• Association between carbohydrate intake and serum lipids

      Ma, Yunsheng; Li, Youfu; Chiriboga, David E.; Olendzki, Barbara C.; Hebert, James R.; Li, Wenjun; Leung, Katherine; Hafner, Andrea R.; Ockene, Ira S. (2006-04-04)
      BACKGROUND: The effect of dietary carbohydrate on blood lipids has received considerable attention in light of the current trend in lowering carbohydrate intake for weight loss. OBJECTIVES: To evaluate the association between carbohydrate intake and serum lipids. METHODS: Blood samples and 24-hour dietary and physical activity recall interviews were obtained from each subject at quarterly intervals for five consecutive quarters between 1994 and 1998 from 574 healthy adults in Central Massachusetts. Relationships between serum lipids and dietary carbohydrate factors were assessed using linear mixed models and adjusting for other risk factors known to be related to blood lipids. Both cross-sectional and longitudinal results were reported. RESULTS: Cross-sectional analysis results from this study suggest that higher total carbohydrate intake, percentage of calories from carbohydrate, glycemic index (GI) and/or glycemic load (GL) are related to lower high-density lipoprotein cholesterol (HDL-C) and higher serum triacylglycerol levels, while higher total carbohydrate intake and/or GL are related to lower total and low-density lipoprotein cholesterol (LDL-C) levels. In a one-year longitudinal analysis, GL was positively associated with total and LDL-C levels, and there was an inverse association between percentage of calories from carbohydrate and HDL-C levels. CONCLUSIONS: Results suggest that there is a complex and predominantly unfavorable effect of increased intake of highly processed carbohydrate on lipid profile, which may have implications for metabolic syndrome, diabetes, and coronary heart disease. Further studies in the form of randomized controlled trials are required to investigate these associations and determine the implications for lipid management.
    • Association between dietary carbohydrates and body weight

      Ma, Yunsheng; Olendzki, Barbara C.; Chiriboga, David E.; Hebert, James R.; Li, Youfu; Li, Wenjun; Campbell, MaryJane; Gendreau, Katherine; Ockene, Ira S. (2005-02-05)
      The role of dietary carbohydrates in weight loss has received considerable attention in light of the current obesity epidemic. The authors investigated the association of body mass index (weight (kg)/height (m)(2)) with dietary intake of carbohydrates and with measures of the induced glycemic response, using data from an observational study of 572 healthy adults in central Massachusetts. Anthropometric measurements, 7-day dietary recalls, and physical activity recalls were collected quarterly from each subject throughout a 1-year study period. Data were collected between 1994 and 1998. Longitudinal analyses were conducted, and results were adjusted for other factors related to body habitus. Average body mass index was 27.4 kg/m(2) (standard deviation, 5.5), while the average percentage of calories from carbohydrates was 44.9 (standard deviation, 9.6). Mean daily dietary glycemic index was 81.7 (standard deviation, 5.5), and glycemic load was 197.8 (standard deviation, 105.2). Body mass index was found to be positively associated with glycemic index, a measure of the glycemic response associated with ingesting different types of carbohydrates, but not with daily carbohydrate intake, percentage of calories from carbohydrates, or glycemic load. Results suggest that the type of carbohydrate may be related to body weight. However, further research is required to elucidate this association and its implications for weight management.
    • Cognitive impairment: an increasingly important complication of type 2 diabetes: the age, gene/environment susceptibility--Reykjavik study

      Saczynski, Jane S.; Jonsdottir, Maria K.; Garcia, Melissa E.; Jonsson, Palmi V.; Peila, Rita; Eiriksdottir, Gudny; Olafsdottir, Elin; Harris, Tamara B.; Gudnason, Vilmundur; Launer, Lenore J. (2008-10-07)
      Persons with type 2 diabetes are at increased risk of cognitive dysfunction. Less is known about which cognitive abilities are affected and how undiagnosed diabetes and impaired fasting glucose relate to cognitive performance. The authors explored this question using data from 1,917 nondemented men and women (average age = 76 years) in the population-based Age, Gene/Environment Susceptibility-Reykjavik Study (2002-2006). Glycemic status groups included diagnosed diabetes (self-reported diabetes or diabetic medication use; n = 163 (8.5%)), undiagnosed diabetes (fasting blood glucose >or=7.0 mmol/L without diagnosed diabetes; n = 55 (2.9%)), and impaired fasting glucose (fasting blood glucose 5.6-6.9 mmol/L; n = 744 (38.8%)). Composites of memory, processing speed (PS), and executive function were constructed from a neuropsychological battery. Linear regression was used to investigate cross-sectional differences in cognitive performance between glycemic groups, adjusted for demographic and health factors. Persons with diagnosed diabetes had slower PS than normoglycemics (beta = -0.12; P < 0.05); diabetes duration of >or=15 years was associated with significantly poorer PS and executive function. Undiagnosed diabetics had slower PS (beta = -0.22; P < 0.01) and poorer memory performance (beta = -0.22; P < 0.05). Persons with type 2 diabetes have poorer cognitive performance than normoglycemics, particularly in PS. Those with undiagnosed diabetes have the lowest cognitive performance.
    • Effect of varying glycemic index meals on blood glucose control assessed with continuous glucose monitoring in youth with type 1 diabetes on basal-bolus insulin regimens

      Nansel, Tonja R.; Gellar, Lauren A.; McGill, Adrienne (2008-01-19)
      OBJECTIVE: The purpose of this study was to test the effect of high glycemic index (HGI) and low glycemic index (LGI) meals on blood glucose levels using continuous blood glucose monitoring in youths with type 1 diabetes. RESEARCH DESIGN AND METHODS: A total of 20 youths on basal-bolus regimens consumed macronutrient-matched HGI and LGI meals 1 day each in a controlled setting in varying order following consumption of a standardized evening meal. Medtronic MiniMed Continuous Glucose Monitoring Systems were used to assess blood glucose (BG) profiles. RESULTS: Participants demonstrated significantly lower daytime mean BG, BG area >180 mg/dl, and high BG index when consuming LGI meals but no differences for daytime BG area <70 mg/dl, daytime low BG index, or any nighttime values. Significantly more BG values <80 mg/dl were treated on LGI days. CONCLUSIONS: Findings indicate that consumption of an LGI diet may reduce glucose excursions, improving glycemic control.
    • High and low glycemic index mixed meals and blood glucose in youth with type 2 diabetes or impaired glucose tolerance.

      Gellar, Lauren A.; Nansel, Tonja R (2009-03-01)
      This cross-over pilot study tested blood glucose response to low and high glycemic index meals in 12 obese youth with type 2 diabetes or impaired glucose tolerance. Participants demonstrated significantly lower mean daytime blood glucose and a trend toward lower variability, suggesting a clinically relevant impact of reducing glycemic index.
    • The Effect of Glycemic Index and Glycemic Load on Glucose Control, Lipid Profiles and Anthropometrics Among Low-Income Latinos With Type 2 Diabetes: A Dissertation

      Gellar, Lauren A. (2011-03-30)
      Background The incidence of type 2 diabetes has increased dramatically, particularly among Latinos. While several studies suggest the beneficial effect of lowering glycemic index and glycemic load in patients with type 2 diabetes, no data exists regarding this issue in the Latino population. The purpose of this study was to determine the effect of lowering glycemic index and glycemic load on diabetes control, lipid profiles and anthropometrics among Latinos with type 2 diabetes. Methods Subjects participated in a 12 month randomized clinical trial. The intervention targeted diabetes knowledge, attitudes and behavioral capabilities related to diabetes self management with content including nutrition and physical activity. The nutrition protocol emphasized reduction in glycemic index, fat, salt and portion size and increase in fiber. The control group was given usual care. Measurements included Hba1c, fasting glucose, total cholesterol (TC), low density lipoproteins (LDL) and high density lipoproteins (HDL), HDL:LDL ratio, TC:HDL ratio, waist circumference and BMI and were collected at baseline, 4 and 12-months. Results Two hundred fifty two Latino adults with type 2 diabetes participated in the study. Baseline mean HbA1C was 8.98% (SD=1.87), BMI was 34.76 kg/cm (SD=6.94), age was 56 (SD=11.18) years and 76% were female. Reduction in glycemic index was positively associated with a reduction in logHbA1c (p=0.006), HDL:LDL ratio (p=0.037) and waist circumference (p=0.003) overtime, but not with fasting glucose, TC, LDL and HDL, TC:HDL ratio, body weight or BMI. No significant associations were found between glycemic load and any measures. Conclusion Results suggest that lowering glycemic index may have a positive effect on some markers of diabetes control, lipid profiles and anthropometrics among Latinos with type 2 diabetes, but not others. While statistically significant reductions in GI and GL were noted, the actual reduction was small. Thus, greater reduction in GI and GL may be needed for clinical significance and greater effect on metabolic outcomes. Future research should target populations with higher baseline GI and GL.