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Dietary Glycaemic Index Labelling: A Global Perspective.
Barclay, AW, Augustin, LSA, Brighenti, F, Delport, E, Henry, CJ, Sievenpiper, JL, Usic, K, Yuexin, Y, Zurbau, A, Wolever, TMS, et al
Nutrients. 2021;(9)
Abstract
The glycaemic index (GI) is a food metric that ranks the acute impact of available (digestible) carbohydrates on blood glucose. At present, few countries regulate the inclusion of GI on food labels even though the information may assist consumers to manage blood glucose levels. Australia and New Zealand regulate GI claims as nutrition content claims and also recognize the GI Foundation's certified Low GI trademark as an endorsement. The GI Foundation of South Africa endorses foods with low, medium and high GI symbols. In Asia, Singapore's Healthier Choice Symbol has specific provisions for low GI claims. Low GI claims are also permitted on food labels in India. In China, there are no national regulations specific to GI; however, voluntary claims are permitted. In the USA, GI claims are not specifically regulated but are permitted, as they are deemed to fall under general food-labelling provisions. In Canada and the European Union, GI claims are not legal under current food law. Inconsistences in food regulation around the world undermine consumer and health professional confidence and call for harmonization. Global provisions for GI claims/endorsements in food standard codes would be in the best interests of people with diabetes and those at risk.
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Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes: A Systematic Review and Updated Meta-Analyses of Prospective Cohort Studies.
Livesey, G, Taylor, R, Livesey, HF, Buyken, AE, Jenkins, DJA, Augustin, LSA, Sievenpiper, JL, Barclay, AW, Liu, S, Wolever, TMS, et al
Nutrients. 2019;(6)
Abstract
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 nowover a decade ago that a published meta-analysis used a predefined standard to identify validstudies. Considering valid studies only, and using random effects dose-response meta-analysis(DRM) while withdrawing spurious results (p < 0.05), we ascertained whether these relationswould 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). Thecombined T2D-GI RR was 1.27 (1.15-1.40) (p < 0.001, n = 10 studies) per 10 units GI, while that forthe 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 2000kcal diet, respectively. In conclusion, among adults initially in good health, diets higher in GI or GLwere robustly associated with incident T2D. Together with mechanistic and other data, thissupports 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 GLare substantial food markers predicting the development of T2D worldwide, for persons ofEuropean ancestry and of East Asian ancestry.
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Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC).
Augustin, LSA, Kendall, CWC, Jenkins, DJA, Willett, WC, Astrup, A, Barclay, AW, Björck, I, Brand-Miller, JC, Brighenti, F, Buyken, AE, et al
Nutrition, metabolism, and cardiovascular diseases : NMCD. 2015;(9):795-815
Abstract
BACKGROUND AND AIMS The positive and negative health effects of dietary carbohydrates are of interest to both researchers and consumers. METHODS International experts on carbohydrate research held a scientific summit in Stresa, Italy, in June 2013 to discuss controversies surrounding the utility of the glycemic index (GI), glycemic load (GL) and glycemic response (GR). RESULTS The outcome was a scientific consensus statement which recognized the importance of postprandial glycemia in overall health, and the GI as a valid and reproducible method of classifying carbohydrate foods for this purpose. There was consensus that diets low in GI and GL were relevant to the prevention and management of diabetes and coronary heart disease, and probably obesity. Moderate to weak associations were observed for selected cancers. The group affirmed that diets low in GI and GL should always be considered in the context of diets otherwise understood as healthy, complementing additional ways of characterizing carbohydrate foods, such as fiber and whole grain content. Diets of low GI and GL were considered particularly important in individuals with insulin resistance. CONCLUSIONS Given the high prevalence of diabetes and pre-diabetes worldwide and the consistency of the scientific evidence reviewed, the expert panel confirmed an urgent need to communicate information on GI and GL to the general public and health professionals, through channels such as national dietary guidelines, food composition tables and food labels.
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Efficacy of carbohydrate counting in type 1 diabetes: a systematic review and meta-analysis.
Bell, KJ, Barclay, AW, Petocz, P, Colagiuri, S, Brand-Miller, JC
The lancet. Diabetes & endocrinology. 2014;(2):133-40
Abstract
BACKGROUND Although carbohydrate counting is the recommended dietary strategy for achieving glycaemic control in people with type 1 diabetes, the advice is based on narrative review and grading of the available evidence. We aimed to assess by systematic review and meta-analysis the efficacy of carbohydrate counting on glycaemic control in adults and children with type 1 diabetes. METHODS We screened and assessed randomised controlled trials of interventions longer than 3 months that compared carbohydrate counting with general or alternate dietary advice in adults and children with type 1 diabetes. Change in glycated haemoglobin (HbA1c) concentration was the primary outcome. The results of clinically and statistically homogenous studies were pooled and meta-analysed using the random-effects model to provide estimates of the efficacy of carbohydrate counting. FINDINGS We identified seven eligible trials, of 311 potentially relevant studies, comprising 599 adults and 104 children with type 1 diabetes. Study quality score averaged 7·6 out of 13. Overall there was no significant improvement in HbA1c concentration with carbohydrate counting versus the control or usual care (-0·35% [-3·9 mmol/mol], 95% CI -0·75 to 0·06; p=0·096). We identified significant heterogeneity between studies, which was potentially related to differences in study design. In the five studies in adults with a parallel design, there was a 0·64% point (7·0 mmol/mol) reduction in HbA1c with carbohydrate counting versus control (95% CI -0·91 to -0·37; p<0·0001). INTERPRETATION There is some evidence to support the recommendation of carbohydrate counting over alternate advice or usual care in adults with type 1 diabetes. Additional studies are needed to support promotion of carbohydrate counting over other methods of matching insulin dose to food intake. FUNDING None.
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Informing food choices and health outcomes by use of the dietary glycemic index.
Chiu, CJ, Liu, S, Willett, WC, Wolever, TM, Brand-Miller, JC, Barclay, AW, Taylor, A
Nutrition reviews. 2011;(4):231-42
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Abstract
Considerable epidemiologic evidence links consuming lower glycemic index (GI) diets with good health, particularly upon aging. The GI is a kinetic parameter that reflects the ability of carbohydrate (CHO) contained in consumed foods to raise blood glucose in vivo. Newer nutritional, clinical, and experimental data link intake of lower dietary GI foods to favorable outcomes of chronic diseases, and compel further examination of the record. Based upon the new information there are two specific questions: 1) should the GI concept be promoted as a way to prolong health, and 2) should food labels contain GI information? Further, what are the remaining concerns about methodological issues and consistency of epidemiological data and clinical trials that need to be resolved in order to exploit the benefits of consuming lower GI diets? These issues are addressed in this review.
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The Australian paradox: a substantial decline in sugars intake over the same timeframe that overweight and obesity have increased.
Barclay, AW, Brand-Miller, J
Nutrients. 2011;(4):491-504
Abstract
Ecological research from the USA has demonstrated a positive relationship between sugars consumption and prevalence of obesity; however, the relationship in other nations is not well described. The aim of this study was to analyze the trends in obesity and sugar consumption in Australia over the past 30 years and to compare and contrast obesity trends and sugar consumption patterns in Australia with the UK and USA. Data on consumption of sugar in Australia, the UK and USA were obtained from the Food and Agriculture Organization for the years 1980-2003. The prevalence of obesity has increased 3 fold in Australians since 1980. In Australia, the UK and USA, per capita consumption of refined sucrose decreased by 23%, 10% and 20% respectively from 1980 to 2003. When all sources of nutritive sweeteners, including high fructose corn syrups, were considered, per capita consumption decreased in Australia (-16%) and the UK (-5%), but increased in the USA (+23%). In Australia, there was a reduction in sales of nutritively sweetened beverages by 64 million liters from 2002 to 2006 and a reduction in percentage of children consuming sugar-sweetened beverages between 1995 and 2007. The findings confirm an "Australian Paradox"--a substantial decline in refined sugars intake over the same timeframe that obesity has increased. The implication is that efforts to reduce sugar intake may reduce consumption but may not reduce the prevalence of obesity.
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Glycemic index, glycemic load, and chronic disease risk--a meta-analysis of observational studies.
Barclay, AW, Petocz, P, McMillan-Price, J, Flood, VM, Prvan, T, Mitchell, P, Brand-Miller, JC
The American journal of clinical nutrition. 2008;(3):627-37
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Abstract
BACKGROUND Inconsistent findings from observational studies have prolonged the controversy over the effects of dietary glycemic index (GI) and glycemic load (GL) on the risk of certain chronic diseases. OBJECTIVE The objective was to evaluate the association between GI, GL, and chronic disease risk with the use of meta-analysis techniques. DESIGN A systematic review of published reports identified a total of 37 prospective cohort studies of GI and GL and chronic disease risk. Studies were stratified further according to the validity of the tools used to assess dietary intake. Rate ratios (RRs) were estimated in a Cox proportional hazards model and combined by using a random-effects model. RESULTS From 4 to 20 y of follow-up across studies, a total of 40 129 incident cases were identified. For the comparison between the highest and lowest quantiles of GI and GL, significant positive associations were found in fully adjusted models of validated studies for type 2 diabetes (GI RR = 1.40, 95% CI: 1.23, 1.59; GL RR = 1.27, 95% CI: 1.12, 1.45), coronary heart disease (GI RR = 1.25, 95% CI: 1.00, 1.56), gallbladder disease (GI RR = 1.26, 95% CI: 1.13, 1.40; GL RR = 1.41, 95% CI: 1.25, 1.60), breast cancer (GI RR = 1.08, 95% CI: 1.02, 1.16), and all diseases combined (GI RR = 1.14, 95% CI: 1.09, 1.19; GL RR = 1.09, 95% CI: 1.04, 1.15). CONCLUSIONS 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.