title: Targeting dietary fat or glycemic load in the treatment of obesity and type 2 diabetes: a randomized controlled trial. Altering source or amount of dietary carbohydrate has acute and chronic effects on postprandial glucose and triglycerides in type 2 diabetes: Canadian trial of Carbohydrates in Diabetes (CCD). A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Effects of a reduced-glycemic-load diet on body weight, body composition, and cardiovascular disease risk markers in overweight and obese adults. Reduced glycemic index and glycemic load diets do not increase the effects of energy restriction on weight loss and insulin sensitivity in obese men and women. Effects of an ad libitum low-glycemic load diet on cardiovascular disease risk factors in obese young adults. An 18-mo randomized trial of a low-glycemic-index diet and weight change in Brazilian women. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Glycemic index of foods: a physiological basis for carbohydrate exchange. Association between dietary glycemic index, glycemic load, and high-sensitivity C-reactive protein. Effects of a low-glycemic load vs low-fat diet in obese young adults: a randomized trial. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Effect of a low glycemic load on body composition and Homeostasis Model Assessment (HOMA) in overweight and obese subjects. Effect of changing the amount and type of fat and carbohydrate on insulin sensitivity and cardiovascular risk: the RISCK (Reading, Imperial, Surrey, Cambridge, and Kings) trial1234 Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. A low-glycemic index diet and exercise intervention reduces TNF(alpha) in isolated mononuclear cells of older, obese adults. Glycemic index, glycemic load, and the risk of acute myocardial infarction in Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study. A randomized clinical trial comparing low-glycemic index versus ADA dietary education among individuals with type 2 diabetes. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Dietary Fiber, Glycemic Load, and Risk of NIDDM in Men The Effect of Increasing Consumption of Pulses and Wholegrains in Obese People: A Randomized Controlled Trial A low-glycemic load diet reduces serum C-reactive protein and modestly increases adiponectin in overweight and obese adults. Preliminary report: the effect of a 6-month dietary glycemic index manipulation in addition to healthy eating advice and weight loss on arterial compliance and 24-hour ambulatory blood pressure in men: a pilot study. Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial. Postprandial Hyperglycemia and Glycemic Variability
abstract: AIMS To compare the effects of lifestyle modification programs that prescribe low-glycemic load ( GL ) vs. low-fat diets in a r and omized trial . METHODS Seventy-nine obese adults with type 2 diabetes received low-fat or low-GL dietary instruction , delivered in 40-week lifestyle modification programs with identical goals for calorie intake and physical activity . Changes in weight , HbA(1c ) , and other metabolic parameters were compared at weeks 20 and 40 . RESULTS Weight loss did not differ between groups at week 20 ( low-fat : -5.7±3.7 % ; low-GL : -6.7±4.4 % , p=.26 ) or week 40 ( low-fat : -4.5±7.5 % ; low-GL : -6.4±8.2 % , p=.28 ) . Adjusting for changes in antidiabetic medications , subjects on the low-GL diet had larger reductions in HbA(1c ) than those on the low-fat diet at week 20 ( low-fat : -0.3±0.6 % ; low-GL : -0.7±0.6 % , p=.01 ) , and week 40 ( low-fat : -0.1±1.2 % ; low-GL : -0.8±1.3 % ; p=.01 ) . Groups did not differ significantly on any other metabolic outcomes ( p≥.06 ) . CONCLUSIONS Results suggest that targeting GL , rather than dietary fat , in a low-calorie diet can significantly enhance the effect of weight loss on HbA(1c ) in patients with type 2 diabetes BACKGROUND AND AIMS Nutrition recommendations for type 2 diabetes ( T2DM ) are partly guided by the postpr and ial responses elicited by diets varying in carbohydrate ( CHO ) . We aim ed to explore whether long-term changes in postpr and ial responses on low-glycemic-index ( GI ) or low-CHO diets were due to acute or chronic effects in T2DM . METHODS AND RESULTS Subjects with diet-alone-treated T2DM were r and omly assigned to high-CHO/high-GI ( H ) , high-CHO/low-GI ( L ) , or low-CHO/high-monounsaturated-fat ( M ) diets for 12-months . At week-0 ( Baseline ) postpr and ial responses after H-meals ( 55 % CHO , GI = 61 ) were measured from 0800 h to 1600 h. After 12 mo subjects were r and omly assigned to H-meals or study diet meals ( L , 57 % CHO , GI = 50 ; M , 44 % CHO , GI = 61 ) . This yielded 5 groups : H diet with H-meals ( HH , n = 34 ) ; L diet with H- ( LH , n = 17 ) or L-meals ( LL , n = 16 ) ; and M diet with H- ( MH , n = 18 ) or M meals ( MM , n = 19 ) . Postpr and ial glucose fluctuations were lower in LL than all other groups ( p < 0.001 ) . Changes in postpr and ial-triglycerides differed among groups ( p < 0.001 ) . After 12 mo in HH and MM both fasting- and postpr and ial-triglycerides were similar to Baseline while in MH postpr and ial-triglycerides were significantly higher than at Baseline ( p = 0.028 ) . In LH , triglycerides were consistently ( 0.18 - 0.34 mmol/L ) higher than Baseline throughout the day , while in LL the difference from Baseline varied across the day from 0.04 to 0.36 mmol/L ( p < 0.001 ) . CONCLUSION Low-GI and low-CHO diets have both acute and chronic effects on postpr and ial glucose and triglycerides in T2DM subjects . Thus , the composition of the acute test-meal and the habitual diet should be considered when interpreting the nutritional implication s of different postpr and ial responses BACKGROUND Little is known about the effects of the amount and type of carbohydrates on risk of coronary heart disease ( CHD ) .  OBJECTIVE The objective of this study was to prospect ively evaluate the relations of the amount and type of carbohydrates with risk of CHD . DESIGN A cohort of 75521 women aged 38 - 63 y with no previous diagnosis of diabetes mellitus , myocardial infa rct ion , angina , stroke , or other cardiovascular diseases in 1984 was followed for 10 y. Each participant 's dietary glycemic load was calculated as a function of glycemic index , carbohydrate content , and frequency of intake of individual foods reported on a vali date d food-frequency question naire at baseline . All dietary variables were up date d in 1986 and 1990 . RESULTS During 10 y of follow-up ( 729472 person-years ) , 761 cases of CHD ( 208 fatal and 553 nonfatal ) were documented . Dietary glycemic load was directly associated with risk of CHD after adjustment for age , smoking status , total energy intake , and other coronary disease risk factors . The relative risks from the lowest to highest quintiles of glycemic load were 1.00 , 1.01 , 1 . 25 , 1.51 , and 1.98 ( 95 % CI : 1.41 , 2.77 for the highest quintile ; P for trend < 0.0001 ) . Carbohydrate classified by glycemic index , as opposed to its traditional classification as either simple or complex , was a better predictor of CHD risk . The association between dietary glycemic load and CHD risk was most evident among women with body weights above average ¿ ie , body mass index ( in kg/m(2 ) ) > /= 23 . CONCLUSION These epidemiologic data suggest that a high dietary glycemic load from refined carbohydrates increases the risk of CHD , independent of known coronary disease risk factors BACKGROUND Lowering the dietary glycemic load and increasing protein intake may be advantageous for weight management . OBJECTIVE This r and omized controlled trial was design ed to evaluate the effects of an ad libitum reduced-glycemic-load ( RGL ) diet on body weight , body composition , and cardiovascular disease ( CVD ) risk markers in overweight and obese adults during an initial weight-loss phase ( 12 wk ) and a weight-loss maintenance phase ( weeks 24 - 36 ) . DESIGN Subjects were assigned to  RGL ( n = 43 ) or low-fat , portion-controlled ( control ; n = 43 ) diet groups . The RGL group was instructed to eat until satisfied , maintaining a low carbohydrate intake during weeks 0 - 2 and adding low-glycemic-index carbohydrate thereafter . Control subjects were instructed to reduce fat intake and decrease portion sizes , with a targeted energy deficit of 500 to 800 kcal/d . RESULTS The RGL group had lost significantly more weight than did the control group at week 12 ( -4.9 and -2.5 kg , respectively ; P = 0.002 ) , but the 2 groups did not differ significantly at week 36 ( -4.5 and -2.6 kg , respectively ; P = 0.085 ) . Changes in fat mass differed between the groups at week 12 ( -1.9 and -0.9 kg , respectively ; P = 0.016 ) but not at week 36 ( -2.0 and -1.3 kg , respectively ; P = 0.333 ) . At the end of the study , no differences were found in responses for CVD risk markers except a larger mean change in HDL cholesterol in the RGL group than in the control group ( 3.8 and 1.9 mg/dL , respectively ; P = 0.037 ) . CONCLUSION These findings provide evidence that an ad libitum RGL diet is a reasonable alternative to a low-fat , portion-controlled eating plan for weight management Reducing the dietary glycemic load and the glycemic index was proposed as a novel approach to weight reduction . A parallel- design , r and omized 12-wk controlled feeding trial with a 24-wk follow-up phase was conducted to test the hypothesis that a hypocaloric diet design ed to reduce the glycemic load and the glycemic index would result in greater sustained weight loss than other hypocaloric diets . Obese subjects ( n = 29 ) were r and omly assigned to 1 of 3 diets providing 3138 kJ less than estimated energy needs : high glycemic index ( HGI ) , low glycemic index ( LGI ) , or high fat ( HF ) . For the first 12 wk , all food was provided to subjects ( feeding phase ) . Subjects ( n = 22 ) were instructed to follow the assigned diet for 24 additional weeks ( free-living phase ) . Total body weight was obtained and body composition was assessed by skinfold measurements . Insulin sensitivity was assessed by the homeostasis model ( HOMA ) . At 12 wk , weight changes from baseline were significant in all groups but not different among groups ( -9.3 + /- 1.3 kg for the HGI diet , -9.9 + /- 1.4 kg for the LGI diet , and -8.4 + /- 1.5 kg for the HF diet ) . All groups improved in insulin sensitivity at the end of the feeding phase of the study . During the free-living phase , all groups maintained their initial weight loss and their improved insulin sensitivity . Weight loss and improved insulin sensitivity scores were independent of diet composition . In summary , lowering the glycemic load and glycemic index of weight reduction diets does not provide any added benefit to energy restriction in promoting weight loss in obese subjects BACKGROUND The optimal nutritional approach for the prevention of cardiovascular disease among obese persons remains a topic of intense controversy . Available approaches range from conventional low-fat to very-low-carbohydrate diets . OBJECTIVE The aim of this pilot study was to evaluate the efficacy of an ad libitum low-glycemic load diet , without strict limitation on carbohydrate intake , as an alternative to a conventional low-fat diet . DESIGN A r and omized controlled trial compared 2 dietary treatments in obese young adults ( n = 23 ) over 12 mo . The experimental treatment emphasized ad libitum consumption of low-glycemic-index foods , with 45 - 50 % of energy from carbohydrates and 30 - 35 % from fat . The conventional treatment was restricted in energy ( 250 - 500 kcal/d deficit ) and fat ( < 30 % of energy ) , with 55 - 60 % of energy from carbohydrate . We compared changes in study outcomes by repeated- measures analysis of log-transformed data and expressed the results as mean percentage change . RESULTS Body weight decreased significantly over a 6-mo intensive intervention in both the experimental and conventional diet groups ( -8.4 % and -7.8 % , respectively ) and remained below baseline at 12 mo ( -7.8 % and -6.1 % , respectively ) . The experimental diet group showed a significantly greater mean decline in plasma triacylglycerols than did the conventional diet group ( -37.2 % and -19.1 % , respectively ; P = 0.005 ) . Mean plasminogen activator inhibitor 1 concentrations decreased ( -39.0 % ) in the experimental diet group but increased ( 33.1 % ) in the conventional diet group ( P = 0.004 ) . Changes in cholesterol concentrations , blood pressure , and insulin sensitivity did not differ significantly between the groups . CONCLUSION An ad libitum low-glycemic load diet may be more efficacious than a conventional , energy-restricted , low-fat diet in reducing cardiovascular disease risk BACKGROUND Despite interest in the glycemic index diets as an approach to weight control , few long-term evaluations are available . OBJECTIVE The objective was to investigate the long-term effect of a low-glycemic-index ( LGI ) diet compared with that of a high-glycemic-index ( HGI ) diet ; all other dietary components were equal . DESIGN After a 6-wk run-in , we r and omly assigned 203 healthy women [ body mass index ( in kg/m2 ) : 23 - 30 ] aged 25 - 45 y to an LGI or an HGI diet with a small energy restriction . The primary outcome measure was weight change at 18 mo . Secondary outcomes included hunger and fasting insulin and lipids . RESULTS Despite requiring a run-in and the use of multiple incentives , only 60 % of the subjects completed the study . The difference in glycemic index between the diets was approximately 35 - 40 units ( 40 compared with 79 ) during all 18 mo of follow-up , and the carbohydrate intake from energy remained at approximately 60 % in both groups . The LGI group had a slightly greater weight loss in the first 2 mo of follow-up ( -0.72 compared with -0.31 kg ) , but after 12 mo of follow-up both groups began to regain weight . After 18 mo , the weight change was not significantly different ( P = 0.93 ) between groups ( LGI : -0.41 kg ; HGI : -0.26 kg ) . A greater reduction was observed in the LGI diet group for triacylglycerol ( difference = -16.4 mg/dL ; P = 0.11 ) and VLDL cholesterol ( difference = -3.7 mg/dL ; P = 0.03 ) . CONCLUSIONS Long-term weight changes were not significantly different between the HGI and LGI diet groups ; therefore , this study does not support a benefit of an LGI diet for weight control . Favorable changes in lipids confirmed previous results BACKGROUND The optimal source and amount of dietary carbohydrate for managing type 2 diabetes ( T2DM ) are unknown . OBJECTIVE We aim ed to compare the effects of altering the glycemic index or the amount of carbohydrate on glycated hemoglobin ( HbA1c ) , plasma glucose , lipids , and C-reactive protein ( CRP ) in T2DM patients . DESIGN Subjects with T2DM managed by diet alone ( n=162 ) were r and omly assigned to receive high-carbohydrate , high-glycemic-index ( high-GI ) , high-carbohydrate , low-glycemic-index ( low-GI ) , or low-carbohydrate , high-monounsaturated-fat ( low-CHO ) diets for 1 y. RESULTS The high-GI , low-GI , and low-CHO diets contained , respectively , 47 % , 52 % , and 39 % of energy as carbohydrate and 31 % , 27 % , and 40 % of energy as fat ; they had GIs of 63 , 55 , and 59 , respectively . Body weight and HbA1c did not differ significantly between diets . Fasting glucose was higher ( P=0.041 ) , but 2-h postload glucose was lower ( P=0.010 ) after 12 mo of the low-GI diet . With the low-GI diet , overall mean triacylglycerol was 12 % higher and HDL cholesterol 4 % lower than with the low-CHO diet ( P<0.05 ) , but the difference in the ratio of total to HDL cholesterol disappeared by 6 mo ( time x diet interaction , P=0.044 ) . Overall mean CRP with the low-GI diet , 1.95 mg/L , was 30 % less than that with the high-GI diet , 2.75 mg/L ( P=0.0078 ) ; the concentration with the low-CHO diet , 2.35 mg/L , was intermediate . CONCLUSIONS In subjects with T2DM managed by diet alone with optimal glycemic control , long-term HbA1c was not affected by altering the GI or the amount of dietary carbohydrate . Differences in total : HDL cholesterol among diets had disappeared by 6 mo . However , because of sustained reductions in postpr and ial glucose and CRP , a low-GI diet may be preferred for the dietary management of T2DM The determine the effect of different foods on the blood glucose , 62 commonly eaten foods and sugars were fed individually to groups of 5 to 10 healthy fasting volunteers .  Blood glucose levels were measured over 2 h , and expressed as a percentage of the area under the glucose response curve when the same amount of carbohydrate was taken as glucose . The largest rises were seen with vegetables ( 70 + /- 5 % ) , followed by breakfast cereals ( 65 + /- 5 % ) , cereals and biscuits ( 60 + /- 3 % ) , fruit ( 50 + /- 5 % ) , dairy products ( 35 + /- 1 % ) , and dried legumes ( 31 + /- 3 % ) . A significant negative relationship was seen between fat ( p less than 0.01 ) and protein ( p less than 0.001 ) and postpr and ial glucose rise but not with fiber or sugar content OBJECTIVE This study examined the relation between quality of dietary carbohydrate intake , as measured by glycemic index ( GI ) and glycemic load ( GL ) , and serum high-sensitivity C-reactive protein ( hs-CRP ) levels . METHODS During a 1-y observational study , data were collected at baseline and at each quarter thereafter . GI and GL were calculated from multiple 24-h dietary recalls ( 24HRs ) , 3 r and omly selected 24HRs at every quarter , with up to 15 24HRs per participant . The  hs-CRP was measured in blood sample s collected at baseline and each of the four quarterly measurement points . Multivariable linear mixed models were used to examine the cross-sectional and longitudinal associations of GI , GL , and hs-CRP . RESULTS Among 582 adult men and women with at least two measurements of diet and hs-CRP , average daily GI score ( white bread = 100 ) was 85 and average GL was 198 , and average hs-CRP was 1.84 mg/L. Overall , there was no association between GI or GL and hs-CRP . Subgroup analyses revealed an inverse association between GL and hs-CRP  among obese individuals ( body mass index > or = 30 kg/m(2 ) ) . CONCLUSION Quality of dietary carbohydrates does not appear to be associated with serum hs-CRP levels .  Among obese individuals , higher dietary GL appears to be related to lower hs-CRP levels . Due to the limited number of studies on this topic and their conflicting results , further investigation is warranted CONTEXT The results of clinical trials involving diet in the treatment of obesity have been inconsistent , possibly due to inherent physiological differences among study participants . OBJECTIVE To determine whether insulin secretion affects weight loss with 2 popular diets . DESIGN , SETTING , AND PARTICIPANTS R and omized trial of obese young adults ( aged 18 - 35 years ; n = 73 ) conducted from September 2004 to December 2006 in Boston , Mass , and consisting of a 6-month intensive intervention period and a 12-month follow-up period . Serum insulin concentration at 30 minutes after a 75-g dose of oral glucose was determined at baseline as a measure of insulin secretion . Outcomes were assessed at 6 , 12 , and 18 months . Missing data were imputed conservatively . INTERVENTIONS A low-glycemic load ( 40 % carbohydrate and 35 % fat ) vs low-fat ( 55 % carbohydrate and 20 % fat ) diet . MAIN OUTCOME MEASURES Body weight , body fat percentage determined by dual-energy x-ray absorptiometry , and cardiovascular disease risk factors . RESULTS Change in body weight and body fat percentage did not differ between the diet groups overall . However , insulin concentration at 30 minutes after a dose of oral glucose was an effect modifier ( group x time x insulin concentration at 30 minutes : P = .02 for body weight and P = .01 for body fat percentage ) . For those with insulin concentration at 30 minutes above the median ( 57.5 microIU/mL ; n = 28 ) , the low-glycemic load diet produced a greater decrease in weight ( -5.8 vs -1.2 kg ; P = .004 ) and body fat percentage ( -2.6 % vs -0.9 % ; P = .03 ) than the low-fat diet at 18 months . There were no significant differences in these end points between diet groups for those with insulin concentration at 30 minutes below the median level ( n = 28 ) . Insulin concentration at 30 minutes after a dose of oral glucose was not a significant effect modifier for cardiovascular disease risk factors . In the full cohort , plasma high-density lipoprotein cholesterol and triglyceride concentrations improved more on the low-glycemic load diet , whereas low-density lipoprotein cholesterol concentration improved more on the low-fat diet . CONCLUSIONS Variability in dietary weight loss trials may be partially attributable to differences in hormonal response . Reducing glycemic load may be especially important to achieve weight loss among individuals with high insulin secretion . Regardless of insulin secretion , a low-glycemic load diet has beneficial effects on high-density lipoprotein cholesterol and triglyceride concentrations but not on low-density lipoprotein cholesterol concentration . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00130299 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE The aim of this study was to compare the effects of different glycemic load diets on biochemical data and body composition , in overweight and obese subjects , during a 6-month period . RESEARCH DESIGN AND METHODS This study was an experimental , r and omized , parallel design . Anthropometric measurements and biochemical data were measured at baseline at 3 and at 6 months . All subjects completed 3-day dietary intake diaries at the baseline period and during the third and the sixth months . At the sixth month , LGL group had a mean intake of 1,360 ± 300 kcal/day and the high glycemic load group ( HGL ) had a mean intake of 1,544 ± 595 kcal/day . RESULTS LGL group obtained a weight reduction of 4.5 % ( p = 0.006 ) and the HGL group of 3.0 % ( p = 0.18 ) . Significant reductions in waist circumference ( 5 % , p = 0.001 ) of the LGL group were observed , 10 % of body fat percentage ( p = 0.001 ) , 4.3 kg ( 13 % ) of body fat ( p = 0.001 ) , 14 % of total cholesterol ( p=0.007 ) , 35 % of high-density lipoproteins ( HDL ) ( p = 0.001 ) , and 10 % of HOMA ( p = 0.009 ) . In the HGL group , reductions of 4.5 % of waist circumference ( p = 0.02 ) , 37 % of HDL ( p = 0.002 ) , and an increase of 8 % of LDL ( p = 0.04 ) were observed . CONCLUSIONS These results suggest that long term LGL diets are more effective for reducing body mass index , body fat , waist circumference and HOMA and , therefore , may contribute in the prevention of diabetes BACKGROUND Insulin sensitivity ( Si ) is improved by weight loss and exercise , but the effects of the replacement of saturated fatty acids ( SFAs ) with monounsaturated fatty acids ( MUFAs ) or carbohydrates of high glycemic index ( HGI ) or low glycemic index ( LGI ) are uncertain . OBJECTIVE We conducted a dietary intervention trial to study these effects in participants at risk of developing metabolic syndrome . DESIGN We conducted a 5-center , parallel design , r and omized controlled trial [ RISCK ( Reading , Imperial , Surrey , Cambridge , and Kings ) ] . The primary and secondary outcomes were changes in Si ( measured by using an intravenous glucose tolerance test ) and cardiovascular risk factors . Measurements were made after 4 wk of a high-SFA and HGI ( HS/HGI ) diet and after a 24-wk intervention with HS/HGI ( reference ) , high-MUFA and HGI ( HM/HGI ) , HM and LGI ( HM/LGI ) , low-fat and HGI ( LF/HGI ) , and LF and LGI ( LF/LGI ) diets . RESULTS We analyzed data for 548 of 720 participants who were r and omly assigned to treatment .  The median Si was 2.7 × 10(-4 ) mL · μU(-1 ) · min(-1 ) ( interquartile range : 2.0 , 4.2 × 10(-4 ) mL · μU(-1 ) · min(-1 ) ) , and unadjusted mean percentage changes ( 95 % CIs ) after 24 wk treatment ( P = 0.13 ) were as follows : for the HS/HGI group , -4 % ( -12.7 % , 5.3 % ) ; for the HM/HGI group , 2.1 % ( -5.8 % , 10.7 % ) ; for the HM/LGI group , -3.5 % ( -10.6 % , 4.3 % ) ; for the LF/HGI group , -8.6 % ( -15.4 % , -1.1 % ) ; and for the LF/LGI group , 9.9 % ( 2.4 % , 18.0 % ) . Total cholesterol ( TC ) , LDL cholesterol , and apolipoprotein B concentrations decreased with SFA reduction . Decreases in TC and LDL-cholesterol concentrations were greater with LGI . Fat reduction lowered HDL cholesterol and apolipoprotein A1 and B concentrations . CONCLUSIONS This study did not support the hypothesis that isoenergetic replacement of SFAs with MUFAs or carbohydrates has a favorable effect on Si . Lowering GI enhanced reductions in TC and LDL-cholesterol concentrations in subjects , with tentative evidence of improvements in Si in the LF-treatment group . This trial was registered at clinical trials.gov as IS RCT N29111298 OBJECTIVE To examine prospect ively the relationship between glycemic diets , low fiber intake , and risk of non-insulin-dependent diabetes mellitus .  DESIGN Cohort study . SETTING In 1986 , a total of 65173 US women 40 to 65 years of age and free from diagnosed cardiovascular disease , cancer , and diabetes completed a detailed dietary question naire from which we calculated usual intake of total and specific sources of dietary fiber , dietary glycemic index , and glycemic load . MAIN OUTCOME MEASURE Non-insulin-dependent diabetes mellitus . RESULTS During 6 years of follow-up , 915 incident cases of diabetes  were documented . The dietary glycemic index was positively associated with risk of diabetes after adjustment for age , body mass index , smoking , physical activity , family history of diabetes , alcohol and cereal fiber intake , and total energy intake . Comparing the highest with the lowest quintile , the relative risk ( RR ) of diabetes was 1.37 ( 95 % confidence interval [ CI ] , 1.09 - 1.71 , P trend=.005 ) . The glycemic load ( an indicator of a global dietary insulin dem and ) was also positively associated with diabetes ( RR= 1.47 ; 95 % CI , 1.16 - 1.86 , P trend=.003 ) . Cereal fiber intake was inversely associated with risk of diabetes when comparing the extreme quintiles ( RR=0.72 , 95 % CI , 0.58 - 0.90 , P trend=.001 ) . The combination of a high glycemic load and a low cereal fiber intake further increased the risk of diabetes ( RR=2.50 , 95 % CI , 1.14 - 5.51 ) when compared with a low glycemic load and high cereal fiber intake . CONCLUSIONS Our results support the hypothesis that diets with a high glycemic load and a low cereal fiber content increase risk of diabetes in women . Further , they suggest that grains should be consumed in a minimally refined form to reduce the incidence of diabetes Low-glycemic index diets and exercise independently improve glucose tolerance and reduce diabetes risk . However , the combined effect of a low-glycemic index diet and exercise on inflammation and glucose metabolism is not known . Therefore , we r and omized 28 insulin-resistant adults ( age : 66 ± 1 y ; BMI : 34.2 ± 0.7 kg · m(-2 ) ) to a 12-wk , low ( LGI = 40 ) or high- ( HGI = 80 ) glycemic index diet plus aerobic exercise  ( 5 d · wk(-1 ) , 60 min · d(-1 ) , 80 - 85 % heart rate(max ) ) intervention . All food and fluids were provided during the study . Inflammation was assessed from cytokine ( TNFα and IL-6 ) secretion using peripheral blood mononuclear cells ( MNC ) stimulated overnight with LPS . Glycemic response was determined following ingestion of a 75-g glucose solution . Fasting blood sample s were collected for additional cytokine [ TNFα , IL-6 , and monocyte chemoattractant protein 1 ( MCP-1 ) ] analysis . Both interventions decreased BMI ( P < 0.001 ) , fasting plasma glucose ( P = 0.01 ) , and insulin ( P = 0.02 ) . The glycemic response was reduced only in the LGI group ( P = 0.04 ) . Plasma and MNC-derived TNFα secretion were reduced in the LGI group ( P = 0.02 ) but increased in the HGI group ( P = 0.02 ) . Secretion of IL-6 from MNC and plasma IL-6 and MCP-1 concentrations were reduced in the LGI group . The change in MNC-derived TNFα ( r = 0.43 ; P = 0.04 ) and plasma MCP-1 ( r = 0.44 ; P = 0.04 ) correlated with decreases in the glycemic response . These data highlight the importance of diet composition in the treatment and prevention of inflammation and hyperglycemia . A low-glycemic index diet has antiinflammatory and antidiabetogenic effects when combined with exercise in older , obese prediabetics BACKGROUND AND AIM The role of dietary glycemic index ( GI ) and glycemic load ( GL ) in coronary heart disease ( CHD ) is unclear . Our aim was to study the association between the dietary GI and GL and the risk of acute myocardial infa rct ion ( AMI ) . METHODS AND RESULTS The study population consisted of 1981 Finnish men from the prospect i ve population -based Kuopio Ischaemic Heart Disease Risk Factor ( KIHD ) Study , aged 42 - 60 years and free of CHD at baseline . During an average follow-up time of 16.1 years , 376 new AMI events occurred . In multivariable-adjusted Cox proportional hazards models , the relative risk ( RR ) for AMI in the highest quartile of GI was 1.25 ( 95 % CI : 0.92 - 1.69 ; P for trend=0.08 ) and for GL 1.11 ( 95 % CI : 0.79 - 1.57 ; P for trend=0.21 ) when compared with the lowest quartile . For overweight ( BMI ≥ 27.5 kg/m² ) men , the multivariable-adjusted RR for AMI in the highest compared to the lowest tertile of GI and GL were 1.58 ( 95 % CI : 1.03 - 2.43 ; P for trend=0.04 , P for interaction=0.01 ) and 2.05 ( 95 % CI : 1.30 - 3.23 ; P for trend=0.002 , P for interaction=0.002 ) , respectively . For physically less active men ; energy expenditure for leisure-time physical activity < 50 kcal/d , the RR for AMI was 1.72 ( 95 % CI : 1.07 - 2.76 ; P for trend=0.04 , P for interaction 0.80 ) with higher GL . CONCLUSIONS Our results suggest that both high dietary GI and GL are associated with increased risk of AMI among overweight and GL possibly among less physically active men OBJECTIVE We compared the effects of a low glycemic index ( GI ) diet with the American Diabetes Association ( ADA ) diet on glycosylated hemoglobin ( HbA1c ) among individuals with type 2 diabetes . METHODS Forty individuals with poorly controlled type 2 diabetes were r and omized to a low-GI or an ADA diet . The intervention , consisting of eight educational sessions ( monthly for the first 6 mo and then at months 8 and 10 ) , focused on a low-GI or an ADA diet .  Data on demographics , diet , physical activity , psychosocial factors , and diabetes medication use were assessed at baseline and 6 and 12 mo . Generalized linear mixed models were used to compare the two groups on HbA1c , diabetic medication use , blood lipids , weight , diet , and physical activity .  RESULTS Participants ( 53 % female , mean age 53.5 y ) were predominantly white with a mean body mass index of 35.8 kg/m(2 ) . Although both interventions achieved similar reductions in mean HbA1c at 6 mo and 12 mo , the low-GI diet group was less likely to add or increase dosage of diabetic medications ( odds ratio 0.26 , P = 0.01 ) . Improvements in high-density lipoprotein cholesterol , triacylglycerols , and weight loss were similar between groups . CONCLUSION Compared with the ADA diet , the low-GI diet achieved equivalent control of HbA1c using less diabetic medication . Despite its limited size , this trial suggests that a low-GI diet is a viable alternative to the ADA diet . Findings should be evaluated in a larger r and omized controlled trial BACKGROUND To our knowledge , no single investigation concerning the long-term effects of overweight status on the risk for hypertension , hypercholesterolemia , diabetes mellitus , and cardiovascular sequelae has been reported . METHODS Relations between categories of body mass index ( BMI ) , cardiovascular disease risk factors , and vascular disease end points were examined prospect ively in Framingham Heart Study participants aged 35 to 75 years , who were followed up to 44 years . The primary outcome was new cardiovascular disease , which included angina pectoris , myocardial infa rct ion , coronary heart disease , or stroke . Analyses compared  overweight ( BMI [ calculated as weight in kilograms divided by the square of height in meters ] , 25.0 - 29.9 ) and obese persons ( BMI > or = 30 )  to a  referent group of normal-weight persons ( BMI , 18.5 - 24.9 ) . RESULTS The age-adjusted relative risk ( RR ) for new hypertension was highly associated with overweight status ( men : RR , 1.46 ; women : RR , 1.75 ) . New hypercholesterolemia and diabetes mellitus were less highly associated with excess adiposity . The age-adjusted RR ( confidence interval [ CI ] ) for cardiovascular disease was increased among those who were overweight ( men : 1.21 [ 1.05 - 1.40 ] ; women : 1.20 [ 1.03 - 1.41 ] ) and the obese ( men : 1.46 [ 1.20 - 1.77 ] ; women : 1.64 [ 1.37 - 1.98 ] ) . High population attributable risks were related to excess weight ( BMI > or = 25 ) for the outcomes hypertension ( 26 % men ; 28 % women ) , angina pectoris ( 26 % men ; 22 % women ) , and coronary heart disease ( 23 % men ; 15 % women ) . CONCLUSIONS The overweight category is associated with increased relative and population attributable risk for hypertension and cardiovascular sequelae . Interventions to reduce adiposity and avoid excess weight may have large effects on the development of risk factors and cardiovascular disease at an individual and population level OBJECTIVE Intake of carbohydrates that provide a large glycemic response has been hypothesized to increase the risk of NIDDM , whereas dietary fiber is suspected to reduce incidence . These hypotheses have not been evaluated prospect ively . RESEARCH DESIGN AND METHODS We examined the relationship between diet and risk of NIDDM in a cohort of 42,759 men without NIDDM or cardiovascular disease , who were 40–75 years of age in 1986 .  Diet was assessed at baseline by a vali date d semiquantitative food frequency question naire . During 6-years of follow-up , 523 incident cases of NIDDM were documented . RESULTS The dietary glycemic index ( an indicator of carbohydrate 's ability to raise blood glucose levels ) was positively associated with risk of NIDDM after adjustment for age , BMI , smoking , physical activity , family history of diabetes , alcohol consumption , cereal fiber , and total energy intake . Comparing the highest and lowest quintiles , the relative risk ( RR ) of NIDDM was 1.37 ( 95 % CI , 1.02–1.83 , P trend = 0.03 ) .  Cereal fiber  was inversely associated with risk of NIDDM ( RR = 0.70 ; 95 % CI , 0.51–0.96 , P trend = 0.007 ; for > 8.1 g/day vs. < 3.2 g/day ) . The combination of a high glycemic load and a low cereal fiber intake further increased the risk of NIDDM ( RR = 2.17 , 95 % CI , 1.04–4.54 ) when compared with a low glycemic load and high cereal fiber intake . CONCLUSIONS These findings support the hypothesis that diets with a high glycemic load and a low cereal fiber content increase risk of NIDDM  in men . Further , they suggest that grains should be consumed in a minimally refined form to reduce the incidence of NIDDM Background : Wholegrain intake is inversely related to weight gain over time , but little information is available on the role of pulses in weight control . Objective : To compare weight loss , metabolic outcomes , and nutrient intakes in obese people assigned to a  diet rich in pulses and wholegrains or a control diet . Methods : R and omized controlled study of 18 months with 113 volunteers ( body mass index [ BMI ] ≥ 28 kg/m2 ) . Diets were based on guidelines published by the National Heart Foundation of New Zeal and . The intervention group was advised to consume 2 serves of pulses and 4 serves of wholegrain foods per day as substitutions for more refined carbohydrates . Results : Fiber intakes were higher , intakes of several vitamins and minerals were better maintained , and dietary glycemic index was lower in the intervention compared with the control group . Mean ( st and ard error [ SE ] ) weight loss at 6 months was 6.0 ( 0.7 ) kg and 6.3 ( 0.6 ) kg in the control and intervention groups , respectively , and was not different between groups ( p > 0.05 ) . Blood pressure , triglycerides , and glycemic load were lowered in both groups compared with baseline . Waist circumference was decreased at 18 months in the intervention compared with the control group ( −2.8 cm ; 95 % confidence interval [ CI ] : −0.4 , −5.1 ) . Conclusions : Incorporation of pulses and wholegrain foods into a weight loss program result ed in a greater reduction in waist circumference compared with the group consuming a control diet , although no difference in weight loss was noted between groups . Retention of several nutrients was better with the pulse and wholegrain diet Low-glycemic load ( GL ) diets improve insulin resistance and glucose homeostasis in individuals with diabetes . Less is known about whether low-GL diets , independent of weight loss , improve the health profile for persons without diabetes or other preexisting conditions . We conducted a r and omized , cross-over feeding study testing low- compared to High-GL diets on biomarkers of inflammation and adiposity in healthy adults . Eighty participants ( n = 40 with BMI 18.5 - 24.9 kg/m² ; n = 40 with BMI 28.0 - 40.0 kg/m² ) completed two 28-d feeding periods in r and om order where one period was a high-GL diet ( mean GL/d = 250 ) and the other a low-GL diet ( mean GL/d = 125 ) . Diets were isocaloric with identical macronutrient content ( as percent energy ) . All food was provided and participants maintained weight and usual physical activity . Height , weight , and DXA were measured at study entry and weight assessed again thrice per week . Blood was drawn from fasting participants at the beginning and end of each feeding period and serum concentrations of high-sensitivity CRP , serum amyloid A , IL-6 , leptin , and adiponectin were measured . Linear mixed models tested the intervention effect on the biomarkers ; models were adjusted for baseline biomarker concentrations , diet sequence , feeding period , age , sex , and body fat mass . Among participants with high-body fat mass ( > 32.0 % for males and > 25.0 % for females ) , the low-GL diet reduced CRP ( P = 0.02 ) and marginally increased adiponectin ( P = 0.06 ) . In conclusion , carbohydrate quality , independent of energy , is important . Dietary patterns emphasizing low-GL foods may improve the inflammatory and adipokine profiles of overweight and obese individuals We aim ed to determine whether altering dietary glycemic index ( GI ) in addition to healthy eating and weight loss advice affects arterial compliance and 24-hour blood pressure ( BP ) , both coronary heart disease ( CHD ) risk factors . Middle-aged men with at least 1 CHD risk were r and omized to a  6-month low-GI ( LGI ) or high-GI ( HGI ) diet . All were advised on healthy eating and weight loss . They were seen monthly to assess dietary compliance and anthropometrics . Carotid-femoral pulse wave velocity ( PWV ) , fasting blood lipid profile , and glucose and insulin concentrations were measured at baseline and at months 3 and 6 . Six-hour postpr and ial glucose and insulin responses and 24-hour ambulatory BP were also assessed at baseline and month 6 . Thirty-eight subjects ( HGI group , n = 16 ; LGI group , n = 22 ) completed the study . At month 6 , groups differed in dietary GI , glycemic load , and carbohydrate intake ( P < .001 ) . Fasting insulin concentration and insulin resistance ( calculated by homeostatic model assessment ) were lower in the LGI than the HGI group ( P < .01 ) . The reduction in total cholesterol and 24-hour BP was bigger in the LGI than the HGI group ( P < .05 ) ; and only the LGI group had significant reductions ( P < .05 ) in PWV , low-density lipoprotein cholesterol , and triacylglycerol concentration . There were no differences in postpr and ial glucose or insulin responses between the groups . The results suggest that an LGI diet may be more beneficial in reducing CHD risk , including PWV and 24-hour BP , even in the setting of healthy eating and weight loss ; and thus , further study is warranted CONTEXT Clinical trials using antihyperglycemic medications to improve glycemic control have not demonstrated the anticipated cardiovascular benefits . Low-glycemic index diets may improve both glycemic control and cardiovascular risk factors for patients with type 2 diabetes but debate over their effectiveness continues due to trial limitations . OBJECTIVE To test the effects of low-glycemic index diets on glycemic control and cardiovascular risk factors in patients with type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS A r and omized , parallel study design at a Canadian university hospital research center of 210 participants with type 2 diabetes treated with antihyperglycemic medications who were recruited by newspaper advertisement and r and omly assigned to receive 1 of 2 diet treatments each for 6 months between September 16 , 2004 , and May 22 , 2007 . INTERVENTION High-cereal fiber or low-glycemic index dietary advice . MAIN OUTCOME MEASURES Absolute change in glycated hemoglobin A(1c ) ( HbA(1c ) ) , with fasting blood glucose and cardiovascular disease risk factors as secondary measures . RESULTS In the intention-to-treat analysis , HbA(1c ) decreased by -0.18 % absolute HbA(1c ) units ( 95 % confidence interval [ CI ] , -0.29 % to -0.07 % ) in the high-cereal fiber diet compared with -0.50 % absolute HbA(1c ) units ( 95 % CI , -0.61 % to -0.39 % ) in the low-glycemic index diet ( P < .001 ) . There was also an increase of high-density lipoprotein cholesterol in the low-glycemic index diet by 1.7 mg/dL ( 95 % CI , 0.8 - 2.6 mg/dL ) compared with a decrease of high-density lipoprotein cholesterol by -0.2 mg/dL ( 95 % CI , -0.9 to 0.5 mg/dL ) in the high-cereal fiber diet ( P = .005 ) . The reduction in dietary glycemic index related positively to the reduction in HbA(1c ) concentration ( r = 0.35 , P < .001 ) and negatively to the increase in high-density lipoprotein cholesterol ( r = -0.19 , P = .009 ) . CONCLUSION In patients with type 2 diabetes , 6-month treatment with a low-glycemic index diet result ed in moderately lower HbA(1c ) levels compared with a high-cereal fiber diet . Trial Registration clinical trials.gov identifier : NCT00438698 The aim of this article is to evaluate the pros and cons of a specific impact of  postpr and ial hyperglycemia and glycemic variability on the — mainly  cardiovascular (CV)—complications of diabetes , above and beyond the average blood glucose ( BG ) as measured by HbA1c or fasting plasma glucose ( FPG ) . The strongest arguments in favor of this hypothesis come from impressive pathophysiological studies , also in the human situation . Measures of oxidative stress and endothelial dysfunction seem to be especially closely related to glucose peaks and even more so to fluctuating high and low glucose concentrations and can be restored to normal by preventing those glucose peaks or wide glucose excursions . The epidemiological evidence , which is more or less confined to postpr and ial hyperglycemia and postglucose load glycemia , is also rather compelling in favor of the hypothesis , although certainly not fully conclusive as there are also a number of conflicting results . The strongest cons are seen in the missing evidence as derived from r and omized prospect i ve intervention studies targeting postpr and ial hyperglycemia longer term , i.e. , over several years , and seeking to reduce hard CV end points . In fact , several such intervention studies in men have recently failed to produce the intended beneficial outcome results . As this evidence by intervention is , however , key for the ultimate approval of a treatment concept in patients with diabetes , the current net balance of attained evidence is not in favor of the hypothesis here under debate , i.e. , that we should care about postpr and ial hyperglycemia and glycemic variability . The absence of a uniformly accepted st and ard of how to estimate these parameters adds a further challenge to this whole debate
target: No significant changes were observed for blood lipids , anthropometric measures , HbA1c and fasting glucose .
  The present systematic review provides evidence for beneficial effects of long-term interventions administering a low glycemic index/load diet with respect to fasting insulin and pro-inflammatory markers such as C-reactive protein which might prove to be helpful in the primary prevention of obesity-associated diseases
background: AIM The aim of the present meta- analysis was to investigate the long-term effects of glycemic index-related diets in the management of obesity with a special emphasis on the potential benefits of low glycemic index/load ( GI/GL ) in the prevention of obesity-associated risks .