Low Glycemic Index Diet Research Articles

Low glycaemic index diets as an intervention for obesity: a systematic review and meta-analysis.

Low glycaemic index (GI) diets may aid in weight loss by reducing postprandial blood glucose excursions, leading to more stable blood glucose concentrations and therefore a reduction in hunger. To test this hypothesis, we conducted a systematic review and meta-analysis of randomized controlled trials comparing low GI diets with other diet types. We included 101 studies involving 109 study arms and 8,527 participants. We meta-analysed the studies using a random-effects model and conducted subgroup analyses and meta-regression based on control diet, blood glucose control, baseline BMI and dietary GI. Low GI diets resulted in small but significant improvements in body weight, BMI, LDL and total cholesterol overall, although no individual control diet was significantly different from low GI diets. Studies in people with normal blood glucose who achieved a difference in GI of 20 points or more resulted in a larger reduction in body weight (SMD=-0.26; 95% CIs [-0.43, -0.09]), and total cholesterol (SMD=-0.24; 95% CIs [-0.42, -0.05]) than studies that only achieved a smaller reduction in GI. Low GI diets, especially diets achieving a substantial decrease in GI, were moderately effective in lowering body weight. However, efforts should be made to increase compliance with low GI diets, in order for them to be effective in people with overweight and obesity.

Five-year follow up of a low glycaemic index dietary randomised controlled trial in pregnancy-no long-term maternal effects of a dietary intervention.

To determine whether a dietary intervention in pregnancy had a lasting effect on maternal outcomes of diet, HbA1c and weight retention 5 years post-intervention; and to establish whether modifiable maternal behaviours were associated with these outcomes. Randomised control trial of low glycaemic index (GI) diet in pregnancy with longitudinal follow up to 5 years post-intervention. Dublin, Ireland (2007-2016). In all, 403 women of 759 (53.1%) were followed up at 5 years. A total of 370 (intervention n = 188; control n = 182) were included in this analysis. Fasting glucose was measured at 13 and 28 weeks' gestation and HbA1c (mmol/mol) at 5-year follow up. Weight retention (kg) from early pregnancy to 5 years post-intervention was calculated. Dietary intakes, anthropometry, and lifestyle factors were measured in pregnancy and 5 years post-intervention. Multiple linear regression models, controlling for confounders, were used for analysis. Maternal diet, HbA1c, and weight retention at 5 years post-intervention. There was no difference between the intervention and control at 5 years post-intervention for any long-term maternal outcomes measured. HbA1c at 5 years post-intervention was associated with early-pregnancy fasting glucose (B 1.70, 95% CI 0.36-3.04) and parity ≥3 (B 1.04, 95% CI 0.09-1.99). Weight retention was associated with change in well-being from pregnancy to 5 years (B -0.06, 95% CI -0.11 to -0.02), gestational weight gain (B 0.19, 95% CI 0.00-0.38), and GI (B 0.26, 95% CI 0.06-0.46) at 5 years. The ROLO low-GI dietary intervention in pregnancy had no impact on maternal dietary intakes, HbA1c or body composition 5 years post-intervention. Maternal factors and lifestyle behaviours in pregnancy have long-term effects on glucose metabolism and weight retention up to 5 years later. Pregnancy factors are associated with maternal glucose metabolism and weight retention 5 years later-findings from the ROLO Study.

Perinatal inflammation and childhood adiposity – a gender effect?

Background: To determine the association of maternal and fetal inflammatory factors with gender-specific infant adiposity, independent of leptin.Methods: Analysis of anthropometry from 265 mother–infant pairs at birth and 280 pairs at 6 months from the randomised control trial of low glycaemic index diet in pregnancy (ROLO) study (Randomised control trial of low glycaemic index diet) and their association with Maternal TNF-alpha, interleukin 6 and leptin as measured in early and late pregnancy and fetal levels in cord blood.Results: No associations were noted in the male cohort. On multiple regression amongst the female neonatal cohort late pregnancy IL-6 was inversely associated with sum of skinfolds (p ≤ .001); at 6 months infant sum of skinfolds were positively associated with early pregnancy IL-6 (p = .046) and central adiposity positively associated with early pregnancy TNF alpha (p = .018) independent of leptin.Conclusion: Although maternal inflammatory cytokines were not associated with neonatal adiposity independent of leptin (as this association is known), both IL-6 and TNF-α were associated with female infant anthropometry at 6 months of age independent of leptin. These results suggest inflammatory cytokines may exert an in-utero influence on later infant adiposity with a tendency to influence female adiposity more than male. Further research is required to ascertain whether these cytokines may be used as reliable early predictors of infant adiposity.

Glycaemic Index of Maternal Dietary Carbohydrate Differentially Alters Fto and Lep Expression in Offspring in C57BL/6 Mice.

Maternal diet and gestational hyperglycaemia have implications for offspring health. Leptin (LEP) and fat mass and obesity-associated (FTO) alleles are known to influence body fat mass in humans, potentially via effects on appetite. We hypothesized that expression of Fto, Lep, and other appetite-related genes (Argp, Npy, Pomc, Cart, Lepr) in the offspring of female mice are influenced by the glycaemic index (GI) of carbohydrates in the maternal diet. C57BL/6 mice were randomly assigned to low or high GI diets and mated with chow-fed males at eight weeks of age. Male pups were weaned at four weeks and randomly divided into two groups, one group following their mother’s diet (LL and HH), and one following the standard chow diet (LC and HC) to 20 weeks. Fto expression was 3.8-fold higher in the placenta of mothers fed the high GI diet (p = 0.0001) and 2.5-fold higher in the hypothalamus of 20-week old offspring fed the high GI (HH vs. LL, p < 0.0001). By contrast, leptin gene (Lep) expression in visceral adipose tissue was 4.4-fold higher in four-week old offspring of low GI mothers (LC vs. HC, p < 0.0001) and 3.3-fold higher in visceral adipose tissue of 20-week old animals (LL vs. HH, p < 0.0001). Plasma ghrelin and leptin levels, and hypothalamic appetite genes were also differentially regulated by maternal and offspring diet. These findings provide the first evidence in an animal model that maternal high GI dietary carbohydrates that are digested and absorbed faster may contribute to programming of appetite in offspring.

A Slow-Digesting, Low-Glycemic Load Nutritional Beverage Improves Glucose Tolerance in Obese Pregnant Women Without Gestational Diabetes.

Obesity is a risk factor for gestational diabetes (gestational diabetes). Low-glycemic index diets attenuate hyperglycemia. We designed a study to determine whether a slow-digesting, low-glycemic load (SD-LGL) beverage improves glucose tolerance in obese pregnant women without GDM. This was a 3-arm comparison study comparing the effects of an SD-LGL nutritional beverage (glycemic load [GL] 730), an isocaloric control beverage (GL 1124), and habitual diet on glycemia in obese pregnant women. Sixteen women (mean body mass index 37 kg/m2) were recruited at 24-28 weeks to receive either the SD-LGL or eucaloric control beverage. This was consumed with breakfast and as a midafternoon snack over 2 days with a controlled diet. Following a 2-day washout period of habitual diet, women completed 2 days on the alternative beverage with controlled diet. A 10-h fast preceded each intervention phase. Twenty-four hour glucose was measured using continuous glucose monitoring. Consumption of the lower GL beverage was associated with improved measures of glycemia, compared with the control beverage and habitual diet at different time periods. Glucose estimates for control versus SD-LDL at 24 h (0.23 mmol/L [0.16 to 0.31], P < 0.001), daytime (0.26 mmol/L [0.18 to 0.34], P < 0.001), and nighttime (0.05 mmol/L [-0.01 to 0.11], P = 0.09). Postprandial glucose was lower after breakfast but not after dinner, compared with the control beverage (0.09 mmol/L [0.01 to 0.18], P = 0.03). A slow-digesting, low-glycemic nutritional beverage may facilitate improved glucose control in obese pregnant women. To address potential benefit for clinical outcomes, a randomized controlled trial is warranted.

Effect of Mediterranean diet combined with low glycemic index diet on glucose and lipid metabolism, and oxidative stress in patients with type 2 diabetes mellitus

Objective To observe the effect of Mediterranean diet with low glycemic index (LGI) diet on glucose and lipid metabolism, and oxidative stress in patients with type 2 diabetes mellitus (T2DM) . Methods From January 2015 to December 2016, a total of 180 patients with T2DM in the Endocrinology Department of Liaocheng People's Hospital of Shandong Province were selected as the research subject by convenient sampling method, and all subjects were divided into A, B and C, three groups by random number table, with 60 patients in each. Patients in A group received diabetes routine diet intervention, patients in B group received Mediterranean diet intervention and patients in C group received Mediterranean diet and LGI diet. The intervention time of all groups were three months, and the change of glucose and lipid metabolism, and oxidative stress before and after intervention were compared among three groups. Results Patients in the C group with Meditterranean diet and LGI diet after 3 months, the FPG (6.60±1.98) mmol/L, 2 hPG (8.34±2.16) mmol/L, HbA1c (7.52±1.12) % and HDL-C (1.00±0.20) mmol/L were lower than those in A group (t=-3.805, -1.996, -5.933, -2.856) and B groups (t=-2.229, -2.881, -2.467, -2.479) , and the differences among groups were statistically significant (P<0.05) . After intervention, the SOD (368.40±66.15) U/ml, Vit C (49.89±5.97) μmol/L and Vit E (28.88±6.55) μmol/L were higher than those in A group (t=4.405, 2.326, 6.670) and B group (t=2.070, 4.960, 2.707) ; The MDA in C group (5.15±1.33) mg/L were lower than that in A group (t=-4.403) and B group (t=-2.174) (P<0.05) . Conclusions Mediterranean diet with LGI diet could reduce glucose and lipid metabolism, and oxidative stress in patients with T2DM, and it may be an effective medical nutrition treatment program. Key words: Diabetes mellitus, type 2; Mediterranean diet; Low glycemic index; Oxidative stress; Glucose and lipid metabolism

Altering Glucose Variability with Low- or High-Glycemic–Index Diets in Adults with Prediabetes Does Not Affect Beta-Cell Function or Markers of Oxidative Stress

High glycemic variability has been associated with increased oxidative stress and β-cell dysfunction. To test whether changes in glycemic variability impact β-cell function and oxidative stress markers in adults with prediabetes, we conducted an RCT where we provided study subjects controlled diets varying in glycemic index (GI) to experimentally manipulate post-prandial glucose excursions. After 2 weeks on a control diet (mean GI= 55-58), subjects were randomized to 1 of 3 groups for 4 weeks: low (LGI &amp;lt;35) GI diet, high (HGI &amp;gt;70) GI diet plus the anti-oxidant N-acetylcysteine (HGI/NAC) 600 mg BID or HGI diet plus placebo (HGI/PLAC). Subjects underwent CGMS (iPro), fasting markers of oxidative stress (GSH/GSSG and TBARS) and an IVGTT at the end of each diet. Independent t-test was used to test the intervention effect on the change in disposition index (DI), a marker of β-cell function. Fifty-two subjects (26M/26F, age 53±10 y, BMI 32.1±6.2 kg/m2) with IFG and/or IGT completed the study (18 LGI, 17 HGI/NAC, 17 HGI/PLAC). The 3 groups did not differ by sex, age, BMI, A1c, fasting or 2 h glucose (ANOVA). On the control diet, DI was inversely correlated with CGMS mean daily glucose (r=-0.33, p=0.02) and daily SD glucose (r=-0.31, p=0.03) and the GSH/GSSG ratio (r=-0.35, p=0.01), but not TBARS (r=0.13, p=0.4). Compared to LGI, HGI/PLAC increased mean CGMS glucose (change -1.4±1.9 LGI vs. 4.6±2.4 HGI/PLAC mg/dl, p=0.05) and SD (change -2.6±1.3 vs. 5.0±2.2, p=0.005). Results did not differ between HGI/PLAC and HGI/NAC. There were no significant intervention effects on DI, TBARS or GSH/GSSG ratio. Changes in CGMS mean glucose and SD and oxidative stress markers did not correlate with changes in DI. In conclusion, GI diet-induced changes in glucose concentrations and variability did not impact β-cell function or oxidative stress markers. These results suggest that glucose variability may be a consequence of β-cell dysfunction rather than a cause. Disclosure K. Utzschneider: Consultant; Self; Novo Nordisk Inc.. T.N. Johnson: None. K. Breymeyer: None. M.L. Neuhouser: None.

Glycemic Index and Glycemic Load of the Diet in a Sample of Pregnant Women with Type 2 Diabetes Mellitus in Northwest Brazil

During pregnancy, women with type 2 diabetes mellitus (DM2) needs specific dietary care to improve glycemic control and improve pregnancy outcomes. The recent updated researches points to dietary assessment and prescription based on glycemic index (GI) and glycemic load (GL) as possible strategies for achieving these goals. This study evaluated the GI and GL of the diet consumed by pregnant women with DM2. It is a quantitative-descriptive study, carried out in a diabetes treatment and care reference center in Brazil, with 20 DM2 pregnant women, randomly selected and interviewed during the outpatient routine visits follow-up. Dietary data were obtained in two 24-hour food recall (one weekday and one on weekend), one of that was collected by phone. These data were taken at home measurements and converted into grams/milliliters for subsequent determination of the GI and GL of the diets (protocol: FAO/WHO,1998) and classified according to Brand-Miller; Foster-Powell and Colagiuri (2003) and Burani (2006). Statistical analysis used the program S.P.S.S version 17, with the chi-square statistical test (p &amp;lt;0.05). The diet of the pregnant women had a low GI (46.27 ± 7.18) and a low GL (64.15 ± 22.79). There was a positive relationship between schooling and GI, and the pregnant DM2 with a lower level of education consumed a moderate GI diet. Few studies have evaluated GI and GL in pregnancy and there are no studies with DM2 pregnant women. Similar studies point to the benefits of low GI and GL diets for glycemic control during gestation to decreased maternal-fetal comorbidities. The study population’s diet had adequate GI and CG, which promotes glycemic control and reduce adverse outcomes. However, it is suggested that larger dietary assessments be performed to further deepen the relationship between diet, metabolic control and pregnancy outcomes of woman with DM2. Disclosure C. Facanha: None. T.U. Passos: None. L.C. Maranhão: None. F.C. Coppola: None. J.D. Martins: None. A.E.F. Melo: None. G. Nogueira: None. M.D. Santos: None. P.A.C. Pontes: None. L.M. Morais: None. D.D. Costa: None.

Association between dietary glycemic index and glycemic load with depression: a systematic review.

A combination of genetic and environmental factors is involved in depression etiology. During the last years, the prevalence of depression has increased in both developed and developing countries. Several studies indicated an association between dietary glycemic index (GI) and glycemic load (GL) with risk of depression. This systematic review was undertaken to summarize the effect of these diet indicators in depression pathogenesis. A comprehensive search strategy was performed in the Pubmed, Embase, Cochrane Library and Scopus databases from 1966 to March 2017. Finally, six studies (three prospective cohort studies and three cross-sectional) were ultimately selected for inclusion in the systematic review. 75298 adults and elderly entered the reviewed studies. All of the included studies had high methodological quality. The present study indicated that the intake of foods with higher GI is associated with disease risk. However, the relationship was found to be inverse for GL, though the association was rather weak. Overall, the findings indicated that a diet with lower dietary glycemic index may be effective to reduce the risk or risk of depression.

Changes in Plasma Metabolite Concentrations after a Low-Glycemic Index Diet Intervention.

To examine whether a low-glycemic index (LGI) diet improves a set of plasma metabolites related to different metabolic diseases, and comparison to a high-glycemic index (HGI) diet and a low-fat (LF) diet. A parallel, randomized trial with three intervention diets: an LGI diet, an HGI diet, and an LF diet. A total of 122 adult overweight and obese subjects were enrolled in the study for 6 months. Blood samples were collected at baseline and at the end of the intervention. The plasma metabolomic profile of 102 subjects was analyzed using three different approaches: GC/quadrupole-TOF, LC/quadrupole-TOF, and nuclear magnetic resonance. Both univariate and multivariate analysis were performed. Serine levels were significantly higher following the LGI diet compared to both the HGI and LF diets (q=0.002), whereas leucine (q=0.015) and valine (q=0.024) were lower in the LGI diet compared to the LF diet. A set of two sphingomyelins, two lysophosphatidylcholines, and six phosphatidylcholines were significantly modulated after the LGI diet compared to the HGI and LF diets (q<0.05). Significant correlations between changes in plasma amino acids and lipid species with changes in body weight, glucose, insulin, and some inflammatory markers are also reported. These results suggest that an LGI diet modulates certain circulating amino acids and lipid levels. These findings may explain the health benefits attributed to LGI diets in metabolic diseases such as type 2 diabetes.

Convenient food made of extruded adzuki bean attenuates inflammation and improves glycemic control in patients with type 2 diabetes: a randomized controlled trial.

ObjectiveExtrusion is a widely used food processing technology. The aim of this study was to investigate the effects of extruded adzuki bean convenient food (EABCF) on glycemic and inflammation control in type 2 diabetes mellitus (T2DM) patients.Patients and methodsIn a randomized controlled trial, 120 T2DM patients were randomly assigned to a control diet group (the low glycemic index [LGI] group, assigned the traditional diabetic low glycemic index diet) or an intervention group (the EABCF group, assigned daily consumption of EABCF). Diet information and blood samples were collected at baseline and after a 4-week intervention. After excluding exogenous insulin users, a subgroup analysis based on baseline fasting insulin (FINS) levels was conducted, and Homeostasis Model Assessment (HOMA) was the target indicator.ResultsA total of 106 patients completed the trial, and 89 participants were included in the subgroup analysis. After the intervention, glycemic control improved in both groups compared to baseline, but the difference was not statistically significant (p>0.05). However, the EABCF group showed decreased inflammation with significantly lower tumor necrosis factor alpha (TNF-α) level compared to the control group (adjusted p<0.01). There was also a slight increase in the interleukin-6 (IL-6) level in the EABCF group (adjusted p=0.004). Moreover, the subgroup analysis found that, after 4 weeks, a diet consisting of EABCF increased insulin secretion to normal levels in the group with hypoinsulinism (baseline FINS<5.2 mU/L). However, the difference only showed a trend toward statistical significance (0.05<p=0.079<0.1).ConclusionEABCF had a similar hypoglycemic effect as the traditional diabetic LGI diet and showed a greater inhibitory effect on inflammation in T2DM patients. However, further clinical studies are needed to explore the underlying mechanism.

Klinik Uygulamalarda Düşük Glisemik ve/veya Besin İnsülin İndeksli Beslenme Yaklaşımları

Obezite, diyabet ve kalp-damar hastalıkları gibi yaşam tarzıyla ilişkili kronik hastalıkların postprandiyal glisemi ve insülinemi ile ilişkisi bilinmektedir. Bu nedenle, araştırmacılar postprandiyal glisemi ve insülinemiyi kontrol altına alabilecek çeşitli yöntem arayışlarına girmiş ve yeni kavramlar geliştirmişlerdir. Bu kavramlardan en önemlileri 1981 yılında ilk kez tanımlanan glisemik indeks iken, diğeri 1997 yılında ortaya atılan besin insülin indeksidir. Glisemik indeks (Gİ), karbonhidrat içeren besinlerin kan glukozunu yükseltme potansiyelini göstermektedir. Besin insülin indeksi (İİ) ise sadece karbonhidrat içeren besinlerin değil, tüketilen tüm besinlerin insülin düzeyi üzerine etkilerini değerlendirmekte ve böylece protein ve yağların olası etkilerini de göz önünde bulundurmaktadır. Günlük diyette daha çok düşük Gİ’li ve/veya İİ’li besinler tercih edilerek uzun dönemde yaşam tarzı ile ilişkili kronik hastalıklara yakalanma riski azaltılabilir. Aynı zamanda, yapılan çalışmalarda düşük Gİ’li ve/veya İİ’li öğünlerin kısa dönem olumlu etkileri olabileceği de gösterilmiştir. Düşük Gİ’li ve/veya İİ’li öğün tüketimi sonrası, yüksek Gİ’li ve/veya İİ’li öğüne göre postprandiyal hiperglisemi ve hiperinsülinemi oluşumunun önlenebileceği ve açlık hissinin azaltılıp, doygunluğu arttırarak iştahın kontrol altına alınabileceği önerilmektedir. Bu nedenle, düşük Gİ’li ve/veya İİ’li diyetlerin obezite ve diyabet tedavisinde yararlı olabileceğine işaret edilmektedir. Günümüzde, sağlıklı bir yaşam için fiziksel aktivite ve yeterli-dengeli beslenmenin yanısıra tüketilen besinlerin kalitesi de önem kazanmaktadır. Besinin Gİ ve İİ değeri besin kalitesini değerlendirmek amacıyla kullanılabilecek kriterler arasında yer almaktadır.

A Low Glycemic Index and Glycemic Load Diet Decreases Insulin-like Growth Factor-1 among Adults with Moderate and Severe Acne: A Short-Duration, 2-Week Randomized Controlled Trial

BackgroundA high glycemic index (GI) and glycemic load (GL) diet may stimulate acne proliferative pathways by influencing biochemical factors associated with acne. However, few randomized controlled trials have examined this relationship, and this process is not completely understood. ObjectiveThis study examined changes in biochemical factors associated with acne among adults with moderate to severe acne after following a low GI and GL diet or usual eating plan for 2 weeks. DesignThis study utilized a parallel randomized controlled design to compare the effect of a low GI and GL diet to usual diet on biochemical factors associated with acne (glucose, insulin, insulin-like growth factor [IGF]-1, and insulin-like growth factor binding protein [IGFBP]-3) and insulin resistance after 2 weeks. ParticipantsSixty-six participants were randomly allocated to the low GI and GL diet (n=34) or usual eating plan (n=32) and included in the analyses. Main outcome measuresThe primary outcomes were biochemical factors of acne and insulin resistance with dietary intake as a secondary outcome. Statistical analysesIndependent sample t tests assessed changes in biochemical factors associated with acne, dietary intake, and body composition pre- and postintervention, comparing the two dietary interventions. ResultsIGF-1 concentrations decreased significantly among participants randomized to a low GI and GL diet between pre- and postintervention time points (preintervention=267.3±85.6 mg/mL, postintervention=244.5±78.7 ng/mL) (P=0.049). There were no differences in changes in glucose, insulin, or IGFBP-3 concentrations or insulin resistance between treatment groups after 2 weeks. Carbohydrate (P=0.019), available carbohydrate (P<0.001), percent energy from carbohydrate (P<0.001), GI (P<0.001), and GL (P<0.001) decreased significantly among participants following a low GI/GL diet between the pre- and postintervention time points. There were no differences in changes in body composition comparing groups. ConclusionsIn this study, a low GI and GL diet decreased IGF-1 concentrations, a well-established factor in acne pathogenesis. Further research of a longer duration should examine whether a low GI and GL diet would result in a clinically meaningful difference in IGF-1 concentrations leading to a reduction in acne. This trial was registered at clinicaltrials.gov as NCT02913001.

A Low Glycaemic Index Diet in Pregnancy Induces DNA Methylation Variation in Blood of Newborns: Results from the ROLO Randomised Controlled Trial

The epigenetic profile of the developing fetus is sensitive to environmental influence. Maternal diet has been shown to influence DNA methylation patterns in offspring, but research in humans is limited. We investigated the impact of a low glycaemic index dietary intervention during pregnancy on offspring DNA methylation patterns using a genome-wide methylation approach. Sixty neonates were selected from the ROLO (Randomised cOntrol trial of LOw glycaemic index diet to prevent macrosomia) study: 30 neonates from the low glycaemic index intervention arm and 30 from the control, whose mothers received no specific dietary advice. DNA methylation was investigated in 771,484 CpG sites in free DNA from cord blood serum. Principal component analysis and linear regression were carried out comparing the intervention and control groups. Gene clustering and pathway analysis were also explored. Widespread variation was identified in the newborns exposed to the dietary intervention, accounting for 11% of the total level of DNA methylation variation within the dataset. No association was found with maternal early-pregnancy body mass index (BMI), infant sex, or birthweight. Pathway analysis identified common influences of the intervention on gene clusters plausibly linked to pathways targeted by the intervention, including cardiac and immune functioning. Analysis in 60 additional samples from the ROLO study failed to replicate the original findings. Using a modest-sized discovery sample, we identified preliminary evidence of differential methylation in progeny of mothers exposed to a dietary intervention during pregnancy.

Naturopathic Oncology Care for Thoracic Cancers: A Practice Survey.

Background and Objectives: There is a lack of information on therapies recommended by naturopathic doctors (NDs) for lung and gastroesophageal cancer care. Study objectives were to: (1) identify the most common interventions considered for use by NDs; (2) identify interventions NDs recommend to support key therapeutic goals; and (3) identify potential contraindications between integrative and conventional therapies. Methods: Oncology Association of Naturopathic Physicians (OncANP) members (n = 351) were invited to complete an electronic survey. Respondents provided information on interventions considered for thoracic cancer pre- and postoperatively across 4 therapeutic domains (supplemental natural health products, physical, mental/emotional, and nutritional), therapeutic goals, and contraindications. This survey was part of the development of the Thoracic Perioperative Integrative Surgical Evaluation trial. Results: Forty-four NDs completed the survey (12.5% response rate), all of whom were trained at accredited colleges in North America and the majority of whom were Fellows of the American Board of Naturopathic Oncology (FABNO) (56.8%). NDs identified significantly more interventions in the postoperative compared to preoperative setting. The most frequently identified interventions included modified citrus pectin, arnica, omega-3 fatty acids, vitamin D, probiotics, exercise, acupuncture, meditation, stress reduction, low glycemic index diet, and Mediterranean diet. Potential contraindications with conventional treatment (surgery, chemotherapy, radiotherapy) differed across natural health products. Conclusions: These findings highlight naturopathic interventions with a high level of use in thoracic cancer care, describe and characterize therapeutic goals and the interventions used to achieve these goals, and provide insight on how practice changes relative to conventional cancer treatment phase.

The Effect of Dietary Glycaemic Index on Glycaemia in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: The increasing prevalence of diabetes in the United Kingdom and worldwide calls for new approaches to its management, and diets with low glycaemic index have been proposed as a useful means for managing glucose response. However, there are conflicting reports and differences in the results of studies in terms of their effectiveness. Furthermore, the impact of low-glycaemic index diets and their long-term use in patients with type 2 diabetes remains unclear. Objectives: The objective of this study was to conduct a systematic review and meta-analysis of the effect of low-glycaemic index diets in patients with type 2 diabetes. Methods: Search methods: Randomised controlled studies were selected from a number of databases (EBSCOHost with links to Health Research databases, PubMed, and grey literature) based on the Population, Intervention, Comparator, Outcomes and Study designs (PICOS) framework. The search terms included synonyms and Medical Subject Headings (MeSH) and involved the use of Boolean operators (AND/OR) which allowed the combination of words and search terms. Selection criteria: As per the selection criteria, the following types of articles were selected: studies on randomised controlled trials, with year of publication between 2008 and 2018, including patients with type 2 diabetes. Thus, studies involving patients with gestational and type 1 diabetes were excluded, as were observational studies. Nine articles which met the inclusion criteria were selected for the systematic review, whereas only six articles which met the criteria were included in the meta-analysis. Data collection and analysis: Studies were evaluated for quality and risk of bias. In addition, heterogeneity, meta-analysis, and sensitivity tests of the extracted data were carried out using Review Manager 5.3 (Review Manager, 2014). Results: The findings of the systematic review showed that the low-glycaemic index (low-GI) diet resulted in a significant improvement (<0.05) in glycated haemoglobin (HbA1c) in two studies: low-GI diet Δ = −0.5% (95% CI, −0.61% to −0.39%) vs. high-cereal fibre diet Δ = −0.18% (95% CI, −0.29% to −0.07%); and low-GI legume diet Δ = −0.5% (95%, −0.6% to −0.4%) vs. high-wheat fibre diet Δ = −0.3% (95% Cl, −0.4 to −0.2%). There was a slight improvement in one study (low glycaemic response = 6.5% (6.3–7.1) vs. control = 6.6% (6.3–7.0) and no significant difference (p > 0.05) in four studies compared with the control diet. Four studies showed improvements in fasting blood glucose in low-GI diets compared to higher-GI diets or control: low-GI diet = 150.8 ± 8.7 vs. higher-GI diet = 157.8 ± 10.4 mg/dL, mean ± SD p = 0.43; low-GI diet = 127.7 vs. high-cereal fibre diet = 136.8 mg/dL, p = 0.02; low-GI diet = 6.5 (5.6–8.4) vs. standard diabetic diet = 6.7 (6.1–7.5) mmol/L, median and interquartile range p > 0.05; and low-GI diet = 7.3 ± 0.3 vs. conventional carbohydrate exchange diet = 7.7 ± 0.4 mmol/L, mean ± SEM (Standard Error of Mean) p < 0.05. The results of the meta-analysis and sensitivity tests demonstrated significant differences (p < 0.001 and p < 0.001, respectively) between the low-GI diet and the higher-GI diet or control diet in relation to glycated haemoglobin. Differences between the low-GI diet and higher-GI diet or control were significant (p < 0.05) with respect to the fasting blood glucose following meta-analysis. Conclusion: The low-GI diet is more effective in controlling glycated haemoglobin and fasting blood glucose compared with a higher-GI diet or control in patients with type 2 diabetes.

Effect of Low-Energy-Dense Diet Rich in Multiple Functional Foods on Weight-Loss Maintenance, Inflammation, and Cardiovascular Risk Factors: A Randomized Controlled Trial

ABSTRACTBackground: There are no investigations regarding the effects of consuming low-energy-dense diets rich in multiple functional foods on weight-loss maintenance, inflammatory markers, and cardiovascular disease (CVD) risk factors simultaneously.Method: This randomized controlled trial design was conducted on 90 men and women who were under a previous weight loss diet. Three months of intervention with recruitment at Allzahra Hospital, Isfahan, Iran, was done. Intervention was conducted following achieving 7–11 kg weight loss. Participants were encouraged to consumed these three: an isocaloric control diet (50% of energy from carbohydrate, 35% from fat, 15% from protein), a low-glycemic-index diet (LE) (60% from carbohydrate, 25% from fat, and 15% from protein), and a low-glycemic-index diet rich in multiple functional foods (LE + FF) (60% from carbohydrate, 25% from fat, and 15% from protein). Fasting blood glucose, serum insulin level, lipid profiles, inflammatory markers, adiponectin, systolic and diastolic blood pressure, and anthropometric measurements were assessed using standard guidelines.Results: The percent changes of weight, waist, and body mass index (BMI), systolic and diastolic blood pressure, malondialdehyde (MDA), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF) α, total cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride, and fasting blood glucose (FBS) were substantially more decreased in the LE + FF group compared to the LE and control groups (p ≤ 0.03). Percent change of adiponectin among the LE + FF group was significantly more enhanced (7.29 ± 0.10) compared with the LE group (1.28 ± 0.20) (p = 0.001). Significantly more increment in the percent change of total antioxidant capacity (TAC) (6.91 ± 0.10) was obtained among the LE + FF group compared to the LE group (1.79 ± 0.04).Conclusions: This study provides established evidence supporting the beneficial effects of a low-energy-dense diet rich in multiple functional foods diet on improving weight-loss maintenance, inflammation, and cardiovascular risk factors.

Ketogenic diet for treatment of intractable epilepsy in adults: A meta-analysis of observational studies.

SummaryThe ketogenic diet (KD) is an effective treatment for children with drug‐resistant epilepsy and has been widely used in young children. Adult patients with intractable epilepsy would also benefit from this dietary treatment. However, only a few studies have been published, and the use of the KD in intractable epilepsy in adults has been limited. This meta‐analysis summarized the findings of the relevant published studies to identify the efficacy of the KD for the treatment of intractable epilepsy in adults. In this meta‐analysis, PubMed, Embase, and Cochrane Library were used for searching studies concerning the effects of the KD and its major subtypes with intractable epilepsy in adults published up to January 10, 2017. The primary outcomes were seizure freedom, seizure reduction by 50% or more, and seizure reduction by <50%. The quality of the methodology of the observational studies was reviewed by using the Newcastle‐Ottawa Scale. We identified 402 articles, of which, 16 studies including 338 patients met the inclusion criteria. The results of the meta‐analysis showed that the combined efficacy rates of all the symptoms of seizure freedom, seizure reduction by 50% or more, and seizure reduction below 50% in adults with intractable epilepsy were 13%, 53%, and 27%, respectively. The adverse reactions of the KD were mild, whereas low glycemic index diet (LGID) and low‐dose fish oil diet (LFOD) may have fewer side effects. Weight loss, high level of low‐density lipoprotein, and elevated total cholesterol were most frequent. The meta‐analysis indicates that the KD for refractory epilepsy in adults is a well‐tolerated treatment and that its side effects are acceptable, which show that the KD is a promising treatment in adult intractable epilepsy. Further research is needed to assess which type of diet or ratio is more effective in the KD treatment.

Physicochemical properties, structure and in vitro digestibility on complex of starch with lotus (Nelumbo nucifera Gaertn.) leaf flavonoids

Lotus leaf flavonoids (LLF) are a group of bioactive natural substances. In this study, the structure, thermal properties, rheology behaviors and in vitro digestibility of cooked LLF-starch complex were investigated. Differential scanning calorimetry (DSC) analysis showed the shift in gelatinization peak to a higher temperature and the decrease in gelatinization enthalpies in the complexes significantly. The short-term retrogradation was retarded either. The flow behaviors of starch pastes changed with adding LLF. Scanning electron microscope (SEM) images showed a less compact structure in LLF-starch complex and laser confocal scanning microscope (CLSM) images detected that LLF mostly distributed around starch granules, which further prove the binding between LLF and starch. Moreover, fourier transform infrared (FTIR) spectroscopy and X-ray diffraction (XRD) elucidated LLF probably interacted with starch by non-covalent bond especially hydrogen bond. In addition, LLF-starch complex exhibited inhibitory effect on starch digestion compared to pregelatinized starch, and the reasonable content of LLF-starch complex was (0.7 g/100 g). Thus, LLF-starch complex can be potentially used as a functional additive for high resistant starch (RS) and low glycemic index (GI) diets.

The efficacy of a high protein/low glycemic index diet intervention in non-obese patients with asthma

EFFORT Asthma study is a randomized controlled trial designed to assess the effects of diet and exercise in non-obese, untrained patients with asthma. We here present results from a subgroup of participants in the diet and control group to assess the feasibility of a high protein and low glycemic index (GI) diet and the effects on body composition. Of the 149 subjects who were included in the study, 76 subjects (30 males) were randomized into either a diet group (n = 38) or a control group (n = 38) and included in the present analysis. The 8 week intervention consisted of a high protein and low GI diet whilst the control group continued habitual diet. Thirty-three patients in the diet and 34 in the control group completed the study. The diet group reduced their energy intake by ~20% and had high dietary compliance. Intake of fatty fish doubled and GI was reduced by 8.4 units. The diet group reduced their weight by 2.3 ± 2.2 kg vs. 0.5 ± 1.8 (p < 0.001), fat mass by 2.2 ± 2.0 kg vs. 0.3 ± 1.6 kg (p < 0.001) and preserved lean body mass (-0.02 ± 1.1 kg). The control group had no changes in body composition. The ad libitum high protein-low GI diet resulted in a greater loss of fat mass among non-obese patients with asthma. The subjects were satisfactory and highly compliant with the dietary regimen.