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Division of Endocrinology, Children’s Hospital, Boston, MA 02115
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONThe glycemic indexLow fat vs. low...Effects of GI on...ObesitySUMMARYREFERENCES |
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KEY WORDS: • glycemic index • obesity • diet • dietary carbohydrate • blood glucose
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONThe glycemic indexLow fat vs. low...Effects of GI on...ObesitySUMMARYREFERENCES |
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), the American Heart Association (1996)
and the American Diabetes Association (1997)
recommend a low fat diet to prevent and treat obesity.
However, the effect of dietary fat on body fat has been questioned in
recent years (Katan et al. 1997
, Larson et al. 1996
, Willett 1998
). Epidemiologic studies do
not show consistently that high levels of dietary fat promote weight
gain (Kant et al. 1995
, Larson et al. 1996
, Ludwig et al 1999a
, Nicklas 1995
), and weight loss with consumption of low fat diets is
characteristically modest and transient (Katan et al. 1997
, Lissner and Heitmann 1995
). Moreover, mean
fat intake in the United States has decreased since the 1960s, from
42% to ~34% of dietary energy (Lenfant and Ernst 1994
, Nicklas 1995
, Stephen and Wald 1990
), whereas the prevalence of overweight has risen to 1 in 4
children and 1 in 2 adults (Flegal et al. 1998
,
Troiano and Flegal 1998
). These observations suggest
that dietary factors other than fat play an important role in body
weight regulation. |
The glycemic index |
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TOPABSTRACTINTRODUCTIONThe glycemic indexLow fat vs. low...Effects of GI on...ObesitySUMMARYREFERENCES |
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). GI is defined as the
area under the glucose response curve after consumption of 50 g
carbohydrate from a test food divided by the area under the curve after
consumption of 50 g carbohydrate from a control food, either white
bread or glucose (Wolever et al. 1991
). Over the past
two decades, the GI of most commonly consumed
carbohydrate-containing foods has been measured
(Foster-Powell and Miller 1995
).
Many factors together, including carbohydrate type, fiber, protein,
fat, food form and method of preparation, determine the GI of a
particular food (Bjorck et al. 1994
, Estrich et al. 1967
, Welch et al. 1987
, Wolever et al. 1991
). Contrary to common belief, carbohydrate digestion
rate, and therefore glycemic response, is not related to saccharide
chain length. For example, Wahlqvist and colleagues demonstrated
similar changes in blood glucose, plasma insulin and plasma fatty acid
concentrations after consumption of glucose as a monosaccharide,
disaccharide, oligosaccharide or polysaccharide (starch)
(Wahlqvist et al. 1978
). In fact, sugar may have a lower
GI than some "complex carbohydrates" (Foster-Powell and Miller 1995
) as demonstrated by an improvement in glycemic
control among subjects with Type 1 diabetes mellitus after isoenergetic
substitution of sucrose for starch (Rickard et al. 1998
). In general, refined grain products and potato have a
high GI, exceeding that of table sugar by up to 50%, whereas most
vegetables, fruits and legumes have a low GI.
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Low fat vs. low GI |
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TOPABSTRACTINTRODUCTIONThe glycemic indexLow fat vs. low...Effects of GI on...ObesitySUMMARYREFERENCES |
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, Popkin et al. 1992
,
Stephen et al. 1995
). The carbohydrate that replaces fat
in low fat diets is typically high in GI. According to data from the
Department of Agriculture, >80% of the carbohydrate consumed by
children ages 2–18 y would have a GI equal to or greater than that of
table sugar (Subar et al. 1998
). Moreover, carbohydrate
absorption rate (and therefore GI) is increased after a low fat meal
because fat acts to delay gastric emptying (Estrich et al. 1967
, Welch et al. 1987
). Thus, the GI of the
American diet has probably increased in recent years. Might this
increase have contributed to the rising prevalence of obesity? |
Effects of GI on appetite |
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TOPABSTRACTINTRODUCTIONThe glycemic indexLow fat vs. low...Effects of GI on...ObesitySUMMARYREFERENCES |
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). For example, Leathwood and Pollet (1988)
found lower
blood glucose levels and slower return of hunger after meals with bean
puree (a low GI starch) compared with meals with potato (a high GI
starch). Holt and colleagues showed that glycemic and insulinemic
responses to various breakfast cereals are inversely related to satiety
score (Holt et al. 1992
). In fact, all but one of these
16 studies demonstrated increased satiety, delayed return of hunger or
decreased ad libitum food intake after low compared with high GI foods.
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). The low GI meal was a vegetable omelet with fruit, the
medium GI meal was "steel-cut" oatmeal (a preparatory method that
slows digestion rate) and the high GI meal was "instant" oatmeal.
The medium and high GI meals were composed of similar foods to control
for the effects of other potentially confounding dietary factors,
whereas the low GI meal was designed to increase the range of GI in the
study beyond that that could be achieved by manipulating food structure
alone. Subjects included 12 obese teenage boys, at least 120% of ideal
body weight, but otherwise in good health. After the test breakfasts, area under the blood glucose curve differed between the high, medium and low GI meals as expected [284, 141 and 76.6 (mmol·min)/L, respectively]. The rapid absorption of glucose from the high GI meal resulted in relatively high insulin and low glucagon concentrations. These hormonal changes would be expected to promote uptake of glucose in muscle, liver and fat tissue, restrain hepatic release of glucose and inhibit lipolysis. As a consequence, access to the two major metabolic fuels was effectively impaired in the postabsorptive period, as shown by a "reactive hypoglycemia" (difference in glucose nadir of -0.5 mmol/L, P = 0.02) and lower free fatty acid concentrations 3 to 5 h after the high compared with the low GI meals. Subjects also consumed significantly more energy after the high GI (5.8 MJ) compared with the medium GI (3.8 MJ, P < 0.05) or the low GI (3.2 MJ, P = 0.01) test lunches.
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Obesity |
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TOPABSTRACTINTRODUCTIONThe glycemic indexLow fat vs. low...Effects of GI on...ObesitySUMMARYREFERENCES |
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, Jenkins et al. 1987
, Wolever and Bolognesi 1996
). The functional hyperinsulinemia associated
with high GI diets may promote weight gain by preferentially directing
nutrients away from oxidation in muscle and toward storage in fat.
Cusin and colleagues reported that rats pretreated with insulin showed
increased glucose utilization in white adipose tissue, but decreased
utilization in muscle, changes that were associated with increased food
intake and weight gain (Cusin et al. 1992
). In humans,
high acute insulin secretion after intravenous glucose tolerance tests
predicts weight gain among glucose-tolerant offspring of parents
with diabetes mellitus (Sigal et al. 1997
). Pima Indian
children with elevated fasting insulin levels gain prospectively more
weight than those children with normal insulin levels (Odeleye et al. 1997
). Indeed, excessive weight gain is recognized to be
a complication of insulin treatment in Type 2 diabetes mellitus (UK Prospective Diabetes Study Group 1998
) and intensive insulin
treatment in Type I diabetes mellitus (Diabetes Control and Complication Trial Group 1988
). Thus, hormonal responses to a high GI
diet appear to lower circulating levels of metabolic fuels, stimulate
hunger and favor storage of fat, events that may promote excessive
weight gain. |
SUMMARY |
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TOPABSTRACTINTRODUCTIONThe glycemic indexLow fat vs. low...Effects of GI on...ObesitySUMMARYREFERENCES |
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The optimal diet for the prevention and treatment of obesity, if one
exists, remains to be determined. In particular, the effects of GI on
body weight regulation must be explored in long-term clinical
trials. Nevertheless, a growing body of theoretical and experimental
work suggests that diets designed to lower the insulin response to
ingested carbohydrate (e.g., low GI) may improve access to stored
metabolic fuels, decrease hunger, and promote weight loss. Such a diet
would contain abundant quantities of vegetables, fruits and legumes,
moderate amounts of protein and healthful fats, and decreased intake of
refined grain products, potato and concentrated sugars (Fig. 1
). Indeed, this diet bears a close resemblance to that consumed by human
ancestors over the last several hundred thousand years (Eaton and Konner 1985
). Finally, reductions in dietary GI may also
lower the risks for various conditions associated with
hyperinsulinemia, such as diabetes mellitus (Salmeron et al. 1997
) and cardiovascular disease (Frost et al. 1999
, Jenkins et al. 1985
, Lamarche et al. 1998
).
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FOOTNOTES |
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2 Supported by grants from the Charles H. Hood Foundation, the Children’s Hospital League and the National Institutes of Health (1K08 DK02440).
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TOPABSTRACTINTRODUCTIONThe glycemic indexLow fat vs. low...Effects of GI on...ObesitySUMMARYREFERENCES |
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