Low-GI and/or low-GL diets are independently associated with a reduced risk of certain chronic diseases. In diabetes and heart disease, the protection is comparable with that seen for whole grain and high fiber intakes. The findings support the hypothesis that higher postprandial glycemia is a universal mechanism for disease progression.

Feeding a protein-bound source of sialic acid during early development enhanced learning and increased expression of 2 genes associated with learning in developing piglets. Sialic acid in mammalian milks could play a role in cognitive development.

OBJECTIVE -To determine the long-term effect of low glycemic index dietary advice on metabolic control and quality of life in children with type 1 diabetes.RESEARCH DESIGN AND METHODS -Children with type 1 diabetes (n ϭ 104) were recruited to a prospective, stratified, randomized, parallel study to examine the effects of a measured carbohydrate exchange (CHOx) diet versus a more flexible low-glycemic index (GI) dietary regimen on HbA 1c levels, incidence of hypo-and hyperglycemia, insulin dose, dietary intake, and measures of quality of life over 12 months.RESULTS -At 12 months, children in the low-GI group had significantly better HbA 1c levels than those in the CHOx group (8.05 Ϯ 0.95 vs. 8.61 Ϯ 1.37%, P ϭ 0.05). Rates of excessive hyperglycemia (Ͼ15 episodes per month) were significantly lower in the low-GI group (35 vs. 66%, P ϭ 0.006). There were no differences in insulin dose, hypoglycemic episodes, or dietary composition. The low-GI dietary regimen was associated with better quality of life for both children and parents.CONCLUSIONS -Flexible dietary instruction based on the food pyramid with an emphasis of low-GI foods improves HbA 1c levels without increasing the risk of hypoglycemia and enhances the quality of life in children with diabetes. Diabetes Care 24:1137-1143, 2001T ype 1 diabetes is one of the most challenging medical disorders because of the demands it imposes on day-to-day life. Good glycemic control, as judged by HbA 1c levels, is clearly related to reduced risk of microvascular complications (1). Although diet plays a major role in the overall management of type 1 diabetes, it is often classed as the most difficult aspect of treatment (2,3). Furthermore, there are surprisingly few longterm studies to support current dietary recommendations. Weighed carbohydrate "exchanges," introduced in the 1950s, have been used to ensure an even distribution of complex carbohydrates throughout the day. Carbohydrate counting and higher carbohydrate intake are now recommended, although in practice, emphasis is still placed on limiting carbohydrates to a specified level and avoiding refined sugars (4,5).Different carbohydrate foods affect blood glucose levels to varying degrees, as measured by their glycemic index (GI) (6,7). Foods such as legumes and dairy products have a low GI, whereas ordinary breads, potatoes, and rice have a high GI (8). Carbohydrate counting and "exchange" diets imply that equal carbohydrate portions have the same effect on glycemia. Not only is the theoretical basis of the exchange system questionable, it is difficult to understand and implement without knowing the carbohydrate content of food (9). Several studies have shown that exchange diets do not improve glycemic control (9,10) and that many children with diabetes and their parents cannot understand or follow them (11-13). It has also been suggested that quantifying carbohydrate intake may be associated with some physiological and psychological problems, including disordered eating behavior (14). This information and the emergi...

Published meta-analyses indicate significant but inconsistent incident type-2 diabetes (T2D)-dietary glycemic index (GI) and glycemic load (GL) risk ratios or risk relations (RR). It is now over a decade ago that a published meta-analysis used a predefined standard to identify valid studies. Considering valid studies only, and using random effects dose–response meta-analysis (DRM) while withdrawing spurious results (p < 0.05), we ascertained whether these relations would support nutrition guidance, specifically for an RR > 1.20 with a lower 95% confidence limit >1.10 across typical intakes (approximately 10th to 90th percentiles of population intakes). The combined T2D–GI RR was 1.27 (1.15–1.40) (p < 0.001, n = 10 studies) per 10 units GI, while that for the T2D–GL RR was 1.26 (1.15–1.37) (p < 0.001, n = 15) per 80 g/d GL in a 2000 kcal (8400 kJ) diet. The corresponding global DRM using restricted cubic splines were 1.87 (1.56–2.25) (p < 0.001, n = 10) and 1.89 (1.66–2.16) (p < 0.001, n = 15) from 47.6 to 76.1 units GI and 73 to 257 g/d GL in a 2000 kcal diet, respectively. In conclusion, among adults initially in good health, diets higher in GI or GL were robustly associated with incident T2D. Together with mechanistic and other data, this supports that consideration should be given to these dietary risk factors in nutrition advice. Concerning the public health relevance at the global level, our evidence indicates that GI and GL are substantial food markers predicting the development of T2D worldwide, for persons of European ancestry and of East Asian ancestry.

Because birth weight and ponderal index may predict chronic disease in later life, a low-GI diet may favorably influence long-term outcomes.

The between-laboratory SD of the GI values is approximately 9. Standardized data analysis and low within-subject variation (refCV<30%) are required for accuracy. The results suggest that common misconceptions exist about which factors do and do not need to be controlled to improve precision. Controlled studies and cost-benefit analyses are needed to optimize GI methodology. The trial was registered at clinicaltrials.gov as NCT00260858.

Both postprandial hyperglycemia and insulin resistance (IR) have implications for the development of cardiovascular disease. The present study was designed to examine differences in postprandial glycemia and insulin sensitivity among young adults of different ethnic origins. Lean, healthy subjects (n = 60) from five ethnic groups [20 European Caucasians, 10 Chinese, 10 South East (SE) Asians, 10 Asian Indians and 10 Arabic Caucasians] were matched for age, body mass index, waist circumference, birth weight and current diet. A 75-g white bread carbohydrate challenge was fed to assess postprandial glycemia and insulinemia. Insulin sensitivity was assessed in three groups by the euglycemic-hyperinsulinemic clamp and in all subjects by homeostasis model assessment (HOMA) modeling. Postprandial hyperglycemia (incremental area under the curve) and insulin sensitivity (M-value) both showed a twofold variation among the groups (P < 0.001) and were significantly related to each other (R(2) = 56%, P < 0.001). Young SE Asians had the highest postprandial glycemia and lowest insulin sensitivity, whereas European and Arabic Caucasian subjects were the most insulin sensitive and carbohydrate tolerant. These findings suggest that IR is evident even in lean, young adults of some ethnic groups and is associated with significant increases in postprandial glycemia and insulinemia in response to a realistic carbohydrate load.

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