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Dietary Insulin Load and Cancer Recurrence and Survival in Patients With Stage III Colon Cancer: Findings From CALGB 89803 (Alliance).
Morales-Oyarvide, V, Yuan, C, Babic, A, Zhang, S, Niedzwiecki, D, Brand-Miller, JC, Sampson-Kent, L, Ye, X, Li, Y, Saltz, LB, et al
Journal of the National Cancer Institute. 2019;(2):170-179
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Abstract
BACKGROUND Evidence suggests that diets inducing postprandial hyperinsulinemia may be associated with increased cancer-related mortality. The goal of this study was to assess the influence of postdiagnosis dietary insulin load and dietary insulin index on outcomes of stage III colon cancer patients. METHODS We conducted a prospective observational study of 1023 patients with resected stage III colon cancer enrolled in an adjuvant chemotherapy trial who reported dietary intake halfway through and six months after chemotherapy. We evaluated the association of dietary insulin load and dietary insulin index with cancer recurrence and survival using Cox proportional hazards regression adjusted for potential confounders; statistical tests were two-sided. RESULTS High dietary insulin load had a statistically significant association with worse disease-free survival (DFS), comparing the highest vs lowest quintile (adjusted hazard ratio [HR] = 2.77, 95% confidence interval [CI] = 1.90 to 4.02, Ptrend < .001). High dietary insulin index was also associated with worse DFS (highest vs lowest quintile, HR = 1.75, 95% CI = 1.22 to 2.51, Ptrend= .01). The association between higher dietary insulin load and worse DFS differed by body mass index and was strongest among patients with obesity (HR = 3.66, 95% CI = 1.88 to 7.12, Pinteraction = .04). The influence of dietary insulin load on cancer outcomes did not differ by mutation status of KRAS, BRAF, PIK3CA, TP53, or microsatellite instability. CONCLUSIONS Patients with resected stage III colon cancer who consumed a high-insulinogenic diet were at increased risk of recurrence and mortality. These findings support the importance of dietary management following resection of colon cancer, and future research into underlying mechanisms of action is warranted.
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Effects of added PGX®, a novel functional fibre, on the glycaemic index of starchy foods.
Brand-Miller, JC, Atkinson, FS, Gahler, RJ, Kacinik, V, Lyon, MR, Wood, S
The British journal of nutrition. 2012;(2):245-8
Abstract
The development of lower-glycaemic index (GI) foods requires simple, palatable and healthy strategies. The objective of the present study was to determine the most effective dose of a novel viscous fibre supplement (PGX®) to be added to starchy foods to reduce their GI. Healthy subjects (n 10) consumed glucose sugar (50 g in water × 3) and six starchy foods with a range of GI values (52-72) along with 0 (inert fibre), 2.5 or 5 g granular PGX® dissolved in 250 ml water. GI testing according to ISO Standard 26,642-2010 was used to determine the reduction in GI. PGX® significantly reduced the GI of all six foods (P < 0.001), with an average reduction of 19 % for the 2.5 g dose and 30 % for the 5 g dose, equivalent to a reducing the GI by 7 and 15 units, respectively. Consuming small quantities of the novel functional fibre PGX®, mixed with water at the start of a meal, is an effective strategy to reduce the GI of common foods.
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Food insulin index: physiologic basis for predicting insulin demand evoked by composite meals.
Bao, J, de Jong, V, Atkinson, F, Petocz, P, Brand-Miller, JC
The American journal of clinical nutrition. 2009;(4):986-92
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Abstract
BACKGROUND Diets that provoke less insulin secretion may be helpful in the prevention and management of diabetes. A physiologic basis for ranking foods according to insulin "demand" could therefore assist further research. OBJECTIVE We assessed the utility of a food insulin index (FII) that was based on testing isoenergetic portions of single foods (1000 kJ) in predicting the insulin demand evoked by composite meals. DESIGN Healthy subjects (n = 10 or 11 for each meal) consumed 13 different isoenergetic (2000 kJ) mixed meals of varying macronutrient content. Insulin demand predicted by the FII of the component foods or by carbohydrate counting and glycemic load was compared with observed insulin responses. RESULTS Observed insulin responses (area under the curve relative to white bread: 100) varied over a 3-fold range (from 35 +/- 5 to 116 +/- 26) and were strongly correlated with insulin demand predicted by the FII of the component foods (r = 0.78, P = 0.0016). The calculated glycemic load (r = 0.68, P = 0.01) but not the carbohydrate content of the meals (r = 0.53, P = 0.064) also predicted insulin demand. CONCLUSIONS The relative insulin demand evoked by mixed meals is best predicted by a physiologic index based on actual insulin responses to isoenergetic portions of single foods. In the context of composite meals of similar energy value, but varying macronutrient content, carbohydrate counting was of limited value.
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Physiological validation of the concept of glycemic load in lean young adults.
Brand-Miller, JC, Thomas, M, Swan, V, Ahmad, ZI, Petocz, P, Colagiuri, S
The Journal of nutrition. 2003;(9):2728-32
Abstract
Dietary glycemic load, the mathematical product of the glycemic index (GI) of a food and its carbohydrate content, has been proposed as an indicator of the glucose response and insulin demand induced by a serving of food. To validate this concept in vivo, we tested the hypotheses that 1). portions of different foods with the same glycemic load produce similar glycemic responses; and 2). stepwise increases in glycemic load for a range of foods produce proportional increases in glycemia and insulinemia. In the first study, 10 healthy subjects consumed 10 different foods in random order in amounts calculated to have the same glycemic load as one slice of white bread. Capillary blood samples were taken at regular intervals over the next 2 h. The glycemic response as determined by area under the curve was not different from that of white bread for nine foods. However, lentils produced lower than predicted responses (P < 0.05). In the second study, another group of subjects was tested to determine the effects of increasing glycemic load using a balanced 5 x 5 Greco-Latin square design balanced for four variables: subject, dose, food and order. Two sets of five foods were consumed at five different glycemic loads (doses) equivalent to one, two, three, four and six slices of bread. Stepwise increases in glycemic load produced significant and predictable increases in both glycemia (P < 0.001) and insulinemia (P < 0.001). These findings support the concept of dietary glycemic load as a measure of overall glycemic response and insulin demand.
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Effect of low-glycemic-index dietary advice on dietary quality and food choice in children with type 1 diabetes.
Gilbertson, HR, Thorburn, AW, Brand-Miller, JC, Chondros, P, Werther, GA
The American journal of clinical nutrition. 2003;(1):83-90
Abstract
BACKGROUND The practicality of diets with a low glycemic index (GI) is controversial. Theoretically, low-GI diets may limit food choice and increase dietary fat intake, but there is little objective evidence to support such a theory. OBJECTIVE The objective was to determine the effect of low-GI dietary advice on dietary quality and food choice in children with diabetes. DESIGN Children aged 8-13 y with type 1 diabetes (n = 104) were recruited to a prospective, randomized study comparing the effects of traditional carbohydrate-exchange dietary advice (CHOx) with those of more flexible low-GI dietary advice (LowGI). We determined the effect on long-term macronutrient intake and food choice with the use of 3-d food diaries. RESULTS There were no differences in reported macronutrient intakes during any of the recording periods. After 12 mo, intakes of dietary fat (33.5 +/- 5.6% and 34.2 +/- 6.7% of energy, P = 0.65), carbohydrate (48.8 +/- 5.4% and 48.6 +/- 6.5% of energy, P = 0.86), protein (17.6 +/- 2.5% and 17.3 +/- 3.7% of energy, P = 0.61), total sugars, and fiber did not differ significantly between the CHOx and LowGI groups, respectively. The average number of different carbohydrate food choices per day also did not differ significantly. Subjects in the lowest-GI quartile consumed less carbohydrate as potato and white bread, but more carbohydrate as dairy-based foods and whole-grain breads than did subjects in the highest-GI quartile. CONCLUSION Children with diabetes who receive low-GI dietary advice do not report more limited food choices or a diet with worse macronutrient composition than do children who consume a traditional carbohydrate-exchange diet.
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The effect of flexible low glycemic index dietary advice versus measured carbohydrate exchange diets on glycemic control in children with type 1 diabetes.
Gilbertson, HR, Brand-Miller, JC, Thorburn, AW, Evans, S, Chondros, P, Werther, GA
Diabetes care. 2001;(7):1137-43
Abstract
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 = 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 +/- 0.95 vs. 8.61 +/- 1.37%, P = 0.05). Rates of excessive hyperglycemia (>15 episodes per month) were significantly lower in the low-GI group (35 vs. 66%, P = 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.
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The effects of sugar-free vs sugar-rich beverages on feelings of fullness and subsequent food intake.
Holt, SH, Sandona, N, Brand-Miller, JC
International journal of food sciences and nutrition. 2000;(1):59-71
Abstract
This study compared the effects of equal volumes of sugar-rich and sugar-free beverages on feelings of hunger and fullness and the ad libitum consumption of a palatable, fat-rich snack. Eleven healthy males consumed equal volumes (375 mL) of three drinks (sugar-rich cola, sugar-free cola, mineral water) in random order on separate mornings. After 20 min, the subjects were able to snack freely on potato crisps during the next 90 min. Each subject's individual bowl of potato crisps was covertly replenished at 15 min intervals while the subjects were completing appetite and mood ratings. After the 110 min experimental period, the subjects' ad libitum food intake from a buffet-style lunch was covertly recorded. On leaving the laboratory, the subjects filled in a weighed food dairy for the rest of the day. The equal-volume preloads initially decreased hunger to a similar degree and potato crisp intake during the first 15 min interval was not significantly different among the three preloads. On average, total energy intakes from the crisps and lunch were not significantly different among the preloads, and by the end of the day, total energy intakes were similar for the three test conditions. Therefore, the low-calorie/low-sugar drinks did not facilitate a reduced energy intake by the lean, non-dieting male subjects.