Post on 24-Apr-2018
Glycemic Index: History and Clinical Application
David J.A. Jenkins
Clinical Nutrition & Risk Factor Modification Center St. Michael’s Hospital;
Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario,
Canada
Oldways Preservation Trust, Boston, MA – A not for profit organization promoting traditionally “healthy” ways of eating (eg. Mediterranean Diet, etc.) H
Agriculture and Agrifoods Canada (AAFC) – SAB Canadian Agriculture Policy Institute (CAPI) – SAB Canadian Institute of Health Research (CIHR) – G Canadian Foundation for Innovation (CFI) –G Pulse Canada - SAB Saskatchewan Pulse Growers – SAB Ontario Research Fund (ORF) – G Advanced Foods and material Network (AFMNet) – G International Tree Nut Council Nutrition Research and Education Foundation
and the Peanut Institute – G, H Almond Board of California, Modesto, CA – A branch of the USDA (therefore
“not for Profit”) to promote the use of almonds. C,H,G
C = Consultancies; H = Honorarium; SAB = Scientific Advisory Boards; G = Grants
Conflict of Interest
• Barilla, Italy – A general food company. Producer of pasta and baked goods. G • Haine Celestial, CA – One of the largest Health Food companies in the US. G • Loblaws Supermarkets – Canada’s largest supermarket chain.G, SAB Sanitarium Company, Sydney, Australia – Australia’s largest health food manufacturing
company and soy food producer. G, SAB The Coco Cola sugar Advisory Board . C, H,SAB Griffin Hospital, New Haven- For the development of the Nuval System. C, H, SAB Abbott Laboratories, Algorithms for Diabetes Management. C, H, SAB Unilever - Canada – Guidelines for the management of hyperlipidemia. G,C,H Wife and is a Director of Glycemic Index Laboratories, Toronto, CA – Financial relationship
of a spouse The California Strawberry Commission, Watsonville, CA – Another USDA not for profit
group to explore possible health benefits and to promote the use of strawberries. SAB Kellogg’s, Canada – C, H, SAB Quaker Oats, Canada-C, H, SAB
C = Consultancies; H = Honorarium; SAB = Scientific Advisory Boards; G = Grants
Conflict of Interest
1981 - 1st Glycemic Index Paper1
1995 - 1st International GI Tables2
1997 - Concept of Glycemic Load3,4
(GI x CH2O) 1995- - Demonstration of the importance of 2007 BMI/Insulin resistance as a
determinant of relevance of GI/GL5,6,7,8 1) Jenkins DJ, et al. Am J Clin Nutr. 1981 Mar;34(3):362-6.
2) Foster-Powell K, Miller JB. Am J Clin Nutr. 1995 Oct;62(4):871S-890S. 3) Salmerón J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC. JAMA. 1997 Feb 12;277(6):472-7. 4) Salmerón J, Ascherio A, Rimm EB, Colditz GA, Spiegelman D, Jenkins DJ, Stampfer MJ, Wing AL, Willett WC. Diabetes Care. 1997 Apr;20(4):545-50. 5) Wolever TM, Bentum-Williams A, Jenkins DJ. Diabetes Care.1995 Jul;18(7):962-70. 6) Liu S, Willett WC, Stampfer MJ, Hu FB, Franz M, Sampson L, Hennekens CH, Manson JE. Am J Clin Nutr. 2000 Jun;71(6):1455-61. 7) Wolever TM, Mehling C. BJN. 2002 87:477-487. 8) Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, Ludwig DS. JAMA. 2007 May 16;297(19):2092-102.
GI: Evolution of the Concept
Copyright ©2008 The Endocrine Society
Ford, E. S. et al. J Clin Endocrinol Metab 2008;93:s1-s8
Trends in the prevalence of obesity (BMI >= 30 kg/m2) among U.S. adults aged 18 yr or older, Behavioral Risk Factor Surveillance System (BRFSS)
OBESITY
Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1990, 1995 and 2001
1990 1995
2001
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).
No Data <4% 4%-6% 6%-8% 8%-10% >10%
DIABETES
Diabetes on the Rise
Current prevalence of Diabetes worldwide % of Popula7on with diabetes
Diabetes on the Rise
% of Popula7on with diabetes Prevalence of Diabetes in 2030 worldwide
Intensive Glycemic Control in Type 2 Diabetes on CHD Risk
Turnbull FM et al Diabetologia. 2009 (11):2288-98.
Glycemic Index/ Load
Salmeron et al. JAMA 1997;277:472-7
Glycemic Load and Cereal Fiber Intake in Women And Risk of Type II Diabetes
(75,000 Nurses over 10y)
Glycemic Load & T2DM in Adults
Livesey et al. Am J Clin Nutr 2013;97:584–96.
Livesey et al. Am J Clin Nutr 2013;97:584–96.
Adjustments to:
SEX= 50% Men, 50% Women
CORR= Dietary instrument validity centered on a correlation of 0.70
FUY= Follow-up to 10 years
ETH= Ethnicity to 50% European and American 50% other ethnicities
Glycemic Load & T2DM in Adults after adjustments
Pooled Risk Estimate for CHD comparing highest to lowest GL quantiles
Study or Subgroup WeightRelative Risk
IV, Random, 95% CIRelative Risk
IV, Random, 95% CI
Relative Risk
GL & CHD Risk
Mirrahimi A, Jenkins D et. al. JAHA 2012;1:e000752
Ma X, et al. Atherosclerosis; 223 (2012): 491-496
GI and CVD
Barclay et al. Am J Clin Nutr. 2008
Meta-Analysis of GI & Common Cancers
Choi Y, Giovannucci E, and Lee JE. British Journal of Nutrition (2012), 108, 1934–1947
GI and Diabetes-Related Cancers Significant
Choi Y, Giovannucci E, and Lee JE. British Journal of Nutrition (2012), 108, 1934–1947
GI and Diabetes-Related Cancers Non-Significant
Acarbose Viscous Fibers Low glycemic foods
Slow Release Carbohydrate
Chiasson J-L, Josse RG, Hanefeld M, et al. JAMA 2003;346:393.
CVD Events
Acarbose
↓ 49% RR
STOP-NIDDM Trial
STOP-NIDDM Trial
Chiasson J-L, Josse RG, Hanefeld M, et al. JAMA 2003;346:393.
Hypertension
(new cases)
Acarbose
↓ 34% RR
GI & Diabetes Management Meta-analysis
Brand-Miller et al. Diabetes Care. 2003
Favours low GI Favours High GI
Goff L, D.E. Cowland, L. Hooper, G.S. Frost. Nutrition, Metabolism & Cardiovascular Diseases (2013) 23, 1e10
GI & LDL-C
0
5
10
15
20
25
Admission Low GI High GI
PAI-1
act
ivity
(U/m
l)
Jarvi AE, et al. Diabetes Care 1999;22:10-8.
Mean ± sd 22.2 ± 14.7 9.4 ± 11.0 20.2 ± 16.1
** ***
Glycemic Index and Thrombosis PAI-1
Jensen et al. Am J Clin Nutr.2008
GI and Thrombosis PAI-1
Wk0 Wk10 Wk0 Wk10 High GI Low GI
PAI-1 activity (U/mL)
0
2
4
6
8
10
12
14
Liu et al. Am J Clin Nutr 2002;75:492-8
BMI > 25
BMI < 25
Glycemic Load and CRP at High and Low BMI
-0.2
0.0
0.2
0.4
Time×Diet: p=0.084 -3
0
3
6A1c
High GI Low GI Low Carb
0 3 6 9 12
-0.3
0.0
0.3
0.6
Time×Diet: p=0.041 -4
0
4
8Fasting Glucose
Months
Res
idua
ls(%
)(m
mol
/L)
Percentage of B
aseline
High GI & Fiber
Low GI
Low Carb
Wolever et al., Am J Clin Nutr 2008;87:114 –25.
CRP on High and Low GI Diets
SLOTH
GLUTTONY
RX = Diets for Fat People
Liu, Willett, Stampfer, Hu, Franz, Sampson, Hennekens, Manson. Am J Clin Nutr. 2000 Jun;71(6):1455-61.
Multivariate RR of CHD according to body mass index (BMI) and Glycemic load (GL): 10y of
follow-up in the Nurses Health Study (n=65,000)
Ebbeling CB… Ludwig DS. JAMA. 2007 May 16;297(19):2092-102.
Insulin Response Determines Weight Loss
Valtuena S et. al. Am J Clin Nutr 2006;84:136-42
FATTY LIVER (NAFL) and GI
Effect of a Low GL Diet vs. a High Fiber Diet on %HbA1c over 3 Months
Data are presented as ITT mean treatment difference in HbA1c ±SEM, P-values define the significance between treatments using LS means . IR= Insulin Resistance, IR Risk Factors were defined as the following baseline values: HbA1c≥7.2 (median baseline value of the cohort); HDL-C ≤1.3mmol/L for women and ≤1.0mmol/L for men; Triglyceride ≥ 1.7mmol/L; Systolic blood pressure ≥130mmHg or diastolic blood pressure ≥85mmHg ; Waist Circumference ≥88 for women and ≥102 for men; Age ≥ 58 (median age of cohort).
-‐0.80
-‐0.70
-‐0.60
-‐0.50
-‐0.40
-‐0.30
-‐0.20
-‐0.10
0.00
All Par2cipants ≥1 IR Risk Factor
≥2 IR Risk Factors
≥3 IR Risk Factors
≥4 IR Risk Factors
≥5 IR Risk Factors
Betw
een Treatm
ent D
ifferen
ce
(%Hb
A1c Unit)
P= 0.076 P= 0.076 P= 0.117
P= 0.084
P= 0.017
P= 0.002
n=141 n=140 n=121
n=78
n=34
n=18
Ajala et al. Am J Clin Nutr. 2013
Low GI compared to other diets for T2DM
Collaborators: Dr. Livia Augustin Dr. Russell de Souza Dr. Cyril Kendall Dr. Alexandra Jenkins Dr. John Sievenpiper Dr. Vladimir Vuksan Dr. Thomas Wolever Graduate Students: Laura Chiavaroli Arash Mir-rahimi Stephanie Nishi Kristie Srichaikul
Acknowledgements
Staff: Sonia Blanco Judy Coveney Dorothea Faulkner Christopher Ireland Sandy Mitchell Melanie Paquette Darshna Patel Sandhya Sahye-Pudaruth