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Evidence that carbohydrate-to-fat ratio and taste, but not energy density or NOVA level of processing, are determinants of food liking and food reward.
Rogers, PJ, Vural, Y, Berridge-Burley, N, Butcher, C, Cawley, E, Gao, Z, Sutcliffe, A, Tinker, L, Zeng, X, Flynn, AN, et al
Appetite. 2024;:107124
Abstract
This virtual (online) study tested the common but largely untested assumptions that food energy density, level of processing (NOVA categories), and carbohydrate-to-fat (CF) ratio are key determinants of food reward. Individual participants (224 women and men, mean age 35 y, 53% with healthy weight, 43% with overweight or obesity) were randomised to one of three, within-subjects, study arms: energy density (32 foods), or level of processing (24 foods), or CF ratio (24 foods). They rated the foods for taste pleasantness (liking), desire to eat (food reward), and sweetness, saltiness, and flavour intensity (for analysis averaged as taste intensity). Against our hypotheses, there was not a positive relationship between liking or food reward and either energy density or level of processing. As hypothesised, foods combining more equal energy amounts of carbohydrate and fat (combo foods), and foods tasting more intense, scored higher on both liking and food reward. Further results were that CF ratio, taste intensity, and food fibre content (negatively), independent of energy density, accounted for 56% and 43% of the variance in liking and food reward, respectively. We interpret the results for CF ratio and fibre in terms of food energy-to-satiety ratio (ESR), where ESR for combo foods is high, and ESR for high-fibre foods is low. We suggest that the metric of ESR should be considered when designing future studies of effects of food composition on food reward, preference, and intake.
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Effects of a modestly lower carbohydrate diet in gestational diabetes: a randomized controlled trial.
Mijatovic, J, Louie, JCY, Buso, MEC, Atkinson, FS, Ross, GP, Markovic, TP, Brand-Miller, JC
The American journal of clinical nutrition. 2020;(2):284-292
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BACKGROUND Lower carbohydrate diets have the potential to improve glycemia but may increase ketonemia in women with gestational diabetes (GDM). We hypothesized that modestly lower carbohydrate intake would not increase ketonemia. OBJECTIVE To compare blood ketone concentration, risk of ketonemia, and pregnancy outcomes in women with GDM randomly assigned to a lower carbohydrate diet or routine care. METHODS Forty-six women aged (mean ± SEM) 33.3 ± 0.6 y and prepregnancy BMI 26.8 ± 0.9 kg/m2 were randomly assigned at 28.5 ± 0.4 wk to a modestly lower carbohydrate diet (MLC, ∼135 g/d carbohydrate) or routine care (RC, ∼200 g/d) for 6 wk. Blood ketones were ascertained by finger prick test strips and 3-d food diaries were collected at baseline and end of the intervention. RESULTS There were no detectable differences in blood ketones between completers in the MLC group compared with the RC group (0.1 ± 0.0 compared with 0.1 ± 0.0 mmol/L, n = 33, P = 0.31, respectively), even though carbohydrate and total energy intake were significantly lower in the intervention group (carbohydrate 165 ± 7 compared with 190 ± 9 g, P = 0.04; energy 7040 ± 240 compared with 8230 ± 320 kJ, P <0.01, respectively). Only 20% of participants in the MLC group met the target intake compared with 65% in the RC group (P <0.01). There were no differences in birth weight, rate of large-for-gestational-age infants, percent fat mass, or fat-free mass between groups. CONCLUSIONS An intervention to reduce carbohydrate intake in GDM did not raise ketones to clinical significance, possibly because the target of 135 g/d was difficult to achieve in pregnancy. Feeding studies with food provision may be needed to assess the benefits and risks of low-carbohydrate diets. This trial was registered at www.anzctr.org.au as ACTRN12616000018415.
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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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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 a low-glycemic index diet during pregnancy on offspring growth, body composition, and vascular health: a pilot randomized controlled trial.
Kizirian, NV, Kong, Y, Muirhead, R, Brodie, S, Garnett, SP, Petocz, P, Sim, KA, Celermajer, DS, Louie, JC, Markovic, TP, et al
The American journal of clinical nutrition. 2016;(4):1073-82
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BACKGROUND Elevated maternal blood glucose concentrations may contribute to macrosomia, adiposity, and poorer vascular health in the offspring. OBJECTIVE The aim was to explore the effect of a low-glycemic index (low-GI) diet during pregnancy on offspring growth, adiposity, and arterial wall thickness during infancy. DESIGN This was a longitudinal follow-up study in a self-selected subgroup of mother-infant pairs (n= 59) participating in a larger randomized trial comparing the effects on perinatal outcomes of a low-GI diet and a conventional high-fiber (HF) diet during pregnancy. Infant anthropometric measurements were taken every month for 6 mo and then at 9 and 12 mo of age. Adiposity was assessed at birth and at 3 mo by air-displacement plethysmography by using the Pea Pod system (Cosmed) and at 6 and 12 mo by bioimpedance analysis (Bodystat). Aortic intima-media thickness was assessed at 12 mo by high-resolution ultrasound (Philips). RESULTS Maternal dietary GI was lower in the low-GI group than in the HF group (51 ± 1 compared with 57 ± 1;P< 0.001). No differences in neonatal outcomes were observed in the main trial. In the self-selected subsample, birth weight and length z scores were lower in the low-GI group than in the HF group (birth weight z score: 0.2 ± 0.2 compared with 0.7 ± 0.2, respectively;P= 0.04; birth length z score: 0.3 ± 0.2 compared with 0.9 ± 0.2, respectively;P= 0.04), but adiposity from birth to 12 mo of age and growth trajectories from 1 to 12 mo of age were similar. Aortic intima-media thickness was lower in the low-GI group than in the HF group (657 ±12 compared with 696 ± 12 μm, respectively;P= 0.02), which was partly mediated by differences in birth weight. CONCLUSION In women at risk of gestational diabetes mellitus, a low-GI diet influences offspring birth weight, birth length, and arterial wall thickness in early childhood, but not adiposity or growth trajectory during the first year of life. This trial was registered at anzctr.org.au as ACTRN12610000681055.
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Effect of a low glycaemic index diet in gestational diabetes mellitus on post-natal outcomes after 3 months of birth: a pilot follow-up study.
Louie, JC, Markovic, TP, Ross, GP, Foote, D, Brand-Miller, JC
Maternal & child nutrition. 2015;(3):409-14
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A low glycaemic index (LGI) diet during pregnancy complicated by gestational diabetes mellitus (GDM) may offer benefits to the mother and infant pair beyond those during pregnancy. We aimed to investigate the effect of an LGI diet during pregnancy complicated with GDM on early post-natal outcomes. Fifty-eight women (age: 23-41 years; mean ± SD pre-pregnancy body mass index: 24.5 ± 5.6 kg m(-2) ) who had GDM and followed either an LGI diet (n = 33) or a conventional high-fibre diet (HF; n = 25) during pregnancy had a 75-g oral glucose tolerance test and blood lipid tests at 3 months post-partum. Anthropometric assessments were conducted for 55 mother-infant pairs. The glycaemic index of the antenatal diets differed modestly (mean ± SD: 46.8 ± 5.4 vs. 52.4 ± 4.4; P < 0.001), but there were no significant differences in any of the post-natal outcomes. In conclusion, an LGI diet during pregnancy complicated by GDM has outcomes similar to those of a conventional healthy diet. Adequately powered studies should explore the potential beneficial effects of LGI diet on risk factors for chronic disease.
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Validation of the food insulin index in lean, young, healthy individuals, and type 2 diabetes in the context of mixed meals: an acute randomized crossover trial.
Bell, KJ, Bao, J, Petocz, P, Colagiuri, S, Brand-Miller, JC
The American journal of clinical nutrition. 2015;(4):801-6
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BACKGROUND The Food Insulin Index (FII) is a novel classification of single foods based on insulin responses in healthy subjects relative to an isoenergetic reference food. OBJECTIVE Our aim was to compare day-long responses to 2 nutrient-matched diets predicted to have either high or low insulin demand in healthy controls and individuals with type 2 diabetes (T2DM). DESIGN Twenty adults (10 healthy adults and 10 adults with T2DM) were recruited. On separate mornings, subjects consumed either a high- or low-FII diet in random order. Diets consisted of 3 consecutive meals (breakfast, morning tea, and lunch), matched for macronutrients, fiber, and glycemic index (GI), but with 2-fold difference in insulin demand as predicted by the FII of the component foods. Postprandial glycemia and insulinemia were measured in capillary plasma at regular intervals over 8 h. RESULTS As predicted by their GI, there were no differences in glycemic responses between the 2 diets in either group (mean ± SEM; healthy: 6.2 ± 0.2 compared with 6.1 ± 0.1 mmol/L · min, P = 0.429; T2DM: 9.9 ± 1.3 compared with 10.3 ± 1.6 mmol/L · min, P = 0.485). Compared with the high-FII diet, mean postprandial insulin response over 8 h was 53% lower with the low-FII diet in healthy subjects (mean ± SEM; incremental AUCinsulin 31,900 ± 4100 pmol/L · min compared with 68,100 ± 11,400 pmol/L · min, P = 0.003) and 41% lower in subjects with T2DM (mean ± SEM; incremental AUCinsulin 11,000 ± 1800 pmol/L · min compared with 18,700 ± 3100 pmol/L · min, P = 0.018). Incremental AUCinsulin was statistically significantly different between diets when groups were combined (P = 0.001). CONCLUSIONS The FII algorithm may be a useful tool for reducing postprandial hyperinsulinemia in T2DM, thereby potentially improving insulin resistance and β-cell function. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12611000654954.
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Dietary micronutrient intake during pregnancy is a function of carbohydrate quality.
Goletzke, J, Buyken, AE, Louie, JC, Moses, RG, Brand-Miller, JC
The American journal of clinical nutrition. 2015;(3):626-32
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BACKGROUND Despite normal gestational weight gain, dietary studies in pregnant women show intakes below the recommendations for energy and micronutrients. OBJECTIVE This study compared changes in dietary intake from the second to third trimester with emphasis on energy intake and carbohydrate quality. DESIGN These post hoc analyses were based on 566 women participating in the Pregnancy and Glycemic Index Outcomes study, a randomized controlled trial comparing the effect of low-glycemic index (GI) dietary advice with healthy eating advice on selected pregnancy outcomes. With the use of multilevel mixed-regression analysis, changes in total energy intake, starch, sugar, fiber intake, GI, and glycemic load (GL) were correlated with intake of different micronutrients. RESULTS Energy intake decreased in the third trimester, and most women did not meet the national recommended amounts for iron, folate, and dietary fiber from food sources alone. After adjustment for age, ethnicity, prepregnancy body mass index, and intervention group, change in energy intake was positively related to change in intake of all micronutrients (P < 0.001). GI, GL, and starch intake were inversely related to micronutrient intake (P < 0.001), whereas higher total sugars predicted higher intake (P < 0.001). Associations with dietary fiber were inconsistent. CONCLUSIONS Normal pregnancy can be associated with a decline in energy and micronutrient intake from diet. Low dietary GI and GL were the best predictors of a favorable micronutrient profile. This trial was registered at www.anzctr.org.au as ACTRN12610000174088.
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Dose-response effect of a novel functional fibre, PolyGlycopleX(®), PGX(®), on satiety.
Solah, VA, Brand-Miller, JC, Atkinson, FS, Gahler, RJ, Kacinik, V, Lyon, MR, Wood, S
Appetite. 2014;:72-6
Abstract
The objective of this research was to determine the dose-response effects of a palatable, viscous and gel forming fibre, PolyGlycopleX(®) (PGX(®)), [(α-D-glucurono-α-manno-β-D-manno-β-D-gluco), (α-Lgulurono-β-D mannurono), (β-D-gluco-β-D-mannan)] on satiety, and to gain insight into the underlying mechanisms that lead to appetite inhibition. Healthy subjects (n = 10), aged between 20.3 and 29.2 years, consumed PGX(®), in granular form at 2.5, 5.0 and 7.5 g, and a 5g inulin control, with a standard breakfast. The PGX(®) doses of 2.5 and 7.5 g mixed with water at the start of breakfast increased satiety (iAUC of 140.0 and 157.7, P = 0.025 and 0.001, respectively) compared to the control. The most effective dose (7.5g) was palatable and corresponded to a 34% increase in fullness, measured using a visual analogue scale and incremental area under the curve, and resulted in a delayed postprandial glycaemic response when compared with the control.
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Pregnancy and Glycemic Index Outcomes study: effects of low glycemic index compared with conventional dietary advice on selected pregnancy outcomes.
Moses, RG, Casey, SA, Quinn, EG, Cleary, JM, Tapsell, LC, Milosavljevic, M, Petocz, P, Brand-Miller, JC
The American journal of clinical nutrition. 2014;(3):517-23
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BACKGROUND Eating carbohydrate foods with a high glycemic index (GI) has been postulated to result in fetoplacental overgrowth and higher infant body fat. A diet with a low glycemic index (LGI) has been shown to reduce birth percentiles and the ponderal index (PI). OBJECTIVES We investigated whether offering LGI dietary advice at the first antenatal visit would result in a lower fetal birth weight, birth percentile, and PI than providing healthy eating (HE) advice. This advice had to be presented within the resources of routine antenatal care. DESIGN The Pregnancy and Glycemic Index Outcomes study was a 2-arm, parallel-design, randomized, controlled trial that compared the effects of LGI dietary advice with HE advice on pregnancy outcomes. Eligible volunteers who attended for routine antenatal care at <20 wk of gestation were randomly assigned to either group. RESULTS A total of 691 women were enrolled, and 576 women had final data considered. In the LGI group, the GI was reduced from a mean (± SEM) of 56 ± 0.3 at enrollment to 52 ± 0.3 (P < 0.001) at the final assessment. There were no significant differences in primary outcomes of fetal birth weight, birth percentile, or PI. In a multivariate regression analysis, the glycemic load was the only significant dietary predictor (P = 0.046) of primary outcomes but explained <1% of all variation. CONCLUSION A low-intensity dietary intervention with an LGI diet compared with an HE diet in pregnancy did not result in any significant differences in birth weight, fetal percentile, or PI.
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Improving the estimation of mealtime insulin dose in adults with type 1 diabetes: the Normal Insulin Demand for Dose Adjustment (NIDDA) study.
Bao, J, Gilbertson, HR, Gray, R, Munns, D, Howard, G, Petocz, P, Colagiuri, S, Brand-Miller, JC
Diabetes care. 2011;(10):2146-51
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OBJECTIVE Although carbohydrate counting is routine practice in type 1 diabetes, hyperglycemic episodes are common. A food insulin index (FII) has been developed and validated for predicting the normal insulin demand generated by mixed meals in healthy adults. We sought to compare a novel algorithm on the basis of the FII for estimating mealtime insulin dose with carbohydrate counting in adults with type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 28 patients using insulin pump therapy consumed two different breakfast meals of equal energy, glycemic index, fiber, and calculated insulin demand (both FII = 60) but approximately twofold difference in carbohydrate content, in random order on three consecutive mornings. On one occasion, a carbohydrate-counting algorithm was applied to meal A (75 g carbohydrate) for determining bolus insulin dose. On the other two occasions, carbohydrate counting (about half the insulin dose as meal A) and the FII algorithm (same dose as meal A) were applied to meal B (41 g carbohydrate). A real-time continuous glucose monitor was used to assess 3-h postprandial glycemia. RESULTS Compared with carbohydrate counting, the FII algorithm significantly decreased glucose incremental area under the curve over 3 h (-52%, P = 0.013) and peak glucose excursion (-41%, P = 0.01) and improved the percentage of time within the normal blood glucose range (4-10 mmol/L) (31%, P = 0.001). There was no significant difference in the occurrence of hypoglycemia. CONCLUSIONS An insulin algorithm based on physiological insulin demand evoked by foods in healthy subjects may be a useful tool for estimating mealtime insulin dose in patients with type 1 diabetes.