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Abstract

Low-fat diets produce spontaneous weight loss in the research setting, but as a public health strategy, they have been disappointing. Insulin resistance and impairments in insulin secretory function leading to postprandial hyperglycaemia are now common, making the current context greatly different to that of 25 years ago. There is increasing evidence that reducing the proportion of energy derived from carbohydrate or reducing the glycaemic index (GI) of the carbohydrate improves the rate of fat loss and cardiovascular risk factors. The proposed mechanisms include higher satiety, higher metabolic rate, reduced postprandial glycaemia and/or insulinaemia and higher fat oxidation. Although dietary glycaemic load can be reduced either by lowering the GI of the carbohydrate or by reducing carbohydrate energy, the metabolic and physiological consequences are not the same. Exchanging high for low-GI foods, without changing the macronutrient ratio, may be optimal because it is simple, cost-effective and often associated with higher intake of whole grains and greater food volume, and factors that maximize the chance of sustained weight loss. Healthy low-GI diets allow for moderate intakes of sugars, including sweetened dairy foods, fruits and confectionery items, and can be easily adapted for individuals of different ethnicities, vegetarians and low-income groups.Keywords: glycaemic index, glycaemic load, carbohydrate, weight loss, insulin resistance
REVIEW
Low-glycaemic index diets and body weight regulation
J McMillan-Price and J Brand-Miller
Human Nutrition Unit, School of Molecular and Microbial Biosciences, The University of Sydney, NSW, Australia
Low-fat diets produce spontaneous weight loss in the research setting, but as a public health strategy, they have been
disappointing. Insulin resistance and impairments in insulin secretory function leading to postprandial hyperglycaemia are now
common, making the current context greatly different to that of 25 years ago. There is increasing evidence that reducing the
proportion of energy derived from carbohydrate or reducing the glycaemic index (GI) of the carbohydrate improves the rate of
fat loss and cardiovascular risk factors. The proposed mechanisms include higher satiety, higher metabolic rate, reduced
postprandial glycaemia and/or insulinaemia and higher fat oxidation. Although dietary glycaemic load can be reduced either by
lowering the GI of the carbohydrate or by reducing carbohydrate energy, the metabolic and physiological consequences are not
the same. Exchanging high for low-GI foods, without changing the macronutrient ratio, may be optimal because it is simple,
cost-effective and often associated with higher intake of whole grains and greater food volume, and factors that maximize the
chance of sustained weight loss. Healthy low-GI diets allow for moderate intakes of sugars, including sweetened dairy foods,
fruits and confectionery items, and can be easily adapted for individuals of different ethnicities, vegetarians and low-income
groups.
International Journal of Obesity (2006) 30, S40–S46. doi:10.1038/sj.ijo.0803491
Keywords: glycaemic index; glycaemic load; carbohydrate; weight loss; insulin resistance
Introduction
Both quantity and quality of carbohydrate are central to the
debate surrounding the optimal diet for body weight
regulation. Over the past two decades, higher carbohydrate
intake, particularly of refined and high-glycaemic index (GI)
carbohydrate, has accompanied increases in obesity, type 2
diabetes and the metabolic syndrome.
1–3
Although temporal
associations do not prove cause-and-effect, the Western
high-carbohydrate diet with its abundance of high-GI foods
may not be optimal in populations with varying degrees of
insulin resistance and beta-cell dysfunction.
4,5
Individuals
with severe insulin resistance or type 2 diabetes find
sustained weight loss difficult.
6
The relationship of the GI
and dietary glycaemic load (GL, the product of the GI and
carbohydrate content) to the development and progression
of chronic diseases is controversial.
7,8
Clinicians and health
professionals remain sceptical, calling for greater scientific
evidence on which to base advice to patients. The accelerat-
ing obesity epidemic, together with the striking results of
animal studies comparing long-term effects of high-GI and
low-GI diets,
9
make the task of resolving the debate more
pressing.
The GI and GL
The GI is a system of ranking the glycaemic potential of the
carbohydrates in different foods. It was first proposed as an
alternative means of classifying carbohydrate-containing
foods in 1981
10
and defined by its in vivo methodology, that
is, as the blood glucose response of a 50-g carbohydrate
portion of food, expressed as a percentage for the same
amount of carbohydrate from a reference food.
11
In vitro
measures of rate of digestion while helpful in some contexts,
cannot be used as true measures of the GI.
12
In 1997, the
Food and Agriculture Organization (FAO) of the United
Nations and the World Health Organization convened an
expert consultation on carbohydrates in human nutrition,
involving scientists from 13 countries. The subsequent
recommendations passed to member countries stated that
the GI could be employed as a useful indicator of the impact
of foods on blood glucose, but that it should be used to
compare foods of similar macronutrient composition within
food groups and for clinical applications including diabetes
and impaired glucose tolerance.
13
Major diabetes associa-
tions, including Diabetes UK,
14
the Canadian Diabetes
Association
15
and Diabetes Australia,
16
recommend judi-
cious use of the GI. More recently, the American Diabetes
Association recognized that the use of the GI ‘can provide an
additional benefit over that observed when total carbohy-
drate is considered alone’.
17
Beyond diabetes, the application
Correspondence: Professor J Brand-Miller, School of Molecular and Microbial
Biosciences (G08), University of Sydney, NSW, 2006, Australia.
E-mail: j.brandmiller@mmb.usyd.edu.au
International Journal of Obesity (2006) 30, S40– S46
&
2006 Nature Publishing Group All rights reserved 0307-0565/06
$
30.00
www.nature.com/ijo
of the GI to weight control,
18
sports performance,
19
cardiovascular disease
20
and cancer prevention
21,22
is con-
troversial and is the subject of ongoing research.
Although the GI compares the glycaemic potential of
foods gram-for-gram of carbohydrate, the overall blood
glucose response to a serving of food is determined by both
the quantity and quality (GI) of carbohydrate.
23
Dietary GL,
defined as the GI/100 g of carbohydrate, has therefore been
proposed as a measure of the overall blood glucose- and
insulin-raising potential of the diet. By definition, dietary GL
can be reduced in two ways – either by lowering the GI of the
carbohydrate or by reducing the total carbohydrate in the
diet. Both the methods can reduce postprandial glucose and
insulin responses, but are likely to have different metabolic
effects both acutely and in the long term.
24
GI and weight control
The application of the GI to weight regulation is relatively
recent but already vigorously debated.
25,26
Proponents argue
that several features of low-GI foods are potentially bene-
ficial for weight control. They include the ability to promote
satiety and delay hunger, reduce fluctuations in glycaemia
and insulinaemia, promote higher rates of fat oxidation and
minimize declines in metabolic rate during energy restric-
tion. As Campfield and Smith
27
established that ‘dynamic’
falls in blood glucose influenced meal initiation in both
animals and humans, the satiating qualities of low-GI foods
may be more closely related to slower rates of digestion and
absorption in the gut, rather than postprandial glycaemia per
se.
28
Raw and partially gelatinized starches (in legumes,
whole grains and pasta) are more slowly digested than fully
gelatinized starches (in most breads and breakfast cereals).
29
As a consequence, partially digested food particles can reach
lower parts of the ileum where they stimulate the secretion
of satiety signals such as glucagon like peptide-1(GLP-1).
30
Many sugary foods containing sucrose, fructose and/or
lactose have relatively low-GI values, not because they are
slowly digested, but because the component sugars fructose
and galactose have minimal effect on glycaemia. Hence
weight-for-weight of carbohydrate, a food based on sucrose
(or equimolar mixture of glucose and fructose) will have a
lower GI than the one based on rapidly digested starch (a
glucose polymer) such as cornflakes.
31
The satiating and
metabolic characteristics of low-GI sugary foods will vary
from those of low-GI starchy foods. In practice, however, it is
difficult to tease out the separate effects of GI, palatability,
volume, fibre and other factors that influence satiety
responses to realistic meals.
When food appearance and nutrient content have been
matched as closely as possible, low-GI solid foods induce
greater satiety than their high-GI counterparts, and are
followed by less energy intake at subsequent meals.
32
Jimenez-Cruz and Gutierrez-Gonzalez
33
showed that a low-
compared to a high-GI lunch resulted in a higher satiety
perception in people with type 2 diabetes. Agus et al.
34
reported a greater energy intake from snacks on days 7 and 8,
following 6 days of an energy-restricted high- compared to
low-GI diet. Warren et al.
35
found that low-GI foods eaten at
breakfast had a significant impact on food intake at lunch in
normal and overweight children. Our group showed that
progressive refining of whole-wheat grains resulted in a step-
by-step increase in the food’s GI rating and a reciprocal
decrease in satiety.
36
Similarly, mixed meals with low-GI
values were found to induce greater secretion of cholecysto-
kinin, a gut peptide associated with satiation, and more
fullness over a 180-min period.
37
Over the course of a week,
overweight men were found to reduce spontaneously their
intake by 25% when fed ad libitum combined low GI and
high protein, low-fat diet.
38
Not all studies have reported
higher satiety after low-GI foods. Indeed, Anderson et al.
39
demonstrated the reverse, that is, higher satiety 60 min after
consumption of high-GI solutions compared with low-GI
solutions. Alfenas and Mattes
40
reported no effect of GI/GL
on either glycaemic response or appetite, but their study has
been criticized on methodological grounds.
41,42
In a review
of 16 studies, Ludwig
32
concluded that low-GI foods
increased satiety or delayed return of hunger or decreased
ad libitum food intake in all but one study.
It has been suggested that the GI influences subsequent
food intake by altering the availability of fuel sources in the
postprandial period. Following a high-GI meal, hyperinsuli-
naemia, along with low plasma glucagon, stimulates the
uptake of glucose and fatty acids into muscle, fat and liver
cells, whereas simultaneously suppressing lipolysis. Conse-
quently, circulating levels of the two major metabolic fuels,
glucose and fatty acids, are reduced. This in turn may lead to
a rise in counter-regulatory hormones, that stimulate hunger
and promote eating.
43
Differences in GI are known to dictate differences in fuel
partitioning and oxidation during rest and exercise.
44,45
Stevenson et al.
46
measured substrate metabolism in a 3-h
rest period following breakfast and lunch of either low- or
high-GI. They confirmed that glucose and insulin responses
following both meals were significantly lower, and the total
amount of fat oxidized during the 3–-h rest period was
significantly higher in the low-GI compared to the high-GI
trial. The same research group previously reported signifi-
cantly higher fat oxidation during exercise, following a low-
GI compared to high-GI breakfast
47
and in a more recent
study, a low-GI breakfast contributed less carbohydrate to
glycogen stores than a high-GI breakfast, but there was a
better preservation of glycogen during subsequent exercise,
most likely as a result of higher fat oxidation.
48
This has
implications not only for athletes aiming for maximal
performance, but also for the recreational exerciser aiming
for weight control.
Physiologically, these results can be explained: high-GI
meals produce larger glycaemic and insulinaemic responses,
which in turn produce a greater increase in carbohydrate
Low-glycaemic index diets and body weight regulation
J McMillan-Price and J Brand-Miller
S41
International Journal of Obesity
oxidation via rapid activation of key rate-limiting enzymes.
Meanwhile intermediates of glucose oxidation, such as
malonyl-CoA, strongly inhibit fatty-acid transport into
mitochondria, resulting in decreased fatty-acid oxidation.
49
Longer exposure to chronic hyperglycaemia and hyperinsu-
linaemia results in decreased expression of the rate-limiting
enzymes and alters the potential for fat oxidation. A reduced
capacity to oxidize fatty acids has been found in obese
insulin-resistant humans
50
and obesity-prone rats,
51
and
several prospective studies have linked lower rates of fat
oxidation with greater weight gain.
52,53
It has further been
suggested that the counter-regulatory hormone response
following a high-GI meal may also have a proteolytic effect
and increase the loss of lean body mass over time. This in
turn may affect resting energy expenditure (REE). Agus
et al.
34
reported less of a fall in REE during weight loss, with a
low- compared to a high-GI diet; and recently Pereira et al.
54
showed a blunted fall in REE after 10% weight loss was
achieved following a low-GL as opposed to low-fat diet,
despite similar changes in the body composition.
The effects of GI on metabolic changes can more easily be
quantified in animal models, where the GI of the diet can be
tightly controlled with no change in other dietary factors.
After 18 weeks, rats fed a high-GI diet, compared to those fed
a low-GI diet, had approximately 40% more body fat and
almost 10% less lean mass, despite similar body weight; and
mice on a high-GI diet had almost twice the body fat of those
on a low-GI diet after only 9 weeks.
55
Earlier studies found a
high-GI diet-stimulated fatty-acid synthase and lipogenesis
in normal and, to a lesser extent, diabetic rats;
56
whereas a
low-GI diet decreased glucose incorporation into lipids and
adipocyte diametre in both normal and diabetic rats.
57
Population studies provide further evidence that the
glycaemic effect of the diet might influence body fat stores
in humans. In an observational study of 572 healthy
American adults, body mass index (BMI) was found to be
positively associated with the GI of the carbohydrate, but
not with carbohydrate intake (grams or % energy (E)) or
GL.
58
Similarly, in the EURODIAB Complications Study of
nearly 3000 adults with type 1 diabetes, a lower GI of the diet
predicted lower waist-to-hip ratio and waist circumference in
men, independent of carbohydrate, fat and fibre.
59
Intervention studies
Clinical trials published in the last few years provide support
for the hypothesis that low GI diets improve weight loss and/
or fat metabolism. Spieth et al.
60
compared the effects of a
low-GI diet with an energy restricted, low-fat diet in the
management of paediatric obesity. Significantly more pa-
tients in the low-GI group achieved a decrease in BMI of at
least 3 kg/m
2
in just over 4 months. Similarly Ebbeling et al.
61
showed that an ad libitum, reduced-GL diet was more
effective over 12 months at reducing both BMI and body
fat in obese adolescents than a conventional energy
restricted, low-fat diet. A recent study in Austrian obese
adults advised to follow a high carbohydrate, low-GI diet for
24 weeks, reported significant reductions in body fat and
unusually small losses in lean mass, with good adherence to
the diet.
62
Although the diet was not directly compared to
any other, the mean weight loss reported (8.9 kg) after 24
weeks was exactly that of the high-protein group in Skov
et al.’s
63
study with similar fat mass reduction. The latter
reported a mean loss of only 5.1 kg in a high-carbohydrate
group. Finally, Pittas et al.
64
found that overweight adults
with relatively greater insulin secretion in response to a
glucose challenge lost more weight when assigned to a low-
GL hypocaloric diet for 24 weeks, but there was no
differential effect of diet in individuals who had relatively
lower insulin secretion.
Shorter-term studies have shown an effect of GI on weight
or body composition. A 5-week low-GI, compared to a high-
GI, diet resulted in a significant decrease of B700 g in body
fat and a tendency to increase lean mass without any change
in body weight in healthy men;
65
and in a cross-over study
comparing the effects of four diets (high-fat, low-GI, high-
sucrose and high-GI) over 24 days, despite being adviced to
maintain an identical energy intake, there was significant
weight loss only on the low GI.
66
Not all studies have shown improved weight loss with a
low-GI diet. Ebbeling et al.
67
compared a low-GI diet with a
conventional energy- and fat-restricted diet over 12 months
(6 months intensive intervention and 6 months follow-up)
in obese young adults. Body weight in both groups had
decreased significantly at 6 months (8.4 and 7.8%,
respectively) and weight loss was reasonably maintained
well at 12 months with no significant differences between
the groups at either time point (although there were
differences in other cardio-vascular risk factors in favour of
the low-GI diet). Similarly, whereas there were benefits of a
low-GI, compared to high-GI, diet in reducing risk factors
for ischaemic heart disease, there was no significant
improvement in weight loss or body composition found in
a 10-week study of healthy, overweight women.
68
In a
comparison of three reduced-energy diets varying in GI and
GL (high-GI/high-GL, low-GI/low-GL and high-fat/low-GL/
high-GI), weight loss was found to be independent of diet
composition.
69
Methodological issues might explain the failure to detect
differences between high- and low-GI diets. In the latter
study, body composition was estimated using skin-fold
measurements, a difficult procedure in obese subjects. When
energy intake is markedly reduced or strictly controlled,
differences in weight loss are unlikely to be detected. Finally,
the calculated GI and GL of the diets may not reflect real
differences between the diets.
Diets in which protein intake is increased at the expense of
carbohydrate intake also reduce dietary GL and postprandial
glycaemia and insulinaemia, whereas increasing satiety and
rate of weight loss.
70,71
However, no published studies have
Low-glycaemic index diets and body weight regulation
J McMillan-Price and J Brand-Miller
S42
International Journal of Obesity
compared the relative efficacy of high-protein and low-GI
diets for weight loss. Recently, we conducted a 12-week
intervention in 129 overweight adults who were randomly
assigned to one of the four ad libitum diets of varying
protein, carbohydrate and GI, but similar fat (30% E) and
fibre content. Diet 1 was a low-fat diet with 55% E as
carbohydrate, Diet 2 was a low-GI version of Diet 1; Diet 3
was a high-protein diet with 25% E as protein and 45% as
carbohydrate; Diet 4 was a low-GI version of Diet 3. Most
foods were provided and dietary adherence was excellent.
Although all four groups lost modest amounts of weight, the
proportion that lost 45% body weight varied significantly
by Diet: 31, 56, 66 and 33% in the Diet groups 1, 2, 3 and 4,
respectively (P¼0.011). Differences were stronger in women,
particularly for body fat loss (3.170.4, 4.970.6,
4.870.4, 3.670.7, respectively, P¼0.007). Despite
equivalent weight loss, total and low-density lipoprotein
(LDL)-cholesterol increased significantly on the high pro-
tein, high-GI diet (Diet 3) compared with the fall on the
high-carbohydrate, low-GI diet (Diet 2, P¼0.013). Changes
in glucose homeostasis as determined by homeostasis model
assessment (HOMA) did not vary significantly by the diet.
Thus, both high-protein and low-GI diets increased the rate
of body fat loss, but a high-protein diet may have adverse
effects unless carbohydrate quality is considered.
GI and cardiovascular disease
Irrespective of weight loss, low-GI diets are often associated
with improved cardiovascular risk factors, implying differ-
ences in lipid metabolism. In the Nurses’ Health Study
72
of
approximately 75 000 women in the US, GL was directly
associated with risk of coronary heart disease (CHD) after
adjustment for known risk factors. The relative risk in the
highest compared to lowest quintile of GL was almost the
double. Furthermore, classifying carbohydrates by their GI,
as opposed to the conventional simple–complex classifica-
tion, was shown to be a better predictor of CHD risk. These
associations were even stronger for women with a BMI X23.
An inverse relationship was found between GI and GL, and
high-density lipoprotein (HDL)-cholesterol in a US study of
almost 14 000 adults, regardless of sex or BMI;
73
in women in
the Nurses’ Health Study;
74
and in Europeans with type 1
diabetes.
75
GI was the only dietary variable significantly
related to HDL-cholesterol in a study of middle-aged British
adults.
76
Although high-carbohydrate diets have been asso-
ciated with higher triacylglycerides (TG), the evidence
suggests that not all carbohydrates act in the same way.
The findings from the Nurses’ Health Study showed a strong
positive association between GL and TG, with both GI and
carbohydrate contributing independently to the association,
which was strengthened in women with high BMI.
74
In the
two studies in obese young adults of 1-year duration, a low-
GL diet was shown to be more effective at lowering TG than
a conventional low-fat, energy-restricted diet.
54,77
A short-
term (6 days) study showed that a low-GI low-fat high-
protein diet, compared to phase 1 of the American Heart
Association (AHA) diet, reduced TG by 35% and increased
LDL peak diametre.
38
Not all studies have found such relationships. The
Zutphen Elderly Study of elderly men in the Netherlands
found no relationship between GI and risk of CHD, nor with
the blood levels of cholesterol, HDL-cholesterol, TAG,
insulin or glucose.
78
In an Italian case–control study of
non-diabetic subjects with a first episode of non-fatal acute
myocardial infarction, GI was associated with increased risk
only in those aged X60 years and the overweight.
79
GI and GL may increase the risk of CHD in a number of
ways. Although hyperglycaemia has long been known to
increase the risk of cardiovascular disease in people with
diabetes, the effect of high-blood glucose levels in healthy
people without diabetes was not recognized until recently. A
meta-analysis of prospective studies found that postchal-
lenge blood glucose level even in the non-diabetic range had
a linear relationship with cardiovascular disease risk, and the
risk appeared to be higher in women.
80
Glucose ‘spikes’
induce oxidative stress and protein glycation, both factors
causing damage over the long term to the vascular system.
81
GI may influence disease risk through effects on insulin
sensitivity. Low-GI diets have been shown to improve insulin
sensitivity in subjects with CHD,
82,83
diabetes
84
and obe-
sity.
85
A high-GI diet has been shown to increase postpran-
dial insulin resistance.
66
In lean young subjects, however,
low-GI diets had little or no effect on insulin sensitivity as
determined by the euglycaemic, hyperinsulinaemic clamp.
86
Finally, a high-GI diet may increase the risk of cardio-
vascular disease by exacerbating the proinflammatory
process. High sensitivity C-reactive protein (hs-CRP) is a
sensitive marker for systemic inflammation and has been
shown in several large prospective studies to be related to an
increased risk of ischaemic heart disease. In the Women’s
Health Study, dietary GL was found to be significantly and
positively associated with plasma hs-CRP, independent of
conventional risk factors.
87
The association was stronger in
overweight women than the normal weight subjects. In an
intervention study, CRP levels improved more after weight
loss on a low-GL diet compared to a low-fat diet.
54
Dietary fibre
High-fibre diets are increasingly associated with favourable
effects on body weight regulation, partly through effects on
insulin sensitivity. In young adults, low-fibre consumption
predicted higher 10-year weight gain, waist-to-hip ratio, and
2-h post-glucose insulin levels (a measure of insulin
resistance) to a greater extent than did total or saturated
fat consumption.
88
The Inter99 Study
89
from Denmark
reported an inverse relationship between dietary fibre and
Low-glycaemic index diets and body weight regulation
J McMillan-Price and J Brand-Miller
S43
International Journal of Obesity
insulin resistance, but no such association was found with GI
or GL. Although fibre and GI are not precisely related,
viscous dietary fibres and foods in which the natural cell wall
architecture remains intact (e.g. legumes) are associated with
lower GI values.
90
In these cases, it is impossible to separate
an effect of fibre per se from any purported effect of lowering
postprandial glycaemia. It is likely that at least part of the
beneficial effect of high-fibre diets in observational and
intervention studies may be due to their ability to slow the
carbohydrate absorption. Unfortunately, the dietary assess-
ment methods used in most of the large-scale epidemiolo-
gical studies have been designed to estimate fibre
consumption, but not the GI. Outside Australia and Canada,
the lack of reliable GI values for the vast majority of cereal
foods may lead to inaccurate coding of the food database.
Conclusions
Low-fat and high-carbohydrate diets produced spontaneous
weight loss in the research setting, but as a public health
strategy, they have been disappointing. Postprandial hyper-
glycaemia, insulin resistance and impairments in insulin
secretory function are now common, even in the young,
making the current context greatly different to that which
existed 25 years ago. Identifying simple, cost-effective diet-
ary strategies for prevention and management is a matter of
urgency. Intervention studies are showing that reducing the
proportion of energy derived from carbohydrate or reducing
the GI of the carbohydrate improves either the rate of weight
loss or cardiovascular risk factors, including total and LDL-
cholesterol and insulin sensitivity. The proposed mechan-
isms include higher satiety, higher metabolic rate, reduced
postprandial glycaemia and/or insulinaemia and higher fat
oxidation.
Although dietary GL can be reduced by various strategies
(e.g. lowering the GI of the carbohydrate or reducing
carbohydrate intake at the expense of higher protein or fat
intake), the metabolic and physiological consequences may
vary. Reducing the GI of the carbohydrate without changing
the macronutrient ratio is arguably the optimal strategy
because it is simple (‘that for that’) and often matched with
higher intake of wholegrain (with coincident micronutri-
ents), greater food volume and higher satiety; factors that
minimize the chance of weight regain. Low-GI diets allow for
moderate intakes of sugars, including sweetened dairy foods,
fruits and confectionery items that increase the acceptability
of any diet. Moreover, low-GI diets are ethnically and
culturally sensitive and easily adopted by vegetarians and
low-income groups.
Most importantly, low-GI diets appear to ‘press the right
emotional buttons,’ motivating individuals to adopt a diet
that not only ‘controls’ blood glucose levels but is coin-
cidentally healthy. Although high-fibre diets have limited
appeal, low-GI diets have proved popular in many countries.
Unscientific terminology such as ‘sugar-highs, sugar-lows,’
‘fuller for longer,’ ‘slow-release energy,’ ‘sustained energy,’
may be scorned by scientists but are concepts that have
intrinsic appeal to members of the public. In Australia, the
media has played an important role in popularizing the GI
and handled the science and practicalities of low-GI diets
responsibly.
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... It leads to the decrease of glucose and fatty acid in circulation ad stimulate the increase of hormone indicating hunger and make the consumer keep consuming food. 29 This phenomenon is following the study conducted in Iran in 2015 that high consumption of SSBs can increase central obesity risk as 35%. 8 Physical inactivity is one of the factors of central obesity prevalence. ...
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Background: Several risk factors for central obesity include high Sugar-sweetened Beverages (SSBs) intake, lack of physical activity, and lack of sleep duration. High fructose corn syrup, the sweetener used in SSBs, increase body weight because of the bad effect of insulin secretion and leptin release. The fructose from this beverage can increase visceral adiposity accumulation. Objectives: This study aimed to analyze the intake of Sugar-sweetened Beverages (SSBs), physical activity, and sleep duration as risk factors for central obesity among women in the reproductive Age Methods: This study used case-control design consists of 38Subjects in case and control groups. All women were in childbearing age (20-29 years) selected using a simple random sampling technique. The data taken were weight, height, waist circumference, and hip circumference. Food intake and sugar-sweetened beverage intake were obtained by using Semi-Quantitative Food Frequency (SQ-FFQ) questionnaire. Physical activity data were obtained using the International Physical Activity Questionnaire (IPAQ) questionnaire. Sleep duration data were obtained using the Pittsburgh Sleep Quality Index (PSQI). Chi-Square test and logistic regression were used to analyze the data. Results: There were a significant relationship between Sugar Sweetened Beverages intake (p = 0.002, OR =5.926), energy intake of SSBs (p = 0.035, OR = 2.979) physical activity (p = 0.035, OR = 0.3111), duration of morning sleep / afternoon (p = 0.000; OR = 9.44) and sleep duration (p = 0.028, OR = 4.42) with central obesity. But there were no significant relationship between energy intake (p = 0.375), carbohydrates (p = 0.1), protein (p = 0.3), fat (p = 0.1) and fibers with central obesity. Conclusion: High intake of sugar-sweetened beverages, short duration of night's sleep and the duration>2 hours/day of a long day sleep are risk factors for increasing the incidence of central obesity among Women in reproductive Age.
... The results indicated that reducing the GI and the percentage carbohydrate and increasing the protein and fat calories increased the glomerular filtration rate and improved biomarkers of renal disease. Another group studied the effect of GI and GL of carbohydrates on the risk for CVD 43 . Overweight or obese adults were assigned either to one of the four diets with reduced-fat and high-fibre content for a duration of 12 wk. ...
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Dietary carbohydrates form the major source of energy in Asian diets. The carbohydrate quantity and quality play a vital function in the prevention and management of diabetes. High glycaemic index foods elicit higher glycaemic and insulinaemic responses and promote insulin resistance and type 2 diabetes (T2D) through beta-cell exhaustion. This article reviews the evidence associating dietary carbohydrates to the prevalence and incidence of T2D and metabolic syndrome (MS) in control of diabetes and their role in the complications of diabetes. Cross-sectional and longitudinal studies show that higher carbohydrate diets are linked to higher prevalence and incidence of T2D. However, the association seems to be stronger in Asian-Indians consuming diets high in carbohydrates and more marked on a background of obesity. There is also evidence for high carbohydrate diets and risk for MS and cardiovascular disease (CVD). However, the quality of carbohydrates is also equally important. Complex carbohydrates such as brown rice, whole wheat bread, legumes, pulses and green leafy vegetables are good carbs. Conversely, highly polished rice or refined wheat, sugar, glucose, highly processed foods such as cookies and pastries, fruit juice and sweetened beverages and fried potatoes or French fries are obviously 'bad' carbs. Ultimately, it is all a matter of balance and moderation in diet. For Indians who currently consume about 65-75 per cent of calories from carbohydrates, reducing this to 50-55 per cent and adding enough protein (20-25%) especially from vegetable sources and the rest from fat (20-30%) by including monounsaturated fats (e.g. groundnut or mustard oil, nuts and seeds) along with a plenty of green leafy vegetables, would be the best diet prescription for the prevention and management of non-communicable diseases such as T2D and CVD.
... Hal ini menyebabkan makan secara berlebihan dan peningkatan sintesis massa lemak tubuh. 12 Massa lemak tubuh yang besar berhubungan dengan kadar leptin yang tinggi serta kejadian menarche yang lebih awal. Leptin berperan dalam pematangan fungsi organ reproduksi atau disebut gonadarche dan meningkatkan sekresi androgen adrenal atau disebut adrenarche. ...
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Latar Belakang : Angka kejadian menarche dini makin meningkat beberapa tahun terakhir. Menarche yang terlalu dini meningkatkan risiko penyakit degeneratif. Asupan sugar-sweetened beverage berlebih menyebabkan tingginya kadar hormon seks dan IGF-1 di sirkulasi dan mempercepat menarche. Massa lemak tubuh yang besar berhubungan dengan kadar leptin yang tinggi serta kejadian menarche yang lebih awal. Penelitian bertujuan mengetahui hubungan asupan sugar-sweetened beverage dan massa lemak tubuh dengan kejadian menarche dini.Metode : Desain penelitian case control dengan jumlah sampel 20 anak perempuan pada setiap kelompok yang berusia 10,1-11,9 tahun dipilih secara consecutive sampling. Data asupan sugar-sweetened beverage dan asupan zat gizi diperoleh menggunakan Semi Quantitative Food Frequency Questionaire (SQFFQ), massa lemak tubuh dengan persamaan regresi berdasarkan indeks massa tubuh, usia, dan jenis kelamin, dan aktivitas fisik dengan Physical Activity Questionnaire for Children (PAQ-C). Data dianalisis dengan uji Chi-Square dan uji regresi logistik ganda.Hasil : Terdapat hubungan asupan sugar-sweetened beverage (p <0,001), massa lemak tubuh (p 0,003), asupan kalsium (p 0,020), dan aktivitas fisik (p 0,016) dengan kejadian menarche dini. Uji multivariat menunjukkan bahwa hanya asupan sugar-sweetened beverage yang berpengaruh terhadap kejadian menarche dini (p 0,007).Simpulan : Asupan sugar-sweetened beverage dan massa lemak tubuh berhubungan dengan kejadian menarche dini. Asupan sugar-sweetened beverage merupakan faktor risiko kejadian menarche dini.
... In an observational study on 572 healthy individuals, a positive association was found between BMI and glycemic index of carbohydrates. Ebbeling et al., in his study showed that a reduced glycemic load diet was found to be more effective at reducing both BMI and body fat over a period of 12 months, when compared to conventional energy-restricted, low-fat diet [13]. Vol. 6, Issue 4, pp: (137-141), Month: October -December 2018, Available at: www.researchpublish.com ...
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Healthy diet and lifestyle modifications are paramount for weight management in obese individuals. The purpose of this case study was to determine the effect of an Integrated Approach, that includes diet and lifestyle modifications, on the body weight of a morbidly obese individual. The subject of this case study was a 34-year old man who presented with 43% body fat and a BMI of 47.1 kg/m 2. Upon reviewing the case history, the doctor decided to treat the subject for a period of 9 months using the Integrated Approach that included nutritional therapy, ayurvedic herb support, vitamins, minerals, dietary supplements, regular exercise and lifestyle modifications. Modifications to lifestyle and food plan were made by the nutritionist following each weekly visit based on the subject's progress. With the Integrated Approach the patient managed a 18% reduction in his body fat, in addition to experiencing relief from acidity and constipation. His weight reduced from 137.2 kg to 67.5 kg in 1 year and 9 months.
... Moreover, they do not have the negative health effects of CHO restriction. More studies must be performed to understand effect on glycogen storeging and performance in athletes (68). High calcium intake, as in high diary diets, seems to be inversely related to BMI, body fat and obesity although no changes in body composition have been reported. ...
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Nutritional science is increasingly seen in sports practice as an instrument capable of influencing the performance, recovery and gene expression of the athlete. Vice versa, the performance itself is able to modify human metabolism and the use of substrates for energy purposes. Since even small changes are important for the athlete, nutritional science must be considered a precision medicine in which standardized protocols apply to the needs of the individual athlete (based on the type of sport, the frequency of training and its intensity, the goals in terms of weight and muscle mass) in order to minimize measurement errors. The study of the baseline composition of the athlete’s body is essential to build up a nutritional plan that follows the athlete before, during and after competition, with the aim of optimizing performance and preventing the onset of fatigue. The purpose of this review is to sum up the most recent guidelines, underlining the key points of the current state of art on the best strategies to achieve specific goals in terms of changes or maintenance of body weight, preparing adequately the athlete for competition and encouraging recovery, with a brief mention to the psycho-behavioral dimension that nutrition acquires in sports practice.
... Therefore, the less sweet, refreshing, and pleasant milk preload may have contributed to incomplete compensation at the subsequent meal. Furthermore, high glycemic carbohydrates have been shown to be associated with a reduced appetite and food intake in the very short term (eg, 1 h), whereas lower glycemic carbohydrates showed a more delayed effect on the perception of satiety (eg, 2-3 h) (44,45). We found a linear relation between the glucose content of the preloads and AUC plasma glucose concentrations. ...
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Background: It is unclear whether energy-containing drinks, especially those sweetened with high-fructose corn syrup (HFCS), promote positive energy balance and thereby play a role in the development of obesity. Objective: The objective was to examine the satiating effects of HFCS and sucrose in comparison with milk and a diet drink. Design: The effects of 4800-mL drinks containing no energy or 1.5 MJ from sucrose, HFCS, or milk on satiety were assessed, first in 15 men and 15 women with a mean (±SD) body mass index (BMI; in kg/m²) of 22.1 ± 1.9 according to visual analogue scales (VAS) and blood variables and second in 20 men and 20 women (BMI: 22.4 ± 2.1) according to ingestion of a standardized ad libitum meal (granola cereal + yogurt, 10.1 kJ/g). Results: Fifty minutes after consumption of the 1.5-MJ preload drinks containing sucrose, HFCS, or milk, 170%-mm VAS changes in satiety were observed. Glucagon-like peptide 1 (GLP-1) (P < 0.001) and ghrelin (P < 0.05) concentrations changed accordingly. Compensatory energy intake did not differ significantly between the 3 preloads and ranged from 30% to 45%. Energy intake compensations were related to satiety (r = 0.35, P < 0.05). No differences were observed between the effects of the sucrose- and HFCS-containing drinks on changes in VAS and on insulin, glucose, GLP-1, and ghrelin concentrations. Changes in appetite VAS ratings were a function of changes in GLP-1, ghrelin, insulin, and glucose concentrations. Conclusion: Energy balance consequences of HFCS-sweetened soft drinks are not different from those of other isoenergetic drinks, eg, a sucrose-drink or milk.
... Le régime à bas IG augmente la sensation de satiété (71), diminue la glycémie post prandiale, donne un meilleur résultat sur le métabolisme et l'augmentation de l'oxydation des graisses (72). ...
Thesis
L’éducation thérapeutique du patient est un processus continu passant par l’apprentissage d’informations sur une pathologie chronique, permettant ainsi un meilleur contrôle de celle-ci. Dans le cas du diabète, il concerne surtout l’enseignement sur l’alimentation. Lors d’une consultation de médecine générale, le temps imparti permet difficilement de prodiguer des conseils diététiques. Le but de cette étude est d'évaluer si une information donnée sous forme de fiche alimentaire, associée à un conseil minimal, permettait de changer le comportement alimentaire des patients diabétiques de type 2, d'améliorer ainsi leur observance, et d’améliorer les paramètres clinico-biologiques dont l’hémoglobine glyquée. Il s’agit d’une étude descriptive quantitative avec évaluation avant et après intervention. L’échantillon a été recruté dans les cabinets de médecine générale de Haute-Normandie et parmi les patients âgés de 30-80 ans, non insulinodépendants et n'ayant bénéficié d'aucune modification de traitement durant l'étude. Après récupération du questionnaire rempli par le patient, une fiche alimentaire lui est remise. Le second questionnaire a été délivré lors de la consultation de suivi à 3 mois. Au vue du faible échantillonnage, on ne peut conclure significativement. Néanmoins on retrouve une évolution du comportement alimentaire, mais sans amélioration significative de l’hémoglobine glyquée. Ces résultats dépendent non seulement de la taille de l’échantillon étudié, mais surtout de la volonté propre au patient à vouloir ce changement. Il est intéressant de noter une corrélation entre l’amélioration de l’hémoglobine glyquée et l’observance déclarée.
Chapter
Obesity is a chronic, often progressive disease, with a complex web of psychological, social, and biological factors underpinning why people overeat, struggle to be active, and gain excess body weight and adiposity. As such its management is not simply about eating less and exercising more, rather there is a need to understand the drivers to excess weight gain with comprehensive assessment identifying modifiable factors. Multicomponent programmes including dietary treatment, physical activity, and behaviour modification are more effective than interventions focusing on one aspect alone (Avenell et al. 2004). Rather than one superior dietary intervention there are a range of effective evidence-based treatments that can be matched to patient preferences and the presence and/or severity of comorbid disease. Behavioural modification focuses on patient-centred care, incorporating motivational, behavioural, and cognitive elements and recognizes that nurse’s attitudes and skills can have a profound effect on patient outcomes.
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utilization during subsequent exercise muscle glycogen storage at rest but augments its Ingestion of a high-glycemic index meal increases You might find this additional information useful...2/707#BIBL 1 other HighWire hosted article: This article has been cited by [PDF] [Full Text] [Abstract] , August 1, 2006; 84 (2): 354-360. Am. J. utilization during subsequent exercise in women Influence of high-carbohydrate mixed meals with different glycemic indexes on substrate including high-resolution figures, can be found at: Updated information and services http://jap.physiology.org/cgi/content/full/99/2/707 can be found at: Journal of Applied Physiology about Additional material and information http://www.the-aps.org/publications/jappl This information is current as of August 7, 2006 .. those papers emphasizing adaptive and integrative mechanisms. It is published 12 times a year (monthly) by the American publishes original papers that deal with diverse areas of research in applied physiology, especially
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