionnaire ◽

Cereal Fiber

Epidemiologic evidence for the role of glycemic index (GI) and glycemic load (GL) in the prevention of type 2 diabetes (T2D) has been mixed. The American Diabetes Association’s nutrition recommendations for T2D prevention state that there is not sufficient, consistent evidence to conclude that low GL diets reduce T2D risk but acknowledge the role of low GI foods rich in fiber in preventing T2D. Therefore, our objectives were to 1) prospectively examine the association of dietary GI and GL with T2D in 3 US cohorts, and 2) conduct an updated meta-analysis of the previous literature including results from our 3 cohorts. We prospectively followed 74,248 women from the Nurses’ Health Study (1984-2008), 86,484 women from the Nurses’ Health Study II (1991-2009), and 40,525 men from the Health Professionals Follow-up Study (1986-2008) who were free of diabetes, cardiovascular disease, and cancer at baseline. Diet was assessed every 4 years using a validated questionnaire. During 3,738,507 person-years of follow-up, we documented 14,482 T2D cases. In pooled multivariable analyses, after adjusting for dietary and non-dietary covariates including body mass index, those in the highest quintile of energy-adjusted GI had a 34% higher risk (95% CI: 27-43%) of T2D. Participants in the highest quintile of energy-adjusted GL had a 13% higher risk (95% CI: 5-22%) for T2D. Participants in the highest tertile of GI/GL and lowest tertile of cereal fiber had about a 50% (GI, RR=1.59, 95% CI:1.47-1.73; GL, RR=1.47, 95% CI:1.32-1.63) higher risk for T2D compared to those in the lowest tertile of GI/GL and highest tertile of cereal fiber. In the updated meta-analysis (675,767 participants and 45,570 T2D cases), the summary RRs (95% CIs) comparing the highest versus lowest categories of GI and GL were 1.19 (1.15-1.24) and 1.13 (1.09-1.18), respectively (Figure 1A and 1B). Our findings provide further evidence that a high GI/GL diet is associated with a higher T2D risk. Public health recommendations for T2D prevention should incorporate GI and GL in meal planning.

Download Full-text

The Role of Glycemic Index and Glycemic Load In Cardiovascular Disease And Its Risk Factors: A Review of The Recent Literature

Current Atherosclerosis Reports ◽

10.1007/s11883-013-0381-1 ◽

2013 ◽

Vol 16 (1) ◽

Cited By ~ 50

Author(s):

Arash Mirrahimi ◽

Laura Chiavaroli ◽

Korbua Srichaikul ◽

Livia S. A. Augustin ◽

John L. Sievenpiper ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Glycemic Index ◽

Recent Literature ◽

Glycemic Load

Download Full-text

Glycemic Index and Glycemic Load of the Diet in a Sample of Pregnant Women with Type 2 Diabetes Mellitus in Northwest Brazil

Diabetes ◽

10.2337/db18-54-lb ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 54-LB

Author(s):

CRISTINA FACANHA ◽

TATIANA U. PASSOS ◽

LIVIANE C. MARANHÃO ◽

FRANCIELLE C. COPPOLA ◽

JULIANA D. MARTINS ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Pregnant Women ◽

Glycemic Index ◽

Glycemic Load

Download Full-text

New Insight into Diabetes Management: From Glycemic Index to Dietary Insulin Index

Current Diabetes Reviews ◽

10.2174/1573399815666190614122626 ◽

2020 ◽

Vol 16 (4) ◽

pp. 293-300 ◽

Cited By ~ 1

Author(s):

Zahra Yari ◽

Vahideh Behrouz ◽

Hamid Zand ◽

Katayoun Pourvali

Keyword(s):

Glycemic Index ◽

Diabetes Management ◽

Glycemic Load ◽

Insulin Response ◽

Diet Therapy ◽

Current Data ◽

Diabetic Patients ◽

Carbohydrate Counting ◽

Insulin Requirements ◽

Insight Into

Background: Despite efforts to control hyperglycemia, diabetes management is still challenging. This may be due to focusing on reducing hyperglycemia and neglecting the importance of hyperinsulinemia; while insulin resistance and resultant hyperinsulinemia preceded diabetes onset and may contribute to disease pathogenesis. Objective: The present narrative review attempts to provide a new insight into the management of diabetes by exploring different aspects of glycemic index and dietary insulin index. Results: The current data available on this topic is limited and heterogeneous. Conventional diet therapy for diabetes management is based on reducing postprandial glycemia through carbohydrate counting, choosing foods with low-glycemic index and low-glycemic load. Since these indicators are only reliant on the carbohydrate content of foods and do not consider the effects of protein and fat on the stimulation of insulin secretion, they cannot provide a comprehensive approach to determine the insulin requirements. Conclusion: Selecting foods based on carbohydrate counting, glycemic index or glycemic load are common guides to control glycemia in diabetic patients, but neglect the insulin response, thus leading to failure in diabetes management. Therefore, paying attention to insulinemic response along with glycemic response seems to be more effective in managing diabetes.

Download Full-text