Carbohydrate quality, glycemic index, glycemic load and cardiometabolic risks in the US, Europe and Asia: A dose-response meta-analysis

BACKGROUND AND AIMS

Despite the proven evidence of high glycemic index (GI) and glycemic load (GL) diets to increase cardiometabolic risks, knowledge about the meta-evidence for carbohydrate quality within world geographic regions is limited. We conducted a meta-analysis to synthesize the evidence of GI/GL studies and carbohydrate quality, gathering additional exposures for carbohydrate, high glycemic carbohydrate, total dietary fiber, and cereal fiber and risks for type 2 diabetes (T2DM), coronary heart disease (CHD), stroke, and mortality, grouped into the US, Europe, and Asia. Secondary aims examined cardiometabolic risks in overweight/obese individuals, by sex, and dose-response dietary variable trends.

METHODS AND RESULTS

40-prospective observational studies from 4-Medline bibliographical databases (Ovid, PubMed, EBSCOhost, CINAHL) were search up to November 2019. Random-effects hazard ratios (HR) and 95% confidence intervals (CI) for highest vs. lowest categories and continuous form combined were reported. Heterogeneity (I²>50%) was frequent in US GI/GL studies due to differing study characteristics. Increased risks ((HR_GI,T2DM,US=1.14;CI:1.06,1.21), HR_GL,T2DM,US=1.02 (1.01, 1.03)), HR_GI,T2DM,Asia=1.25;1.02,1.53), and HR_GL,T2DM,Asia=1.37 (1.17, 1.60)) were associated with cardiometabolic diseases. GI/GL in overweight/obese females had the strongest magnitude of risks in US-and Asian studies. Total dietary fiber (HR_T2DM,US = 0.92;0.88,0.96) and cereal fiber (HR_T2DM,US = 0.83;0.77,0.90) decreased risk of developing T2DM. Among females, we found protective dose-response risks for total dietary fiber (HR_{5g-total-dietary-fiber,T2DM,US} = 0.94;0.92,0.97)_, but cereal fiber showed better ability to lower T2DM risk (HR_{5g-cereal-fiber},_T2DM,US = 0.67;0.60,0.74). Total dietary-and cereal fibers' dose-response effects were nullified by GL, but not so for cereal fiber with GI.

CONCLUSIONS

Overweight/obese females could shift their carbohydrate intake for higher cereal fiber to decrease T2DM risk, but higher GL may cancel-out this effect.

Canagliflozin Increases Calorie Intake in Type 2 Diabetes Without Changing the Energy Ratio of the Three Macronutrients: CANA-K Study

Background: Sodium/glucose cotransporter-2 (SGLT2) inhibitors improve glycemic control and reduce body weight by increasing glycosuria. Although a compensatory increase of food intake has been reported, the long-term effect of SGLT2 inhibitors on food intake remains unclear. This study investigated the influence of canagliflozin on calorie and nutrient intake over 1 year. Materials and Methods: Patients with type 2 diabetes (n = 107) were enrolled and followed prospectively while receiving canagliflozin at 100 mg/day for 12 months. Intake of nutrients was investigated by using the food frequency questionnaire. Hemoglobin A1c, body weight, and satisfaction with diabetes treatment (assessed by the Diabetes Treatment Satisfaction Questionnaire: DTSQ) were also investigated. Results: The baseline total energy intake was 1723 ± 525 kcal/day and it showed a persistent increase during treatment with canagliflozin, being 132 kcal higher at 6 months (P = 0.0058) and 113 kcal higher at 12 months (P = 0.0516). Intake of all three macronutrients (carbohydrate, protein, and fat) was significantly increased after 6 months of canagliflozin treatment (P = 0.0129, P = 0.0160, and P = 0.0314, respectively), but their ratio was unchanged. The DTSQ score improved significantly and both hemoglobin A1c and body weight showed a significant decrease throughout treatment (all P < 0.0001). Conclusions: After patients with type 2 diabetes commenced canagliflozin, their calorie intake increased without changing the ratio of the three macronutrients. Despite elevation of the calorie intake, glycemic control improved and weight loss was achieved. Satisfaction with treatment of diabetes also increased.

Impact of Carbohydrate Ingestion on Cognitive Flexibility and Cerebral Oxygenation during High-Intensity Intermittent Exercise: A Comparison between Maple Products and Usual Carbohydrate Solutions

BACKGROUND

The aim of this study was to compare the effects of carbohydrate (CHO) drinks (6% per volume) sweetened with maple (syrup or sap) to a commercial sports drink, glucose, and a control solution (water) on cognitive flexibility during high-intensity intermittent exercise.

METHODS

Eighty-five active men completed six 3-min bouts at 95% of their maximal aerobic power on a stationary bike, with 3 min of passive rest between efforts. Subjects were randomly allocated to an ingestion condition. Following each exercise bout, subjects ingested 166 mL of the experimental solution, drinking a total of 1 L of the same solution throughout the experimentation. Cognitive flexibility was measured using reaction time and accuracy on the Stroop task. The cognitive task was performed a total of 10 times, including 15 and 30 min post-exercise. Glycemia and cerebral oxygenation were also measured at each time point. Statistical analyses were performed using a two-way ANOVA (Condition × Time) with repeated measures.

RESULTS

The ingestion of maple products and the commercial sports drink led to a lesser increase in glycemia than glucose ingestion. CHO ingestion, when compared to water, induced a slight reduction in reaction times on the cognitive task, especially in the switching trials. CHO ingestion had no impact on cerebral oxygenation.

CONCLUSIONS

This study shows that CHO ingestion, regardless of its type, tends to improve cognitive performance throughout exercise, especially during difficult cognitive tasks.

Predicting Glycemic Index and Glycemic Load from Macronutrients to Accelerate Development of Foods and Beverages with Lower Glucose Responses

Low glycemic index (GI) and/or low glycemic load (GL) are associated with decreased risks of type-2 diabetes and cardiovascular disease. It is therefore relevant to consider GI and GL in the early phases of the development of packaged foods and beverages. This paper proposes a model that predicts GI and GL from macronutrient composition, by quantifying both the impact of glycemic carbohydrates and the GI-lowering effects of nutrients such as proteins, fats and fibers. The precision of the model is illustrated using data on 42 breakfast cereals. The predictions of GI (r = 0.90, median residual = 2.0) and GL (r = 0.96, median residual = 0.40 g) compete well with the precision of the underlying in-vivo data (Standard Error SE = 3.5 for GI). This model can guide product development towards lowering GI and GL, before final confirmation by in vivo testing.

APOE4 Genotype Exerts Greater Benefit in Lowering Plasma Cholesterol and Apolipoprotein B than Wild Type (E3/E3), after Replacement of Dietary Saturated Fats with Low Glycaemic Index Carbohydrates

We examined the impact of APOE genotype on plasma lipids and glucose in a secondary analysis of data from a five-arm, randomised controlled, parallel dietary intervention trial ('RISCK' study), to investigate the impact of replacing saturated fatty acids (SFA) with either monounsaturated fat (MUFA) or carbohydrate of high or low glycaemic index (GI) on CVD risk factors and insulin sensitivity. We tested the impact of APOE genotype (carriage of E2 and E4 alleles versus E3/E3), determined retrospectively, on plasma lipids, lipoproteins and glucose homeostasis at baseline (n = 469), and on the change in these variables after 24 weeks of dietary intervention (n = 389). At baseline, carriers of E2 (n = 70), E4 (n = 125) and E3/E3 (n = 274) expressed marked differences in total plasma cholesterol (TC, p = 0.001), low density lipoprotein cholesterol (LDL-C, p < 0.0001), apolipoprotein B (apo B, p < 0.0001) and total to high density lipoprotein cholesterol ratio (TC:HDL-C, p = 0.002), with plasma concentrations decreasing in the order E4 > E3/E3 > E2. Following intervention, there was evidence of a significant diet x genotype interaction with significantly greater decreases in TC (p = 0.02) and apo B (p = 0.006) among carriers of E4 when SFA was replaced with low GI carbohydrate on a lower fat diet (TC -0.28 mmol/L p = 0.03; apo B -0.1 g/L p = 0.02), and a relative increase in TC (in comparison to E3/E3) when SFA was replaced with MUFA and high GI carbohydrates (TC 0.3 mmol/L, p = 0.03). Among carriers of E2 (compared with E3/E3) there was an increase in triacylglycerol (TAG) when SFA was replaced with MUFA and low GI carbohydrates 0.46 mmol/L p = 0.001). There were no significant interactions between APOE genotype and diet for changes in indices of glucose homeostasis. In conclusion, variations in APOE genotype led to differential effects on the lipid response to the replacement of SFA with MUFA and low GI carbohydrates.

Effects of pea with barley and less-processed maize on glycaemic control in diabetic dogs

The source of starch may interfere with glycaemic control in dogs, but few studies have evaluated these aspects in diabetic dogs. This study compared the effects of two isonutrient diets with different starch sources, peas and barley (PB) v. maize (Mi), on diabetic dogs. The Mi diet was processed in order to generate a lower starch gelatinisation index. In all, fifteen adult diabetic dogs without other conditions were included. The animals were fed two dry extruded rations with moderate levels of fat and starch and high levels of protein and fibre using a random, double-blind cross-over design. Glycaemic curves over 48 h were developed via continuous glucose monitoring after 60 d on each diet and with the same neutral protamine Hagedorn (NPH) insulin dosage. The following were compared: fasting, mean, maximum and minimum blood glucose, maximum and minimum glycaemia difference, glycaemic increment, area under the glycaemic curve, area under the glycaemic increment curve and serum fructosamine concentration. Paired t tests or Wilcoxon signed-rank tests were used to compare the amount of food and nutrients ingested and the dietary effects on glycaemic variables between the diets. Dogs fed the PB diet presented a lower average mean interstitial glucose (P=0·01), longer mean hypoglycaemic time (P<0·01), shorter mean hyperglycaemic time (P<0·01) and smaller difference between maximum and minimum blood glucose levels (P=0·03). Thus, the processing applied to the Mi diet was not sufficient to achieve the same effects of PB on glycaemic control in diabetic dogs.

Association of Dietary Fatty Acids with Blood Lipids is Modified by Physical Activity in Adolescents: Results from the GINIplus and LISA Birth Cohort Studies

The role of consuming different types of fatty acids (FA) at the expense of carbohydrates (CHO), on the blood lipid profile of adolescents is largely unknown, as is the modulating effect of different levels of physical activity (PA). Children from the GINIplus and LISA birth cohorts, with complete data on dietary FA (assessed by food-frequency questionnaires), objectively-measured PA (assessed by accelerometers) and blood lipids (lipoprotein cholesterol and triglycerides) at age 15 years, were included (N = 837). Sex-stratified associations between dietary FA and blood lipids were assessed by linear regression in substitution models which represented isocaloric replacements of CHO with saturated FA (SFA), monounsaturated FA (MUFA), n-3 polyunsaturated FA (PUFA) or n-6 PUFA. To assess the interactions with PA, analyses were then performed stratified by tertiles of different PA levels (sedentary, lifestyle, moderate-to-vigorous (MVPA)). Both sexes presented a significant inverse association between MUFA and triglycerides, and females a direct association between n-3 PUFA and high-density lipoprotein. Stratifying by PA tertiles, associations were mainly restricted to participants with the lowest levels of lifestyle PA, or the highest time spent sedentary. The effects of dietary FA on the lipid profile vary in an activity-specific manner, emphasizing possible synergistic roles of diet and PA.

Fructose intervention for 12 weeks does not impair glycemic control or incretin hormone responses during oral glucose or mixed meal tests in obese men

BACKGROUND AND AIMS

Incretin hormones glucagon-like peptide (GLP)-1 and glucose-dependent insulinotropic polypeptide (GIP) are affected early on in the pathogenesis of metabolic syndrome and type 2 diabetes. Epidemiologic studies consistently link high fructose consumption to insulin resistance but whether fructose consumption impairs the incretin response remains unknown.

METHODS AND RESULTS

As many as 66 obese (BMI 26-40 kg/m²) male subjects consumed fructose-sweetened beverages containing 75 g fructose/day for 12 weeks while continuing their usual lifestyle. Glucose, insulin, GLP-1 and GIP were measured during oral glucose tolerance test (OGTT) and triglycerides (TG), GLP-1, GIP and PYY during a mixed meal test before and after fructose intervention. Fructose intervention did not worsen glucose and insulin responses during OGTT, and GLP-1 and GIP responses during OGTT and fat-rich meal were unchanged. Postprandial TG response increased significantly, p = 0.004, and we observed small but significant increases in weight and liver fat content, but not in visceral or subcutaneous fat depots. However, even the subgroups who gained weight or liver fat during fructose intervention did not worsen their glucose, insulin, GLP-1 or PYY responses. A minor increase in GIP response during OGTT occurred in subjects who gained liver fat (p = 0.049).

CONCLUSION

In obese males with features of metabolic syndrome, 12 weeks fructose intervention 75 g/day did not change glucose, insulin, GLP-1 or GIP responses during OGTT or GLP-1, GIP or PYY responses during a mixed meal. Therefore, fructose intake, even accompanied with mild weight gain, increases in liver fat and worsening of postprandial TG profile, does not impair glucose tolerance or gut incretin response to oral glucose or mixed meal challenge.

Glycaemic index, glycaemic load and risk of cutaneous melanoma in a population-based, case-control study

Glycaemic index (GI) and glycaemic load (GL) are indicators of dietary carbohydrate quantity and quality and have been associated with increased risk of certain cancers and type 2 diabetes. Insulin resistance has been associated with increased melanoma risk. However, GI and GL have not been investigated for melanoma. We present the first study to examine the possible association of GI and GL with melanoma risk. We carried out a population-based, case-control study involving 380 incident cases of cutaneous melanoma and 719 age- and sex-matched controls in a northern Italian region. Dietary GI and GL were computed for each subject using data from a self-administered, semi-quantitative food frequency questionnaire. We computed the odds ratio (OR) for melanoma according to quintiles of distribution of GL and GL among controls. A direct association between melanoma risk and GL emerged in females (OR 2·38; 95 % CI 1·25, 4·52 for the highest v. the lowest quintile of GL score, P for trend 0·070) but not in males. The association in females persisted in the multivariable analysis after adjusting for several potential confounders. There was no evidence of an association between GI and melanoma risk. GL might be associated with melanoma risk in females.

Dietary glycemic index, glycemic load and metabolic profile in children with phenylketonuria

BACKGROUND AND AIMS

No data exist in the current literature on the glycemic index (GI) and glycemic load (GL) of the diet of phenylketonuric (PKU) children. The aims of this study were to examine the dietary GI and GL in PKU children on a low-phenylalanine (Phe)-diet and to evaluate whether an association may exist between the carbohydrate quality and the metabolic profile.

METHODS

Twenty-one PKU children (age 5-11 years) and 21 healthy children, gender and age matched, were enrolled. Dietary (including GI and GL) and blood biochemical assessments were performed.

RESULTS

No difference was observed for daily energy intake between PKU and healthy children. Compared to healthy controls, PKU children consumed less protein (p = 0.001) and fat (p = 0.028), and more carbohydrate (% of total energy, p = 0.004) and fiber (p = 0.009). PKU children had higher daily GI than healthy children (mean difference (95% confidence interval), 13.7 (9.3-18.3)) and higher GL (31.7 (10.1-53.2)). PKU children exhibited lower blood total and low density lipoprotein cholesterol (LDL) levels (p < 0.01) and higher triglyceride level (p = 0.014) than healthy children, while glucose and insulin concentrations did not differ. In PKU children the dietary GL was associated with triglyceride glucose index (Spearman's correlation coefficient = 0.515, p = 0.034).

CONCLUSION

In PKU children a relationship of the dietary treatment with GI and GL, blood triglycerides and triglyceride glucose index may exist. Improvement towards an optimal diet for PKU children could include additional attention to the management of dietary carbohydrate quality.

Randomized Clinical Trial To Compare The Effects Of Preoperative Oral Carbohydrate Loading Versus Placebo On Insulin Resistance And Cortisol Level After Laparoscopic Cholecystectomy

Postoperative insulin resistance, used as a marker of stress response, is clearly an adverse event. It may induce postoperative hyperglycemia, which according to some authors can increase the risk of postoperative complications. One of the elements of modern perioperative care is preoperative administration of oral carbohydrate loading (CHO-loading), which shortens preoperative fasting and reduces insulin resistance. The aim of the study is to establish the influence of CHO-loading on the level of insulin resistance and cortisol in patients undergoing elective laparoscopic cholecystectomy.

MATERIAL AND METHODS

Patients were randomly allocated to one of 2 groups. The intervention group included 20 patients who received CHO-loading (400 ml Nutricia pre-op®) 2 hours prior surgery. The control group received a placebo (clear water). In every patient blood samples were taken 2 hours prior to surgery, immediately after surgery, and on the 1st postoperative day. Levels and changes in glucose, cortisol and insulin resistance were analyzed in both groups.

RESULTS

Although there were differences in the levels of cortisol, insulin, and insulin resistance, no statistically significant differences were observed between groups in every measurement. The length of stay and postoperative complications were comparable in both groups.

CONCLUSIONS

We believe that CHO-loading is not clinically justified in case of laparoscopic cholecystectomy. No effect on the levels of glucose, insulin resistance and cortisol was observed. Even though such procedure is safe, in our opinion there is no clinical benefit from CHO-loading prior to laparoscopic cholecystectomy.

Glycemic index and glycemic load of commercial Italian foods

BACKGROUND AND AIM

The glycemic index (GI) and glycemic load (GL) are useful parameters in the nutritional classification of carbohydrate foods. Diets characterized by a low GI and/or a low GL have been repeatedly and independently associated with decreased risk of diabetes and other chronic diseases. The aim of this study is to report the GI and GL value of carbohydrate-rich foods available on the Italian market and mostly consumed in Italy.

METHODS AND RESULTS

GI values were determined according to FAO/WHO (1997) and ISO (2010). Overall, the 141 commercial foods that were analyzed represent food categories that are the source of >80% carbohydrate intake in Italy. The food items chosen were based mainly on the market share of the brand within each food category and grouped into 13 food categories: 1) beverages: fermented milk drink, juice, smoothie, soft drink; 2) biscuits; 3) breads; 4) bread substitutes; 5) breakfast cereals; 6) cakes and snacks; 7) candy and confectionery; 8) cereals; 9) desserts and ice-creams; 10) marmalade and jam; 11) pasta; 12) pizza; 13) sugar and sweetener.

CONCLUSION

This database of commercial Italian foods partly overcomes the lack of information on GI and GL of local foods, contributing to a better understanding of the association between GI/GL and health and providing a more informed choice to Italian consumers and health practitioners.

Postprandial glucose, insulin and incretin responses to different carbohydrate tolerance tests

BACKGROUND

Few studies have focused on postprandial incretin responses to different carbohydrate meals. Therefore, we designed a study to compare the different effects of two carbohydrates (75 g oral glucose, a monosaccharide and 100 g standard noodle, a polysaccharide, with 75 g carbohydrates equivalently) on postprandial glucose, insulin and incretin responses in different glucose tolerance groups.

METHODS

This study was an open-label, randomized, two-way crossover clinical trial. 240 participants were assigned to take two carbohydrates in a randomized order separated by a washout period of 5-7 days. The plasma glucose, insulin, c-peptide, glucagon and active glucagon-like peptide-1 (AGLP-1) were measured. The incremental area under curve above baseline from 0 to 120 min of insulin (iAUC(0 -120 min)- INS) and AGLP-1(iAUC(0 -120 min)- AGLP-1) was calculated.

RESULTS

Compared with standard noodles, the plasma glucose and insulin after consumption of oral glucose were higher at 30 min (both P < 0.001) and 60 min (both P < 0.001), while lower at 180 min (both P < 0.001), but no differences were found at 120 min. The glucagon at 180 min was higher after consumption of oral glucose (P = 0.010). The AGLP-1 response to oral glucose was higher at 30 min (P < 0.001), 60 min (P < 0.001) and 120 min (P = 0.022), but lower at 180 min (P = 0.027). In normal glucose tolerance (NGT), oral glucose elicited a higher insulin response to the corresponding AGLP-1 (P < 0.001), which was represented by iAUC(0 -120 min) -INS /iAUC(0 -120 min)- AGLP-1, while in type 2 diabetes mellitus (T2DM), standard noodles did (P = 0.001).

CONCLUSIONS

Monosaccharide potentiated more rapid and higher glycemic and insulin responses. Oral glucose of liquid state would elicit a more potent release of AGLP-1. The incretin effect was amplified after consumption of standard noodles in T2DM.

Effect of dietary fructose on portal and systemic serum fructose levels in rats and in KHK-/- and GLUT5-/- mice

Elevated blood fructose concentrations constitute the basis for organ dysfunction in fructose-induced metabolic syndrome. We hypothesized that diet-induced changes in blood fructose concentrations are regulated by ketohexokinase (KHK) and the fructose transporter GLUT5. Portal and systemic fructose concentrations determined by HPLC in wild-type mice fed for 7 days 0% free fructose were <0.07 mM, were independent of time after feeding, were similar to those of GLUT5(-/-), and did not lead to hyperglycemia. Postprandial fructose levels, however, increased markedly in those fed isocaloric 20% fructose, causing significant hyperglycemia. Deletion of KHK prevented fructose-induced hyperglycemia, but caused dramatic hyperfructosemia (>1 mM) with reversed portal to systemic gradients. Systemic fructose in wild-type and KHK(-/-) mice changed by 0.34 and 1.8 mM, respectively, for every millimolar increase in portal fructose concentration. Systemic glucose varied strongly with systemic, but not portal, fructose levels in wild-type, and was independent of systemic and portal fructose in KHK(-/-), mice. With ad libitum feeding for 12 wk, fructose-induced hyperglycemia in wild-type, but not hyperfructosemia in KHK(-/-) mice, increased HbA1c concentrations. Increasing dietary fructose to 40% intensified the hyperfructosemia of KHK(-/-) and the fructose-induced hyperglycemia of wild-type mice. Fructose perfusion or feeding in rats also caused duration- and dose-dependent hyperfructosemia and hyperglycemia. Significant levels of blood fructose are maintained independent of dietary fructose, KHK, and GLUT5, probably by endogenous synthesis of fructose. KHK prevents hyperfructosemia and fructose-induced hyperglycemia that would markedly increase HbA1c levels. These findings explain the hyperfructosemia of human hereditary fructosuria as well as the hyperglycemia of fructose-induced metabolic syndrome.

Effects of carbohydrate-hydration strategies on glucose metabolism, sprint performance and hydration during a soccer match simulation in recreational players

OBJECTIVES

This study compared the effects of three carbohydrate-hydration strategies on blood glucose concentration, exercise performance and hydration status throughout simulated soccer match-play.

DESIGN

A randomized, double-blind and cross-over study design was employed.

METHODS

After familiarization, 14 recreational soccer players completed the soccer match simulation on three separate occasions. Participants consumed equal volumes of 9.6% carbohydrate-caffeine-electrolyte (∼ 6 mg/kg BW caffeine) solution with carbohydrate-electrolyte gels (H-CHO), 5.6% carbohydrate-electrolyte solution with electrolyte gels (CHO) or electrolyte solution and electrolyte gels (PL). Blood samples were taken at rest, immediately before exercise and every 15 min during exercise (first half: 15, 30, 45 min; second half: 60, 75, 90 min).

RESULTS

Supplementation influenced blood glucose concentration (time × treatment interaction: p<0.001); however, none of the supplementation regimes were effective in preventing a drop in blood glucose at 60 min. Mean sprint speed was 3 ± 1% faster in H-CHO when compared with PL (treatment: p=0.047). Supplementation caused a 2.3 ± 0.5% increase in plasma osmolality in H-CHO (p<0.001) without change in CHO or PL. Similarly, mean sodium concentrations were 2.1 ± 0.4% higher in H-CHO when compared with PL (p=0.006).

CONCLUSIONS

Combining high carbohydrate availability with caffeine resulted in improved sprint performance and elevated blood glucose concentrations throughout the first half and at 90 min of exercise; however, this supplementation strategy negatively influenced hydration status when compared with 5.6% carbohydrate-electrolyte and electrolyte solutions.

Enhancing treatment of obesity by using a distracting mini-meal: a new approach to an old problem

OBJECTIVE

The management of obesity, apart from exercise, mainly involves a calorie restriction regimen. A pharmaceutical treatment is often used to improve patient compliance and diet effectiveness, although several side-effects have previously been described. To improve patient compliance and diet effectiveness without incurring unpleasant side-effects, we evaluated whether a distracting mini-meal can physiologically decrease the absorption of fats and carbohydrates.

DESIGN

Two minutes before each of the three meals consumed daily, 32 obese patients were treated with a distracting mini-meal, 32 with metformin, and 32 with placebo. At baseline and after 1, 3, and 6 months of treatment, body weight, body mass index, waist circumference, fasting/post-prandial insulinaemia and glycaemia, homeostasis model assessment-index, triacylglycerols, and total cholesterol were evaluated.

RESULTS

All patients showed good compliance. With the exception of post-prandial glycaemia, a significant reduction in all parameters was documented in every group, albeit the greater variation was observed in patients treated with a distracting mini-meal or metformin. No one showed noteworthy side-effects.

CONCLUSIONS

Our study focuses on a distracting mini-meal that could become a useful tool in enhancing weight loss. The beneficial effect of a distracting meal on insulin resistance, glucose, and lipid metabolism suggest its possible use to prevent or mitigate obesity-related disorders.

Continuous glucose monitoring and cognitive performance in type 2 diabetes

BACKGROUND

Type 2 diabetes is associated with reductions in cognitive function that are associated with glycated hemoglobin (HbA1c) levels, but there is no information on whether cognition is related to postmeal glucose spikes. We explored the relationship of cognition to glucose levels measured by a continuous glucose monitoring system (CGMS) both before and after a weight loss diet.

SUBJECTS AND METHODS

Forty-four white subjects with type 2 diabetes (59.0 ± 6.2 years old; body mass index, 32.8 ± 4.2 kg/m(2); HbA1c, 6.9 ± 1.0%) completed an 8-week energy-restricted (approximately 6-7 MJ, 30% deficit) diet. Cognitive functioning (short-term memory, working memory, speed of processing [inspection time], psychomotor speed, and executive function) was assessed during four practice sessions, baseline, and Week 8. Parallel glucose levels were attained using the CGMS in 27 subjects. Outcomes were assessed by fasting blood glucose (FBG), postprandial peak glucose (G(max)), time spent >12 mmol/L (T > 12), and 24-h area under the glucose curve (AUC(24)).

RESULTS

Despite a fall in FBG of 0.65 mmol/L after 8 weeks, digits backward results correlated with FBG at both Week 0 and Week 8 (r = -0.43, P < 0.01 and r = -0.32, P < 0.01, respectively). Digits forward results correlated with FBG (r = -0.39, P < 0.01), G(max) (r = -0.46, P < 0.05), and AUC(24) (r = -0.50, P < 0.01) at Week 0 and FBG (r = -0.59, P < 0.001), G(max) (r = 0.37, P = 0.01), AUC(24) (r = -0.41, P < 0.01), and percentage weight loss (r = 0.31, P < 0.01) at Week 8. Cognitive function was not altered by weight loss, gender, baseline lipid levels, or premorbid intelligence levels (National Adult Reading Test).

CONCLUSIONS

FBG, G(max,) and AUC(24) were related to cognitive function and an energy-restricted diet for 8 weeks did not alter this relationship.

Effects of everyday life events on glucose, insulin, and glucagon dynamics in continuous subcutaneous insulin infusion-treated type 1 diabetes: collection of clinical data for glucose modeling

BACKGROUND

In the development of glucose control algorithms, mathematical models of glucose metabolism are useful for conducting simulation studies and making real-time predictions upon which control calculations can be based. To obtain type 1 diabetes (T1D) data for the modeling of glucose metabolism, we designed and conducted a clinical study.

METHODS

Patients with insulin pump-treated T1D were recruited to perform everyday life events on two separate days. During the study, patients wore their insulin pumps and, in addition, a continuous glucose monitor and an activity monitor to estimate energy expenditure. The sequence of everyday life events was predetermined and included carbohydrate intake, insulin boluses, and bouts of exercise; the events were introduced, temporally separated, in different orders and in different quantities. Throughout the study day, 10-min plasma glucose measurements were taken, and samples for plasma insulin and glucagon analyses were obtained every 10 min for the first 30 min after an event and subsequently every 30 min.

RESULTS

We included 12 patients with T1D (75% female, 34.3±9.1 years old [mean±SD], hemoglobin A1c 6.7±0.4%). During the 24 study days we collected information-rich, high-quality data during fast and slow changes in plasma glucose following carbohydrate intake, exercise, and insulin boluses.

CONCLUSIONS

This study has generated T1D data suitable for glucose modeling, which will be used in the development of glucose control strategies. Furthermore, the study has given new physiologic insight into the metabolic effects of carbohydrate intake, insulin boluses, and exercise in continuous subcutaneous insulin infusion-treated patients with T1D.

Blood glucose response to rate of consumption of digestible carbohydrate

When the glycemic response to consuming digestible carbohydrate is measured, little or no attention appears to have been paid to the possible effect on this response of the rate at which the food is consumed. We compared glycemic responses when volunteers ate or drank foods containing digestible carbohydrate as rapidly as possible, or in five equal portions over 12 min. Expecting that the response would be greater when the food was consumed rapidly, we found that the responses were equally and randomly distributed between the two rates of eating. At the same time, marked differences were noted in the responses elicited when different individuals consumed the same foods, leading to an investigation of this phenomenon, published elsewhere.

Assessment of endothelial function and blood metabolite status following acute ingestion of a fructose-containing beverage

AIM

Fructose intake has increased concurrent with sugar intake and this increase has been implicated in contributing to the development of metabolic syndrome risk factors. Recent evidence suggests a role for uric acid (UA) as a potential mediator via suppression of nitric oxide (NO) bioavailability. The aim of this study was to explore this hypothesis by measuring changes in UA concentration and systemic NO bioavailability as well as endothelial function in response to acute ingestion of a glucose-fructose beverage.

METHODS

Ten young (26.80 +/- 4.80 years), non-obese (body mass index: 25.1 +/- 2.55 kg m(-2); percent body fat: 13.5 +/- 6.9%) male subjects ingested either a glucose (100 g dextrose in 300 mL) or isocaloric glucose-fructose (glucose : fructose; 45 : 55 g in 300 mL) beverage. Blood was sampled pre- and every 15-min post-ingestion per 90 min and assayed for glucose, lactate, fructose, total nitrate/nitrate, UA and blood lipids. Forearm blood flow and pulse-wave velocity were recorded prior to and at 30 and 45 min time intervals post-ingestion, respectively, while heart rate, systolic and diastolic blood pressure were recorded every 15 min.

RESULTS

The glucose-fructose ingestion was associated with a significant (P < 0.05) increase in plasma lactate concentration and altered free fatty acid levels when compared with glucose-only ingestion. However, UA was not significantly different (P = 0.08) between conditions (AUC: -1018 +/- 1675 vs. 2171 +/- 1270 micromol L(-1) per 90 min for glucose and glucose-fructose conditions respectively). Consequently, no significant (P < 0.05) difference in endothelial function or systemic NO bioavailability was observed.

CONCLUSION

Acute consumption of a fructose-containing beverage was not associated with significantly altered UA concentration, endothelial function or systemic NO bioavailability.

Proposed clinical application for tuning fuzzy logic controller of artificial pancreas utilizing a personalization factor

BACKGROUND

Physicians tailor insulin dosing based on blood glucose goals, response to insulin, compliance, lifestyle, eating habits, daily schedule, and fear of and ability to detect hypoglycemia.

METHOD

We introduce a method that allows a physician to tune a fuzzy logic controller (FLC) artificial pancreas (AP) for a particular patient. It utilizes the physician's judgment and weighing of various factors. The personalization factor (PF) is a scaling of the dose produced by the FLC and is used to customize the dosing. The PF has discrete values of 1 through 5. The proposed method was developed using a database of results from 30 University of Virginia/Padova Metabolic Simulator in silico subjects (10 adults, 10 adolescents, and 10 children). Various meal sizes and timing were used to provide the physician information on which to base an initial dosing regimen and PF. Future decisions on dosing aggressiveness using the PF would be based on the patient's data at follow-up.

RESULTS

Three examples of a wide variation in diabetes situations are given to illustrate the physician's thought process when initially configuring the AP system for a specific patient.

CONCLUSIONS

Fuzzy logic controllers are developed by encoding human expertise into the design of the controller. The FLC methodology allows for the real-time scaling of doses without compromising the integrity of the dosing rules matrix. The use of the PF to individualize the AP system is enabled by the fuzzy logic development methodology.

A lifecourse study of bone resorption in men ages 49-51years: the Newcastle Thousand Families cohort study

It has been suggested that bone health in adulthood is programmed by development in utero. Most previous investigations addressing this topic have focussed on bone mineral density or content, rather than other indicators of bone health, such as biochemical markers of bone turnover. This study investigated whether potential predictors, from different stages of life, influence bone resorption in men aged 49-51years in the Newcastle Thousand Families birth cohort. The cohort originally consisted of all 1142 births in the city of Newcastle upon Tyne, UK in May and June 1947. Detailed information was collected prospectively during childhood, including birth weight and socio-economic circumstances. At 49-51years of age, 574 study members completed a detailed 'Health and Lifestyle' questionnaire, including the European Prospective Investigation of Cancer (EPIC) food frequency questionnaire and 412 study members attended for clinical examination, including 172 men in whom bone resorption was assessed by measurement of serum beta C-telopeptide of type 1 collagen (CTX). A significant trend was seen between increasingly disadvantaged socio-economic status at birth and increased bone resorption (p=0.04, r-squared 2.6%). However, birth weight, standardised for sex and gestational age, was not associated with serum CTX (p=0.77, r-squared 0.05%). Significant trends were also seen between increasing total energy intake (p=0.03, r-squared 2.9%), dietary intake of saturated fat (p=0.02, r-squared 2.6%), protein (p=0.04, r-squared 2.5%) and carbohydrates (p=0.04, r-squared 2.6%) and higher serum CTX. However, on adjustment for total energy intake, none of the other dietary variables was significant at the univariate level maintained significance. Our findings suggest that early socio-economic disadvantage and later dietary factors may be associated with increased bone resorption in middle aged men. However, as little of the variance in serum CTX was explained by the variables included within this investigation, further longitudinal studies, with sufficient statistical power, are required to assess predictors of bone resorption in adulthood and their relative importance.

Pre-operative carbohydrate loading may be used in type 2 diabetes patients

BACKGROUND

Post-operative insulin resistance and hyperglycaemia are associated with an impaired outcome after surgery. Pre-operative oral carbohydrate loading (CHO) reduces post-operative insulin resistance with a reduced risk of hyperglycaemia during post-operative nutrition. Insulin-resistant diabetic patients have not been given CHO because the effects on pre-operative glycaemia and gastric emptying are unknown.

METHODS

Twenty-five patients (45-73 years) with type 2 diabetes [glycated haemoglobin (HbA1c) 6.2 +/- 0.2%, mean +/- SEM] and 10 healthy control subjects (45-72 years) were studied. A carbohydrate-rich drink (400 ml, 12.5%) was given with paracetamol 1.5 g for determination of gastric emptying.

RESULTS

Peak glucose was higher in diabetic patients than in healthy subjects (13.4 +/- 0.5 vs. 7.6 +/- 0.5 mM; P<0.01) and occurred later after intake (60 vs. 30 min; P<0.01). Glucose concentrations were back to baseline at 180 vs. 120 min in diabetic patients and healthy subjects, respectively (P<0.01). At 120 min, 10.9 +/- 0.7% and 13.3 +/- 1.2% of paracetamol remained in the stomach in diabetic patients and healthy, subjects respectively. Gastric half-emptying time (T50) occurred at 49.8 +/- 2.2 min in diabetics and at 58.6 +/- 3.7 min in healthy subjects (P<0.05). Neither peak glucose, glucose at 180 min, gastric T50, nor retention at 120 min differed between insulin (HbA1c 6.8 +/- 0.7%)- and non-insulin-treated (HbA1c 5.6 +/- 0.4%) patients.

CONCLUSIONS

Type 2 diabetic patients showed no signs of delayed gastric emptying, suggesting that a carbohydrate-rich drink may be safely administrated 180 min before anaesthesia without risk of hyperglycaemia or aspiration pre-operatively.

Running to maintain cardiovascular fitness is not limited by short-term fasting or enhanced by carbohydrate supplementation

PURPOSE

This study determined if recreational type of endurance exercise is limited by a short-term fast, such as an overnight fast or benefited by a carbohydrate supplement prior to and during endurance exercise.

METHODS

Six individuals ran at 70% VO2max for 90 min under three dietary conditions (fed, fasted for 16 to 18 h, fasted plus CHO).

RESULTS

RPE, RER, BG (blood glucose), and La (lactate) were similar between conditions throughout 90 min of exercise. FFA was higher (P <or= 0.05) only in the fed and fasted groups after exercise.

CONCLUSION

The psychosomatic sensation, physiologic, and metabolic data all indicated that endurance exercise for up to 90 min for fit individuals is not limited by a short-term fast or enhanced by carbohydrate supplementation. These findings are of interest to persons who exercise to maintain and enhance health and are not concerned with elite performance.

Carbohydrate influences plasma interleukin-6 but not C-reactive protein or creatine kinase following a 32-km mountain trail race

Attenuation of exercise-induced interleukin-6 (IL-6) responses by carbohydrate (CHO) has been demonstrated in studies comparing controlled doses (> or = 0.9 g x kg(-1) x h(-1)) to placebo, but not in studies of voluntary intake. This study sought to determine if attenuation of the IL-6 response during a 32.2-km mountain trail race occurs for high compared to low ad libitum CHO intakes. IL-6, C-reactive protein (CRP), and creatine kinase activity (CK) were analyzed from blood samples collected 12 h pre-, 0, 4, and 24 h post-race. Subjects were grouped into low (n =14, 0.4 +/- 0.1 g x kg(-1) x h(-1)) and high (n =18, 0.8 +/- 0.2 g x kg(-1) x h(-1)) CHO intake groups. IL-6 0 h post-race (P < 0.05) was higher in the low (40.2 +/- 22.7 pg x mL(-1)) compared to the high CHO group (32.7 +/- 22.1 pg x mL(-1)). CRP and CK both increased post-race, but no differences were observed between groups. Attenuation of exercise-induced IL-6 is apparent across a range of CHO intakes.

Glucose and insulin responses to porridge and gruel meals intended for infants

OBJECTIVE

The objective was to determine the glycaemic index (GI) and insulinaemic index (II) of some common products intended for infants; that is, three commercial porridges and one gruel. Also, the influence of added fruit components to porridge on postprandial metabolic responses was studied by comparing corresponding data with a matched model product without fruit.

DESIGN

The volunteers were served the test products in random order following an overnight fast. A white bread was included as a reference product. Capillary blood samples were collected before and during 3 h after the meals.

SETTING

The study was performed at the Department of Applied Nutrition and Food Chemistry, Lund University, Sweden.

SUBJECTS

A total of 10 healthy volunteers, six men and four women, aged 24-41 y, with normal body mass indices, were recruited.

RESULTS

The GIs (67-75) of the commercial porridges and gruel were significantly lower than for the white bread reference (P < 0.05). In contrast, the GI (79) of the model product (porridge without fruit) could not be distinguished from the reference. The IIs (112-149) for the commercial products and model products, respectively, were not significantly different from the reference.

CONCLUSIONS

: The commercial porridges and gruel gave unexpectedly low GIs. In contrast, high IIs were noted. The inconsistency between GI and II could probably be explained by the insulinotrophic effect of the milk component in the products. The fruit and fruit juice added to some of the products had only minor effect on postprandial glycaemia.

SPONSORSHIP

The Swedish Council for Forestry and Agricultural Research.

Leptin gene expression and systemic levels in healthy men: effect of exercise, carbohydrate, interleukin-6, and epinephrine

Leptin, an adipose tissue-derived cytokine, is correlated with adipose mass as obese persons have increased levels of leptin that decrease with weight loss. Previous studies demonstrate that high-energy-expenditure exercise decreases circulating leptin levels, whereas low-energy-expenditure exercise has no effect. We aimed to test the hypothesis that acute exercise reduced leptin mRNA levels in human adipose tissue and that this effect would be ameliorated by carbohydrate supplementation. Because exercise markedly increases circulating IL-6 and epinephrine, we investigated whether the changes in leptin seen with acute exercise could be mediated by IL-6 or epinephrine infusion. Abdominal subcutaneous adipose tissue mRNA and plasma levels of leptin were measured in healthy men in response to 3-h ergometer exercise with or without carbohydrate (CHO) ingestion ( n = 8) and in response to infusion with recombinant human (rh)IL-6 ( n = 11) or epinephrine ( n = 8) or saline. Plasma leptin declined in response to exercise ( P < 0.05) compared with rest, whereas mRNA expression in adipose tissue was unaffected. The exercise-induced decrease in plasma leptin was attenuated by CHO ingestion ( P < 0.001). A 3-h epinephrine infusion decreased plasma leptin ( P < 0.001) to the same level seen with 3 h of exercise, whereas leptin levels were unaffected by rhIL-6 infusion. In conclusion, both acute exercise and epinephrine infusion decreased plasma leptin to a similar extent, whereas there was no effect with rhIL-6 infusion. Acute exercise solely affected leptin plasma levels, as mRNA levels were unchanged. The exercise-induced decrease in circulating leptin was counteracted by CHO ingestion, suggesting a posttranscriptional regulatory mechanism of leptin involving substrate availability.

The beneficial effect of a diet with low glycaemic index on 24 h glucose profiles in healthy young people as assessed by continuous glucose monitoring

Elevated postprandial glycaemia has been linked to CVD in a number of different epidemiological studies involving predominantly non-diabetic volunteers. The MiniMed continuous glucose monitor, which measures blood glucose every 5 min, over a 24 h period, was used to investigate changes in blood glucose readings before and after instigating a diet with low glycaemic index (GI) for 1 week in free-living healthy individuals. Nine healthy people (age 27 (SEM 1.3) years, BMI 23.7 (SEM 0.7) kg/m2, one male, eight females) completed the study. A reduction in GI (59.7 (SEM 2) v. 52.1 (SEM 2), P<0.01) occurred in all nine subjects while energy and other macronutrients remained constant. A significant reduction was also observed in fasting glucose at 06.00 hours (5.4 (SEM 0.2) v. 4.4 (SEM 0.3) mmol/l, P<0.001), mean glucose (5.6 (SEM 0.2) v. 5.1 (SEM 0.2) mmol/l, P=0.004), area under the 24 h glucose curve (8102 (SEM 243) v. 750 (SEM 235) mmol/l per min, P=0.004) and area under the overnight, 8 h glucose curve (2677 (SEM 92) v. 2223 (SEM 121) mmol/l per min, P=0.01). The present study provides important data on how a simple adjustment to the diet can improve glucose profiles that, if sustained in the long term, would be predicted from epidemiological studies to have a favourable influence on CVD.

Decreased Warfarin Effect after Initiation of High-Protein, Low-Carbohydrate Diets

OBJECTIVE:

To report 2 cases of decreased international normalized ratio (INR) after initiation of a high-protein, low-carbohydrate diet.

CASE SUMMARIES:

Case 1. A 67-year-old white woman had been receiving warfarin for 3 years for venous thromboembolism. After initiation of a high-protein, low-carbohydrate diet, the patient required a 22.2% increase (from 45 to 57.5 mg/wk) in warfarin dose. Her INR remained in the therapeutic range on this dose for 8 weeks. When the patient stopped the high-protein, low-carbohydrate diet, a decrease back to the original warfarin dose was required to return to a therapeutic INR. Case 2. A 58-year-old white man had been receiving warfarin for 8 years for a cerebrovascular accident. Initiation of a high-protein, low-carbohydrate diet resulted in a 30% increase (from 26.25 to 37.5 mg/wk) in warfarin dose. His warfarin dose was reduced to the original dose after he stopped the high-protein, low-carbohydrate diet.

DISCUSSION:

The Naranjo probability scale indicated a possible adverse effect between warfarin and high-protein diets. High-protein diets have been shown to increase serum albumin levels. This may result in more warfarin binding to serum albumin, thereby decreasing the anticoagulant effect of warfarin. The increase of albumin occurs rapidly after initiation of a high-protein diet and appears to promptly affect anticoagulation therapy with warfarin.

CONCLUSIONS:

These cases indicate a significant interaction between high-protein, low-carbohydrate diets and warfarin therapy. Patients receiving warfarin therapy should be educated on and monitored for the potential interaction that occurs with warfarin therapy and high-protein, low-carbohydrate diets.

Effect of a rice bran fiber diet on serum glucose levels of diabetic patients in Brazil

Eleven diabetic patients: 5, type 1 and 6, type 2 received a low-fiber diet (I) during 1 week and during the next 7 days the same diet, enriched with 40 g of fiber (30.6% insoluble and 11.7% soluble components) from rice bran (II) per day. Results showed that mean fasting and postprandial serum glucose levels were reduced, but values of high fiber diet were significantly lower (p < 0.001) than that of the lower fiber diet. For all patients, the high-fiber diet increased fecal weight. This increase was due to the fiber excreted, rather than water retained. There was no relationship between the increase in fiber intake and its fecal excretion. Sucrose and raffinose were found in the bran, but not in the feces. Lactose was present in the stools of the patients receiving enriched diet.

Diurnal and acute patterns of postprandial apolipoprotein B-48 in VLDL, IDL, and LDL from normolipidemic humans

Smaller size particles of intestinal origin may be more relevant to atherosclerosis than larger particles because of easier transendothelial transport. We examined the diurnal pattern in response to low-fat high-carbohydrate meals and the effect of a single high-fat milkshake on apoB-48 in very light Sf degrees >400, light Sf degrees 60-400, and dense Sf degrees 20-60 VLDL, IDL, and LDL in 24 subjects (12 in each study). After the high-fat meal, apoB-48 concentrations peaked at 3 h for very light VLDL, 4 h for light VLDL, and 5 h for dense VLDL and IDL, suggesting a delipidation cascade. The diurnal pattern was characterized by a sharp increase in light and dense VLDL apoB-48 after breakfast, reaching the highest concentration 4-8h after breakfast. Less response was observed after lunch, dinner or snack, despite 75% of energy supplied by these meals. The proportion of apoB-48 in LDL in the fasting state ranged between 48 and 54%. LDL apoB-48 concentration decreased by 35% after the high-fat meal, and slowly recovered to near fasting concentrations after 10-12 h. In contrast, in the diurnal study, LDL apoB-48 concentration steady increased peaking 13 h after breakfast, followed by a sharp decrease. In sum, most intestinally synthesized apoB lipoproteins circulate in LDL, and are likely formed in the late postprandial period from larger VLDL-size particles. Although small apoB-48 lipoproteins may be atherogenic remnant particles, their very low concentration may diminish their clinical significance.

High oxidation rates from combined carbohydrates ingested during exercise

Studies that have investigated oxidation of a single carbohydrate (CHO) during exercise have reported oxidation rates of up to 1 g x min(-1). Recent studies from our laboratory have shown that a mixture of glucose and sucrose or glucose and fructose ingested at a high rate (1.8 g x min(-1)) leads to peak oxidation rates of approximately 1.3 g x min(-1) and results in approximately 20 to 55% higher exogenous CHO oxidation rates compared with the ingestion of an isocaloric amount of glucose.

PURPOSE

The purpose of the present study was to examine whether a mixture of glucose, sucrose and fructose ingested at a high rate would result in even higher exogenous CHO oxidation rates (>1.3 g x min(-1)).

METHODS

Eight trained male cyclists (VO2max: 64 +/- 1 mL x kg(-1) BM x min(-1)) cycled on three different occasions for 150 min at 62 +/- 1% VO2max and consumed either water (WAT) or a CHO solution providing 2.4 g x min(-1) of glucose (GLU) or 1.2 g x min(-1) of glucose + 0.6 g x min(-1) of fructose + 0.6 g x min(-1) of sucrose (MIX).

RESULTS

High peak exogenous CHO oxidation rates were found in the MIX trial (1.70 +/- 0.07 g x min(-1)), which were approximately 44% higher (P < 0.01) compared with the GLU trial (1.18 +/- 0.04 g x min(-1)). Endogenous CHO oxidation was lower (P < 0.05) in MIX compared with GLU (0.76 +/- 0.12 and 1.05 +/- 0.06 g x min(-1), respectively).

CONCLUSION

When glucose, fructose and sucrose are ingested simultaneously at high rates (2.4 g x min(-1)) during cycling exercise, exogenous CHO oxidation rates can reach peak values of approximately 1.7 g x min(-1) and estimated endogenous CHO oxidation is reduced compared with the ingestion of an isocaloric amount of glucose.

Effect of Pre-exercise Carbohydrate Ingestion on Plasma Cytokine, Stress Hormone, and Neutrophil Degranulation Responses to Continuous, High-Intensity Exercise

The purpose of the present study was to examine the effect of pre-exercise carbohydrate (CHO) ingestion on circulating leukocyte numbers, plasma interleukin (IL)-6, plasma cortisol, and lipopolysaccharide (LPS)-stimulated neutrophil degranulation responses in moderately trained male cyclists who completed approximately 1-h of high-intensity cycling. The influence of the timing of pre-exercise CHO ingestion was investigated in 8 subjects who consumed 75 g CHO as a glucose solution at either 15 (–15 trial), or 75 (–75 trial) min before the onset of exercise. The influence of the amount of pre-exercise CHO ingestion was investigated in a further 10 subjects who consumed either 25 g or 200 g CHO as a glucose solution or a placebo 45 min before the onset of exercise. At the onset of exercise in the timing experiment, the plasma glucose concentration was significantly (p < .05) lower on the –75 trial compared with pre-drink values, and the plasma cortisol concentration and neutrophil to lymphocyte (N/L) ratio were significantly (p < .05) elevated in the post-exercise period. In the –15 trial, plasma glucose concentration was well maintained, and the plasma cortisol concentration and N/L ratio were not significantly elevated above resting levels. However, LPS-stimulated neutrophil degranulation was similar in the –15 and –75 trials. The amount of CHO ingested had no effect on the magnitude of the rise in the N/L ratio compared with placebo when consumed 45 min pre-exercise. Finally, although an exercise-induced increase in the plasma IL-6 concentration was observed, this effect was independent of pre-exercise CHO ingestion.

Metabolic processes in hypokinetic and rehabilitated men

The present paper summarizes the experimental data on influence of antiorthostatic hypokinesia (49 days) and rationalized nutrition during the rehabilitation period (30 days) on metabolic processes. On the basis of these data a well balanced diet is recommended for the rehabilitation period which follows a long-term bed rest.

Caffeine ingestion does not alter performance during a 100-km cycling time-trial performance

This study analyzed the effect of caffeine ingestion on performance during a repeated-measures, 100-km, laboratory cycling time trial that included bouts of 1- and 4-km high intensity epochs (HIE). Eight highly trained cyclists participated in 3 separate trials' placebo ingestion before exercise with a placebo carbohydrate solution and placebo tablets during exercise (Pl), or placebo ingestion before exercise with a 7% carbohydrate drink and placebo tablets during exercise (Cho), or caffeine tablet ingestion before and during exercise with 7% carbohydrate (Caf). Placebo (twice) or 6 mg.kg(-1) caffeine was ingested 60 min prior to starting 1 of the 3 cycling trials, during which subjects ingested either additional placebos or a caffeine maintenance dose of 0.33 mg.kg(-1) every 15 min to trial completion. The 100-km time trial consisted of five 1-km HIE after 10, 32, 52, 72, and 99 km, as well as four 4-km HIE after 20, 40, 60, and 80 km. Subjects were instructed to complete the time trial and all HIE as fast as possible. Plasma (caffeine) was significantly higher during Caf (0.43 +/- 0.56 and 1.11 +/- 1.78 mM pre vs. post Pl; and 47.32 +/- 12.01 and 72.43 +/- 29.08 mM pre vs. post Caf). Average power, HIE time to completion, and 100-km time to completion were not different between trials. Mean heart rates during both the 1-km HIE (184.0 +/- 9.8 Caf; 177.0 +/- 5.8 Pl; 177.4 +/- 8.9 Cho) and 4-km HIE (181.7 +/- 5.7 Caf; 174.3 +/- 7.2 Pl; 175.6 +/- 7.6 Cho; p <.05) was higher in Caf than in the other groups. No significant differences were found between groups for either EMG amplitude (IEMG) or mean power frequency spectrum (MPFS). IEMG activity and performance were not different between groups but were both higher in the 1-km HIE, indicating the absence of peripheral fatigue and the presence of a centrally-regulated pacing strategy that is not altered by caffeine ingestion. Caffeine may be without ergogenic benefit during endurance exercise in which the athlete begins exercise with a defined, predetermined goal measured as speed or distance.

[Effects of simulated weightlessness on carbohydrate intake and serum lipids]

OBJECTIVE

To observe the effects of simulated weightlessness on the nutritional state and contents of serum lipids in human.

METHOD

Eighteen healthy men were exposed to 21 d bed rest with -6 degrees head down tilt (HDT -6 degrees). Nutrients intake was calculated and the lipids levels were determined on the first, eleventh and twenty-first day.

RESULT

Intake of the three main nutrients, carbohydrates, protein and fat met the physiological requirement essentially, but carbohydrates intake was significantly reduced in the second week. There were no significant differences among the lipid levels during different periods.

CONCLUSION

Simulated weightlessness may exert a short-term and reversible influence on human nutritional intake except for lipids.

Glycaemic index of New Zealand foods

AIM

To determine the glycaemic index values to a range of foods that are unique to New Zealand, and those that are grown and/or manufactured locally.

METHODS

We determined the glycaemic index of 28 carbohydrate foods in both healthy subjects and those with type 2 diabetes. Venous blood samples were collected over two to three hours, and the incremental area under the blood glucose curve was used to calculate glycaemic index values.

RESULTS AND CONCLUSIONS

This study has identified the glycaemic index values for a range of New Zealand foods which will be clinically useful in the nutritional management of individuals with diabetes mellitus. People with diabetes are recommended to choose foods with a low glycaemic index which is associated with optimal blood glucose control and lipid levels.

Acute carbohydrate consumption does not influence resistance exercise performance during energy restriction

The effect of acute carbohydrate consumption on performance and metabolism of resistance-trained males was determined. Twenty-two subjects, assigned to either carbohydrate (C, n = 8), placebo (P, n = 8), or control (N, n = 6), performed standardized workouts every other day for a week prior to testing and throughout the testing period. Three of these workouts (T1, T2, and T3) were the performance test in that the last bouts of leg extension and bench press were done to failure at 80% of 10 repetition maximum. A carbohydrate or placebo beverage was consumed 30 min prior to T3. Blood samples were drawn before and after T2 and T3. There was no effect of carbohydrate or energy restriction on number of repetitions done during the leg extension performance test. Carbohydrate intake prior to a resistance exercise bout done in negative energy balance state did not affect performance or evidence of muscle damage.

[Physiological role of dietary carbohydrates in diet of hungarian population. Epidemiological study]

Authors reviews--upon literature data--the metabolism of carbohydrates, with special regard to lipogenesis, which is of less importance and has no role in obesity. Out of the plasma lipids, in the case of extreme sugar consumption, only the level of triglicerides shows increase. Sugar is one but not the only factor caries. Sugar promotes the learning and remembering function of the brain and possibly, affects behaviour, too. Oligosaccharides may contribute to the favourable changes in the intestinal microflora. Carbohydrates and within them, sugars, play no unfavourable role in the development of diabetes mellitus, obesity, cardiovascular disease, when nutrition is well balanced.

Nutrition survey of the Hungarian population in a randomized trial between 1992-1994

OBJECTIVE

Collection of data relating to nutrition, nutrient supply and nutritional status, and to certain risk factors of diet-related diseases in a group of Hungarian population.

DESIGN

Collection of data on diets three times 24h dietary recall, anthropometric measurements to obtain information about the nutritional status, laboratory tests measurements of biochemical markers.

SUBJECT

Examination of 2559 volunteer adult persons, selected in a quasi random way in Budapest and seven other counties.

RESULTS

The diets of the persons examined contained more than necessary protein 14.6 en%, considerably more fat 38.0 en%, mainly fat of animal origin with low PUFA and including high cholesterol, little total carbohydrate 45.1 en%, in that much added sugar 15.4 en%. Vitamin supply was generally satisfactory, borderline deficiency may be observed in the case of tocopherol equivalent and in some age-groups, first of all in women, in the case of thiamine, riboflavin and pyridoxine. Out of the macro- and microelements, sodium intake is three to four times the acceptable level, potassium and calcium intakes in both genders, iron and zinc intakes in women show deficiency. The mean value for relative body mass, the distribution of BMI values prove a high incidence of overweight 34.3% and obesity 21.1%. Means for biochemical markers appear to indicate that nutrient supply was in the normal range of laboratory tests. The averages of total cholesterol and LDL-cholesterol 5.6 and 3.6 mmol/L, respectively unequivocally suggested the risk of cardiovascular diseases.

CONCLUSIONS

The nutrition of the Hungarian population presents several risk factors of diet-related diseases: P/S ratio of 0.27-0.29, Na/K ratio of 2.6 g/g, intake of some micronutrients (vitamins, macro- and microelements) was low in certain groups of investigated persons.

A fructose-rich diet decreases insulin-stimulated glucose incorporation into lipids but not glucose transport in adipocytes of normal and diabetic rats

To study the cellular mechanisms underlying fructose-induced insulin resistance in rats, the effects of fructose feeding on insulin-stimulated glucose transport, oxidation and incorporation into lipids in epididymal adipocytes were evaluated in 27 normal and 27 noninsulin-dependent diabetic male Sprague-Dawley rats. Diabetes was induced by streptozotocin injection 2 d after birth. At 5 wk of age, both normal and diabetic rats were fed a diet containing 62% carbohydrate as fructose, dextrose or cornstarch. Fructose feeding for 6 wk induced glucose intolerance in normal rats (P < 0.05) and aggravated that of diabetic rats (P < 0.05). Plasma triacylglycerol concentration was higher in fructose-fed than in starch-fed or dextrose-fed rats (P < 0.05). Adipocytes of fructose-fed rats had significantly lower maximum insulin-stimulated glucose incorporation into total lipids than those of rats fed starch, and tended (P = 0.22) to have lower production of CO2 from glucose than adipocytes of the other dietary groups. Glucose transport in adipocytes of dextrose-, starch- and fructose-fed rats did not differ. We conclude that in both normal and diabetic rats, a chronic fructose-rich diet induced hypertriacylglycerolemia, glucose intolerance and insulin resistance of adipocytes.

Carbohydrate utilization by white sturgeon as assessed by oral administration tests

Oral carbohydrate administration tests were used to gain more insight into the ability of white sturgeon (Acipenser transmontanus) to utilize different carbohydrates. Nine carbohydrates in gelatin capsules were administered orally after the sturgeon were fasted for 48 h. Blood was sampled at selected time intervals from 2 to 72 h thereafter. Maximum plasma glucose concentration in the glucose-fed sturgeon was significantly higher (P less than 0.05) than in the maltose-fed sturgeon, which in turn was higher than in sturgeon fed the other carbohydrates. Maximum plasma glucose concentrations in the sturgeon fed fructose, galactose, sucrose, lactose, dextrin, raw cornstarch or cellulose were not significantly different. New findings in this study include the following: 1) plasma glucose concentrations in the glucose- or maltose-fed sturgeon were higher than the other animals under similar conditions; 2) the pattern of plasma galactose and glucose concentrations was similar in sturgeon after they were fed galactose and glucose, respectively, except that the maximum plasma galactose concentration was observed 8 h later than the maximum plasma glucose concentration; and 3) a small amount of the same disaccharide was detected in the plasma of sturgeon 4 to 20 h after they were fed the disaccharides.

Effects of 4 h preexercise carbohydrate feedings on cycling performance

This study determined the effects of consuming three different amounts of liquid carbohydrate 4 h before exercise on the metabolic responses during exercise and on exercise performance. Four hours before exercise subjects consumed either 45 (L) or 156 (M) g of carbohydrate in isocaloric feedings and either 0 (P) or 312 (H) g of carbohydrate. Interval cycling was undertaken for 95 min, followed by a performance trial. Blood glucose had reached basal 1 h after all feedings; blood insulin had reached basal 3 h after ingestion of P, L, and M but was still 84% higher for H at the start of exercise. During exercise insulin averaged 48% higher for H than P. Blood glucose decreased 16% during exercise for P, L, and M, whereas for H there was a transient drop the first 15 min of exercise, after which glucose increased and remained constant throughout exercise. More carbohydrate oxidation occurred during exercise for H vs P, whereas results were similar for L and M. Ingestion of H improved performance by 15% as compared with P, whereas performance was similar for L and M. These results indicate that, despite elevated insulin at the start of and during exercise, consumption of 312 g of carbohydrate 4 h before moderately intense prolonged exercise can improve performance, perhaps via an enhancement of carbohydrate oxidation.

U.S.S.R. and U.S. nutrient intake, plasma lipids, and lipoproteins in men ages 40-59 sampled from Lipid Research Clinics populations

Correlates of high-density lipoprotein (HDL) cholesterol and other lipids and lipoproteins were studied in white men ages 40-59 who were part of the 15% random sample recalled to Visit 2 of the Lipid Research Clinics Program Prevalence Study. Standardized examinations were conducted by two U.S.S.R. and nine U.S. clinics. Mean plasma lipid and lipoprotein cholesterol levels differed significantly between the two countries, with the U.S.S.R. subpopulations having higher mean total plasma and HDL cholesterol levels and HDL/total cholesterol ratios and lower mean triglyceride levels and low-density lipoprotein (LDL)/HDL cholesterol ratios than the U.S. subpopulations. Small, but statistically significant, differences were found in some dietary components. The U.S.S.R. sample had a significantly higher intake of saturated fatty acids, carbohydrates, complex carbohydrates, and kilocalories/kilogram body weight and a significantly lower intake of total fat, polyunsaturated fatty acids, protein, and polyunsaturated/saturated fat ratio. The multiple regression models tested were not major predictors for total plasma cholesterol or LDL cholesterol. Characteristics associated with higher HDL cholesterol levels in both countries were lean body mass, ethanol consumption, abstinence from cigarette smoking, and lower dietary consumption of carbohydrates.

Specific role of glucose in rapid lipogenic activation in vivo

Lipogenesis from glucose C was previously found to be rapidly activated as soon as mice nibbled a fat-free, glucose-rich diet. We have studied here whether such rapid activation is a specific effect of dietary glucose. The flux of endogenous glucose C to total lipid fatty acids (TLFA) in mice fasted for 1 day was compared with the minimal average flux of exogenous dietary glucose to TLFA during a 40-min period after the ingestion of various glucose-rich test meals by previously fasted mice. The fasted mice were injected intravenously with [U-(14)C]glucose, and the flux of glucose C to TLFA and to all "end products" was estimated from serial plasma glucose specific activity measurements and (14)C incorporation into TLFA 30 min after (14)C injection. Only 0.6 to 0.8 micro g of glucose C/min/20 g body wt was converted to TLFA, whereas 208 +/- 16 micro g of glucose C/min/20 g body wt was converted to all "end products" in the fasted animals. Previously fasted mice were fed [(14)C]glucose in small test meals as a neat solid, as a 30% aqueous solution, or as a fat-free, 58% glucose diet. During the next 40 min, the average flux of glucose C into TLFA increased at least 50- to 60-fold, regardless of the form in which glucose was fed; however, when glucose was fed as part of a complete fat-free diet, glucose was utilized at a much lower plasma glucose level than in mice fed either pure solid glucose or an aqueous glucose solution. Rapid activation of lipogenesis from glucose requires only glucose as a dietary constituent.