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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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Is there a dose-response relation of dietary glycemic load to risk of type 2 diabetes? Meta-analysis of prospective cohort studies.
Livesey, G, Taylor, R, Livesey, H, Liu, S
The American journal of clinical nutrition. 2013;(3):584-96
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Abstract
BACKGROUND Although much is known about the association between dietary glycemic load (GL) and type 2 diabetes (T2D), prospective cohort studies have not consistently shown a positive dose-response relation. OBJECTIVE We performed a comprehensive examination of evidence on the dose response that links GL to T2D and sources of heterogeneity among all prospective cohort studies on healthy adults available in the literature. DESIGN We conducted a systematic review of all prospective cohort studies and meta-analyses to quantify the GL-T2D relation both without and with adjustment for covariates. RESULTS Among 24 prospective cohort studies identified by August 2012, the GL ranged from ∼60 to ∼280 g per daily intake of 2000 kcal (8.4 MJ). In a fully adjusted meta-analysis model, the GL was positively associated with RR of T2D of 1.45 (95% CI: 1.31, 1.61) for a 100-g increment in GL (P < 0.001; n = 24 studies; 7.5 million person-years of follow-up). Sex (P = 0.03), dietary instrument validity (P < 0.001), and ethnicity (European American compared with other; P = 0.04) together explained 97% of the heterogeneity among studies. After adjustment for heterogeneities, we used both funnel and trim-and-fill analyses to identify a negligible publication bias. Multiple influence, cumulative, and forecast analyses indicated that the GL-T2D relation tended to have reached stability and to have been underestimated. The relation was apparent at all doses of GL investigated, although it was statistically significant only at >95 g GL/2000 kcal. CONCLUSION After we accounted for several sources of heterogeneity, findings from prospective cohort studies that related the GL to T2D appear robust and consistently indicate strong and significantly lower T2D risk in persons who consume lower-GL diets. This review was registered at http://www.crd.york.ac.uk/PROSPERO as CRD42011001810.
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Interventions to lower the glycemic response to carbohydrate foods with a low-viscosity fiber (resistant maltodextrin): meta-analysis of randomized controlled trials.
Livesey, G, Tagami, H
The American journal of clinical nutrition. 2009;(1):114-25
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Abstract
BACKGROUND The glycemic response to diet has been linked with noncommunicable diseases and is reduced by low-palatable, viscous, soluble fiber (1). Whether a palatable, low-viscous, soluble fiber such as resistant maltodextrin (RMD) has the same effect is unclear. OBJECTIVE The objective was to assess evidence on the attenuation of the blood glucose response to foods by < or = 10 g RMD in healthy adults. DESIGN We conducted a systematic review of randomized, placebo-controlled trials with the use of fixed- and random-effects meta-analyses and meta-regression models. RESULTS We found data from 37 relevant trials to April 2007. These trials investigated the attenuation of the glycemic response to rice, noodles, pastry, bread, and refined carbohydrates that included 30-173 g available carbohydrate. RMD was administered in drinks or liquid foods or solid foods. Placebo drinks and foods excluded RMD. Percentage attenuation was significant, dose-dependent, and independent of the amount of available carbohydrate coingested. Attenuation of the glycemic response to starchy foods by 6 g RMD in drinks approached approximately 20%, but when placed directly into foods was approximately 10% -- significant (P < 0.001) by both modes of administration. Study quality analyses, funnel plots, and trim-and-fill analyses uncovered no cause of significant systematic bias. Studies from authors affiliated with organizations for-profit were symmetrical without heterogeneity, whereas marginal asymmetry and significant heterogeneity arose among studies involving authors from nonprofit organizations because of some imprecise studies. CONCLUSIONS A nonviscous palatable soluble polysaccharide can attenuate the glycemic response to carbohydrate foods. Evidence of an effect was stronger for RMD in drinks than in foods.
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Glycemic response and health--a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes.
Livesey, G, Taylor, R, Hulshof, T, Howlett, J
The American journal of clinical nutrition. 2008;87(1):258S-268S
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Plain language summary
All carbohydrates are ranked based on their glycaemic impact, or the response they provoke in blood glucose after consumption. It has been proposed that diets with a low impact on blood glucose are associated with a reduction in disease risk, however the specific dietary factors and degree of influence of this association remains unclear. The aim of this meta-analysis was to assess which glycaemic impact factors are important for affecting the maintenance of health and management of disease. Data from 45 relevant publications were included to investigate various health risk markers of overweight and obesity, diabetes mellitus and coronary heart disease. This review found that diets with a reduced glycaemic impact and higher unavailable carbohydrate are associated with favourable changes for all examined health risk markers. The authors conclude that these interventions led to improved glycaemic control, therefore provide a compelling diet for managing chronic disease.
Abstract
BACKGROUND Reduction of dietary glycemic response has been proposed as a means of reducing the risk of diabetes and coronary heart disease. The impact of glycemic response on markers of health remains to be elucidated. OBJECTIVE We assessed the evidence relating the glycemic impact of foods to measures relevant for health maintenance and management of disease. DESIGN This was a systematic review and synthesis of interventional evidence from literature reported on glycemic index and markers of health through the use of meta-analyses and meta-regression models. RESULTS Data from 45 relevant publications were found to January 2005. Lower glycemic index (GI) diets reduced both fasting blood glucose and glycated proteins independently of variance in available and unavailable carbohydrate intakes. Elevated unavailable carbohydrate added to improvements in both blood glucose and glycated protein control. These effects were greater in persons with poor fasting blood glucose control. No effects were seen on fasting insulin<100 pmol/L; above this, study numbers were few but consistent with prevention of hyperinsulinemia in some but not all overweight persons. Insulin sensitivity according to a variety of measurement methods was improved by lower GI, higher unavailable carbohydrate interventions in persons with type 2 diabetes, in overweight and obese persons, and in all studies combined. Fasting triacylglycerol in addition to body weight reduction related more to glycemic load than to GI. Glycemic load reduction by >17 g glucose equivalents/d was associated with reduced body weight. CONCLUSIONS Consumption of reduced glycemic response diets are followed by favorable changes in the health markers examined. The case for the use of such diets looks compelling. Unavailable carbohydrate intake is equally important.
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Glycemic response and health--a systematic review and meta-analysis: the database, study characteristics, and macronutrient intakes.
Livesey, G, Taylor, R, Hulshof, T, Howlett, J
The American journal of clinical nutrition. 2008;(1):223S-236S
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Abstract
BACKGROUND Reduction of dietary glycemic response has been proposed as a means of reducing the risk of diabetes and coronary heart disease. Its role in health maintenance and management, alongside unavailable carbohydrate (eg, fiber), is incompletely understood. OBJECTIVE We aimed to assess the evidence relating the glycemic impact of foods to a role in health maintenance and management of disease. DESIGN We searched the literature for relevant controlled dietary intervention trials on glycemic index (GI) according to inclusion and exclusion criteria, extracted the data to a database, and synthesized the evidence via meta-analyses and meta-regression models. RESULTS Among literature to January 2005, 45 relevant publications were identified involving 972 subjects with good health or metabolic disease. With small reductions in GI (<10 units), increases in available carbohydrate, energy, and protein intakes were found in all studies combined. Falling trends in energy, available carbohydrate, and protein intakes then occurred with progressive reductions in GI. Fat intake was essentially unchanged. Unavailable carbohydrate intake was generally higher for intervention diets but showed no trend with GI (falling or rising). Among studies reporting on GI, variation in glycemic load was approximately equally explained by variation in GI and variation in available carbohydrate intake. An exchange of available and unavailable carbohydrate (approximately 1 g/g) was evident in these studies. CONCLUSIONS Among GI studies, observed reductions in glycemic load are most often not solely due to substitution of high for low glycemic carbohydrate foods. Available carbohydrate intake is a confounding factor. The role of unavailable carbohydrate remains to be accounted for.