Glycemic Index in Clinical Practice

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1 Glycemic Index in Clinical Practice David J.A. Jenkins Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada Clinical Nutrition & Risk Factor Modification Center St. Michael s Hospital;

2 Conflict of Interest Griffin Hospital, New Haven- For the development of the Nuval System. C, H, SAB The Canola & Flax Councils of Canada. C, H,SAB Pulse Canada - SAB Saskatchewan Pulse Growers SAB Canadian Institute of Health Research (CIHR) G Canadian Foundation for Innovation (CFI) G Ontario Research Fund (ORF) G Advanced Foods and material Network (AFMNet) G International Tree Nut Council Nutrition Research and Education Foundation and the Peanut Institute G, H Abbott Laboratories, Algorithms for Diabetes Management. C, H, SAB Alpro Soy Foundation - H C = Consultancies; H = Honorarium; SAB = Scientific Advisory Boards; G = Grants

3 Conflict of Interest Oldways Preservation Trust, Boston, MA A not for profit organization promoting traditionally healthy ways of eating (eg. Mediterranean Diet, etc.) H Almond Board of California, Modesto, CA A branch of the USDA (therefore not for Profit ) to promote the use of almonds. C,H,G The California Strawberry Commission, Watsonville, CA Another USDA not for profit group to explore possible health benefits and to promote the use of strawberries. SAB Bayer Consumer Care, Springfield NJ Marketing of nutritional supplements/nutraceuticals. SAB Orafti, Tienen, Belgium Development of prebiotics for modification of colonic microflora. SAB, G C = Consultancies; H = Honorarium; SAB = Scientific Advisory Boards; G = Grants

4 Conflict of Interest Sanitarium Company, Sydney, Australia Australia s largest health food manufacturing company and soy food producer. G, SAB Solae, St. Louis The major US producer of soy protein isolate. C,G Barilla, Italy A general food company. Producer of pasta and baked goods. G Haine Celestial, CA One of the largest Health Food companies in the US. G Loblaws Supermarkets Canada s largest supermarket chain. G, SAB Unilever, Vlaardigen,Netherlands Major margarine producers including Becel and Take Control (plant sterol enriched margarine). G, GP C = Consultancies; H = Honorarium; SAB = Scientific Advisory Boards; G = Grants

5 Conflict of Interest Herbalife International, Century City, CA A nutraceutical company with an emphasis on sourcing plant derived components for weight loss. SAB Nutritional Fundamentals for Health, Montreal, QE A new nutraceutical company exploring and aiming to market food derived components for health. SAB Pacific Health Laboratories INC, Matawan, NJ a nutrition technology company with functional food and nutraceutical products researched and commercialized for sports performance weight loss and type 2 diabetics which can be marketed without prior approval of the FDA. SAB, Stock Metagenics/MetaProteomics, Gig Harbor WA a company assessing natural products from hops which will positively impact individuals with specific genetic susceptibilities for chronic disease. SAB C = Consultancies; H = Honorarium; SAB = Scientific Advisory Boards; G = Grants

6 Conflict of Interest Unilever - Canada Guidelines for the management of hyperlipidemia. G,C,H Agriculture and Agrifoods Canada (AAFC) SAB Canadian Agriculture Policy Institute (CAPI) SAB White wave- Dean Foods, Colorado SAB, C, H The Coco Cola sugar Advisory Board. C, H,SAB Orafti, Tienen, Belgium Development of prebiotics for modification of colonic microflora. SAB, G Wife and is a Director of Glycemic Index Laboratories, Toronto, CA Financial relationship of a spouse Kellogg s, Canada C, H, SAB Quaker Oats, Canada-C, H, SAB C = Consultancies; H = Honorarium; SAB = Scientific Advisory Boards; G = Grants

7 GI: Evolution of the Concept st Glycemic Index Paper st International GI Tables Concept of Glycemic Load 3,4 (GI x CH 2 O) Demonstration of the importance of 2007 BMI/Insulin resistance as a determinant of relevance of GI/GL 5,6,7,8 1) Jenkins DJ, et al. Am J Clin Nutr Mar;34(3): ) Foster-Powell K, Miller JB. Am J Clin Nutr Oct;62(4):871S-890S. 3) Salmerón J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC. JAMA Feb 12;277(6): ) Salmerón J, Ascherio A, Rimm EB, Colditz GA, Spiegelman D, Jenkins DJ, Stampfer MJ, Wing AL, Willett WC. Diabetes Care Apr;20(4): ) Wolever TM, Bentum-Williams A, Jenkins DJ. Diabetes Care.1995 Jul;18(7): ) Liu S, Willett WC, Stampfer MJ, Hu FB, Franz M, Sampson L, Hennekens CH, Manson JE. Am J Clin Nutr Jun;71(6): ) Wolever TM, Mehling C. BJN : ) Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, Ludwig DS. JAMA May 16;297(19):

8

9 OBESITY Trends in the prevalence of obesity (BMI >= 30 kg/m2) among U.S. adults aged 18 yr or older, Behavioral Risk Factor Surveillance System (BRFSS) Ford, E. S. et al. J Clin Endocrinol Metab 2008;93:s1-s8 Copyright 2008 The Endocrine Society

10 DIABETES Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1990, 1995 and No Data <4% 4%-6% 6%-8% 8%-10% >10% Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, JAMA 2003 Jan 1;289(1).

11 Intensive Glycemic Control in Type 2 Diabetes on CHD Risk Turnbull FM et al Diabetologia (11):

12 SLOTH

13 GLUTTONY

14 Glycemic Index / Load

15 Glycemic Load and Cereal Fiber Intake in Women And Risk of Type II Diabetes (75,000 Nurses over 10y) Salmeron J et al. JAMA 1997;277:472-7

16 Glycemic Load & T2DM in Adults Livesey et al. Am J Clin Nutr 2013;97:

17 Mirrahimi A, Jenkins D et. al. JAHA 2012;1:e Pooled Risk Estimate for CHD comparing highest to lowest GL quantiles Study or Subgroup GL & CHD Risk Weight Relative Risk IV, Random, 95% CI Relative Risk IV, Random, 95% CI Relative Risk

18 GI and CVD Ma X, et al. Atherosclerosis; 223 (2012):

19 Slow Release Carbohydrate Acarbose Viscous Fibers Low glycemic foods

20 STOP-NIDDM Trial CVD Events Acarbose 49% RR Chiasson J-L, Josse RG, Hanefeld M, et al. JAMA 2003;346:393.

21 STOP-NIDDM Trial Hypertension (new cases) Acarbose 34% RR Chiasson J-L, Josse RG, Hanefeld M, et al. JAMA 2003;346:393.

22 HbA1c Jenkins DJ, Kendall CW et al JAMA 2008;300(23):

23 Low GI Foods Steel cut oats Barley (vegetable stews) Pumpernickel Bread Parboiled Rice Pasta Beans Peas Lentils etc

24 Vegan Diets use Low GI foods = weight loss Turner-McGrievy GM, Jenkins DJ et. al. J Nutr. 2011;141(8):

25 Vegan Diets in Diabetes (HbA1c) Barnard ND, Katcher HI et. al. Nutr Rev 2009;67(5):255-63

26 Vegan Diets in Diabetes (HbA1c) Barnard ND, Cohen J et. al. Am J Clin Nutr 2009;89(5):1588S-96S

27 GI & Diabetes Management Meta-analysis Favours low GI Favours High GI Brand-Miller JC et al. Diabetes Care. 2003; 26(12):3363-4

28 GI & LDL-C Goff L, D.E. Cowland, L. Hooper, G.S. Frost. Nutrition, Metabolism & Cardiovascular Diseases (2013) 23, 1e10

29 PAI-1 activity (U/ml) Glycemic Index and Thrombosis PAI-1 25 ** *** Admission Low GI High GI Mean ± sd 22.2 ± ± ± 16.1 Jarvi AE, et al. Diabetes Care 1999;22:10-8.

30 GI and Thrombosis PAI PAI-1 activity (U/mL) Wk0 Wk10 Wk0 Wk10 High GI Low GI Jensen et al. Am J Clin Nutr.2008;87(1):

31 Glycemic Load and CRP at High and Low BMI BMI > 25 BMI < 25 Liu et al. Am J Clin Nutr 2002;75:492-8

32 (mmol/l) Residuals (%) Percentage of Baseline CRP on High and Low GI Diets High GI Low GI Low Carb A1c High GI & Fiber Low GI Fasting Glucose Time Diet: p= Low Carb Wolever et al., Am J Clin Nutr 2008;87:

33 Multivariate RR of CHD according to body mass index (BMI) and Glycemic load (GL): 10y of follow-up in the Nurses Health Study (n=65,000) Liu, Willett, Stampfer, Hu, Franz, Sampson, Hennekens, et.al.am J Clin Nutr Jun;71(6):

34 Insulin Response Determines Weight Loss Ebbeling CB, Ludwig DS. JAMA May 16;297(19):

35 Turner-McGrievy GM, Jenkins DJ et al J.Nutr,2011;141:

36 Low GI compared to other diets for T2DM Vegan diets should also be considered as a healthy basis for the above (DJ) Ajala et al. Am J Clin Nutr. 2013;97:505-16

37 Acknowledgements Collaborators: Dr. Livia Augustin Dr. Russell de Souza Dr. Cyril Kendall Dr. Alexandra Jenkins Dr. John Sievenpiper Dr. Vladimir Vuksan Dr. Thomas Wolever Graduate Students: Laura Chiavaroli Arash Mir-rahimi Stephanie Nishi Kristie Srichaikul Staff: Sonia Blanco Judy Coveney Dorothea Faulkner Christopher Ireland Sandy Mitchell Melanie Paquette Darshna Patel Sandhya Sahye-Pudaruth

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