Abstract
BackgroundPrevious epidemiological investigations of associations between dietary glycemic intake and insulin resistance have used average daily measures of glycemic index (GI) and glycemic load (GL). We explored multiple and novel measures of dietary glycemic intake to determine which was most predictive of an association with insulin resistance.MethodsUsual dietary intakes were assessed by diet history interview in women aged 42-81 years participating in the Longitudinal Assessment of Ageing in Women. Daily measures of dietary glycemic intake (n = 329) were carbohydrate, GI, GL, and GL per megacalorie (GL/Mcal), while meal based measures (n = 200) were breakfast, lunch and dinner GL; and a new measure, GL peak score, to represent meal peaks. Insulin resistant status was defined as a homeostasis model assessment (HOMA) value of >3.99; HOMA as a continuous variable was also investigated.ResultsGL, GL/Mcal, carbohydrate (all P < 0.01), GL peak score (P = 0.04) and lunch GL (P = 0.04) were positively and independently associated with insulin resistant status. Daily measures were more predictive than meal-based measures, with minimal difference between GL/Mcal, GL and carbohydrate. No significant associations were observed with HOMA as a continuous variable.ConclusionA dietary pattern with high peaks of GL above the individual's average intake was a significant independent predictor of insulin resistance in this population, however the contribution was less than daily GL and carbohydrate variables. Accounting for energy intake slightly increased the predictive ability of GL, which is potentially important when examining disease risk in more diverse populations with wider variations in energy requirements.
Highlights
Previous epidemiological investigations of associations between dietary glycemic intake and insulin resistance have used average daily measures of glycemic index (GI) and glycemic load (GL)
A meta-analysis showed that diets with a high GI or GL independently increased the risk of type 2 diabetes by 40% and 27%, respectively [6], not all studies were supportive [7,8,9] and the American Diabetes Association has stated that there is insufficient information to claim that diets lower in dietary glycemic intake reduce diabetes risk [10]
Within the n = 329 group, there were no significant differences in Body mass index (BMI), waist to hip ratio, activity level, hormone therapy (HT) status, smoking status between subjects included in the n = 200 compared with the 129 excluded
Summary
Previous epidemiological investigations of associations between dietary glycemic intake and insulin resistance have used average daily measures of glycemic index (GI) and glycemic load (GL). A meta-analysis showed that diets with a high GI or GL independently increased the risk of type 2 diabetes by 40% and 27%, respectively [6], not all studies were supportive [7,8,9] and the American Diabetes Association has stated that there is insufficient information to claim that diets lower in dietary glycemic intake reduce diabetes risk [10] It is not yet clear whether low GI or GL diets have any added advantage over low carbohydrate diets, or whether diets with a high amount of carbohydrate from low GI foods have more metabolic benefits than one of similar GL with a low amount of carbohydrate from high GI foods [11]. In people with type 2 diabetes, a comparison of low carbohydrate versus low GI diets found subjects following the diet lower in carbohydrate showed greater improvements than those on the low GI diet, both diets resulted in improvements in glycemic control [12]
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