Sociodemographic, clinical, and dietary characteristics of overweight adults: a secondary analysis of a population study / Caracterização sociodemográfica, clínica e da alimentação de adultos com excesso de peso: análise secundária de um estudo populacional

ABSTRACT Objective: To estimate the prevalence of overweight among Brazilian adults aged 20 to 59, according to sociodemographic characteristics, health-related behaviors, and food consumption. Methods: A cross-sectional study based on data from a population-based survey in a major metropolitan city in the state of São Paulo, Brazil, conducted between 2015-2016. Prevalences and prevalence ratios were estimated using Poisson regression; food consumption means were estimated using linear regression. Results: We analyzed data from 855 adults, 61% of whom were overweight. The prevalence of overweight was significantly higher among males, those aged 30 or older, with 8 to 11 years of education, and those who reported eating more than they should. The body mass index was significantly associated with hypertension, diabetes, high cholesterol, waist-to-height ratio, taking weight-loss medications, overeating, and the habit of checking labels. Overweight adults reported eating meat with visible fat and drinking soda more frequently than those not overweight. Overweight adults reported eating significantly more grams of food daily and had a higher intake of energy, total fat, saturated fats, trans fats, carbohydrates, protein, insoluble dietary fiber, sodium, and potassium. Their diets had a higher glycemic load when compared to participants who were not overweight. Conclusion: Adults with and without overweight differed in their sociodemographic, dietary, and clinical characteristics. Diet quality was similar between both groups, suggesting a need for improving dietary habits in this population regardless of body weight.

RESUMO Objetivo: Estimar a prevalência de excesso de peso entre adultos brasileiros, de 20 a 59 anos, segundo características sociodemográficas, de comportamentos relacionados à saúde e quanto ao consumo alimentar. Métodos: Estudo transversal, de pesquisa de base populacional, em uma cidade metropolitana de São Paulo - Brasil, conduzida entre os anos de 2015 e 2016. Foram estimadas as prevalências e as razões de prevalência por meio da regressão de Poisson, e as médias de consumo alimentar pelo uso da regressão linear. Resultados: Foram analisados dados referentes à 855 adultos, 61% destes apresentavam sobrepeso. A prevalência de excesso de peso foi significativamente maior entre: homens, com 30 anos ou mais, pessoas que possuíam entre 8 e 11 anos de estudo e entre aqueles que acreditavam comer mais do que deveriam. O índice de massa corporal foi significativamente associado à hipertensão, diabetes, colesterol alto, razão cintura-estatura, uso de medicamentos, comer mais do que deveria e o hábito de checar rótulos. Adultos com excesso de peso ingeriam carnes com gordura e refrigerantes em maior frequência quando comparados à adultos com peso saudável. Adultos com excesso de peso consumiam, significativamente, mais gramas de alimentos por dia e apresentaram maior ingestão de calorias, gorduras totais, saturadas e trans, carboidratos, proteína, fibras insolúveis, sódio e potássio. A dieta deles continha uma maior carga glicêmica quando comparada àqueles com peso saudável. Conclusão: Adultos com e sem excesso de peso, diferiram quanto às características sociodemográficas, dietéticas e clínicas. A qualidade da dieta foi similar em ambos os grupos, o que sugere a necessidade de melhora dos hábitos alimentares da população, independentemente do peso corporal.

Periconceptional Maternal Diet Characterized by High Glycemic Loading Is Associated with Offspring Behavior in NEST.

Maternal periconceptional diets have known associations with proper offspring neurodevelopment. Mechanisms for such associations include improper energy/nutrient balances between mother and fetus, as well as altered offspring epigenetics during development due to maternal nutrient and inflammatory status. Using a comprehensive food frequency questionnaire and assessing offspring temperament with the Infant-Toddler Social and Emotional Assessment (n = 325, mean age = 13.9 months), we sought to test whether a maternal periconceptional diet characterized by high glycemic loading (MGL) would affect offspring temperament using adjusted ordinal regression. After limiting false discovery to 10%, offspring born to mothers in tertile 3 of glycemic loading (referent = tertile 1) were more likely to be in the next tertile of anxiety [OR (95% CI) = 4.51 (1.88-11.07)] and inhibition-related behaviors [OR (95% CI) = 3.42 (1.49-7.96)]. Male offspring were more likely to exhibit impulsive [OR (95% CI) = 5.55 (1.76-18.33)], anxiety [OR (95% CI) = 4.41 (1.33-15.30)], sleep dysregulation [OR (95% CI) = 4.14 (1.34-13.16)], empathy [6.68 (1.95-24.40)], and maladaptive behaviors [OR (95% CI) = 9.86 (2.81-37.18)], while females were more likely to exhibit increased anxiety-related behaviors [OR (95% CI) = 15.02 (3.14-84.27)]. These associations persisted when concurrently modeled with the maternal-Mediterranean dietary pattern. In a subset (n = 142), we also found MGL associated with increased mean methylation of the imprint control region of SGCE/PEG10. In conclusion, these findings highlight the importance of maternal dietary patterns on offspring neurodevelopment, offering avenues for prevention options for mothers.

Effect of a Low-Glycemic Load Diet Intervention on Maternal and Pregnancy Outcomes in Obese Pregnant Women.

The increased prevalence of obese, pregnant women who have a higher risk of glucose intolerance warrants the need for nutritional interventions to improve maternal glucose homeostasis. In this study, the effect of a low-glycemic load (GL) (n = 28) was compared to a high-GL (n = 34) dietary intervention during the second half of pregnancy in obese women (body mass index (BMI) > 30 or a body fat >35%). Anthropometric and metabolic parameters were assessed at baseline (20 week) and at 28 and 34 weeks gestation. For the primary outcome 3h-glucose-iAUC (3h-incremental area under the curve), mean between-group differences were non-significant at every study timepoint (p = 0.6, 0.3, and 0.8 at 20, 28, and 34 weeks, respectively) and also assessing the mean change over the study period (p = 0.6). Furthermore, there was no statistically significant difference between the two intervention groups for any of the other examined outcomes (p ≥ 0.07). In the pooled cohort, there was no significant effect of dietary GL on any metabolic or anthropometric outcome (p ≥ 0.2). A post hoc analysis comparing the study women to a cohort of overweight or obese pregnant women who received only routine care showed that the non-study women were more likely to gain excess weight (p = 0.046) and to deliver large-for-gestational-age (LGA) (p = 0.01) or macrosomic (p = 0.006) infants. Thus, a low-GL diet consumed during the last half of pregnancy did not improve pregnancy outcomes in obese women, but in comparison to non-study women, dietary counseling reduced the risk of adverse outcomes.

Potato Preload Mitigated Postprandial Glycemic Excursion in Healthy Subjects: An Acute Randomized Trial.

This study investigated the preload effect of the medium and high glycemic index (GI) potato, as well as the combination of partially hydrolyzed guar gum (HG) and potato, when ingested prior to a rice meal, on the iso-carbohydrate basis. In a randomized crossover trial, 17 healthy female subjects consumed (1) rice; (2) co-ingestion of highly cooked potato (HP), and rice (HP + R); (3) co-ingestion of minimally cooked potato (MP) and rice (MP + R); (4) preload HP prior to rice meal (PHP + R); (5) preload MP prior to rice meal (PMP + R); (6) co-ingestion of partially hydrolyzed guar gum (HG), HP and rice (HG + HP + R); (7) preload HG prior to co-ingestion of HP and rice (PHG + HP + R); (8) co-preload of HG and HP prior to rice (PHG + PHP + R); and (9) preload of HP prior to co-ingestion of HG and rice (PHP + HG + R). Postprandial glycemic response (GR) tests and subjective satiety tests were conducted for each test food. Cooked potato as a preload to a rice meal could significantly cut the acute postprandial glycemic excursion by around 1.0 mmol/L, irrespective of the GI of the preload. Co-preload of partial hydrolyzed guar gum and highly cooked potato (PHG + PHP + R) resulted in improved acute GR in terms of peak glucose value and glycemic excursion compared with either HG preload or HP preload. All the meals with preload showed comparable or improved self-reported satiety. Within an equicarbohydrate exchange framework, both high-GI and medium-GI potato preload decreased the postprandial glycemic excursion in young healthy female subjects. The combination of HG and HP as double preload resulted in better GR than both single HG or HP preload did.

A Comprehensive Critical Assessment of Increased Fruit and Vegetable Intake on Weight Loss in Women.

No previous reviews or meta-analyses have specifically assessed the effects of increased fruit and vegetable (FV) intake on weight loss with a primary focus on women. Several studies show differences between men and women in how increased FV intake affects their weight loss and maintenance, risk of becoming overweight or obese, and the influence of eating speed and frequency on weight control. This analysis provides a comprehensive and visual assessment of the effects of increasing FV intake and long-term weight change from observational studies and weight loss from randomized controlled trials (RCTs) in women. Consistent evidence from prospective studies and RCTs shows that increased intake of FV is a chief contributor to weight loss in women. This effect is enhanced with concurrent dietary restriction of high energy density (ED) or high-fat foods. Yet, the type of FV differentially impacts weight loss in women. Whole FV intake may influence weight through a variety of mechanisms including a reduction in eating rate, providing a satisfying, very-low to low energy density, low glycemic load or low-fat content. Also, FV are the primary source of dietary fiber, which can provide additional support for weight loss in women when consumed at adequate levels.

The Impact of Dietary Glycemic Index and Glycemic Load on Postprandial Lipid Kinetics, Dyslipidemia and Cardiovascular Risk.

Many recent studies have acknowledged postprandial hypetriglyceridemia as a distinct risk factor for cardiovascular disease. This dysmetabolic state is the result of the hepatic overproduction of very low-density lipoproteins (VLDLs) and intestinal secretion of chylomicrons (CMs), which leads to highly atherogenic particles and endothelial inflammation. Postprandial lipid metabolism does not only depend on consumed fat but also on the other classes of nutrients that a meal contains. Various mechanisms through which carbohydrates exacerbate lipidemia have been identified, especially for fructose, which stimulates de novo lipogenesis. Glycemic index and glycemic load, despite their intrinsic limitations, have been used as markers of the postprandial glucose and insulin response, and their association with metabolic health and cardiovascular events has been extensively studied with contradictory results. This review aims to discuss the importance and pathogenesis of postprandial hypertriglyceridemia and its association with cardiovascular disease. Then, we describe the mechanisms through which carbohydrates influence lipidemia and, through a brief presentation of the available clinical studies on glycemic index/glycemic load, we discuss the association of these indices with atherogenic dyslipidemia and address possible concerns and implications for everyday practice.

Evaluating the association of free sugars intake and glycemic load on cardiometabolic outcomes: A prospective analysis throughout adolescence into early adulthood.

PURPOSE: To prospectively evaluate the relation of free sugars intake and glycemic load with adiposity and insulin resistance, from adolescence into early adulthood. METHODS: Data from the population-based cohort EPITeen (Porto, Portugal) at 13 and 21 years old was used (n = 1034). At both ages, dietary assessment was obtained by food frequency questionnaires (FFQ). Added sugar of each food item was estimated based on a systematic methodology described by Louie et al. Free sugars (FS) were defined according to World Health Organization. To each food item of the FFQ, a calculated mean value of FS and glycemic index was assigned. Dietary glycemic load (GL) was determined for each participant. Sex- and age-specific body mass index z-score (BMIz) and waist-to-weight ratio (WWr) were used as measures of adiposity, and the homeostasis model assessment (HOMA-IR) as a measure of insulin resistance. A cross-lagged path analysis was performed to examine causal relationships between FS intake or dietary GL with BMIz, WWr or HOMA-IR. RESULTS: No significant association was found between intake of FS and dietary GL at 13 years with BMIz, WWr or HOMA-IR at 21. A significant inverse association was found between BMIz at 13 and FS (ß = -0.595,95%CI -0.830, -0.359) and dietary GL (ß = -0.687,95%CI -0.937,-0.437) at 21 years. Intake of FS, dietary GL, as well as BMIz, WWr and HOMA-IR tracked from 13 to 21 years. CONCLUSION: No significant association was found between consumption of FS and GL at 13 years with cardiometabolic features at 21 years. Dietary intake and cardiometabolic outcomes tracked from adolescence into early adulthood.

Association of dietary glycaemic index, glycaemic load, and total carbohydrates with incidence of type-2 diabetes in adults aged ≥40 years: The Multi-Rural Communities Cohort (MRCohort).

AIMS: To examine potential associations between the glycaemic index (GI), glycaemic load (GL), and carbohydrates and the incidence risk of type-2 diabetes (T2D) and the effect modification of obesity among Korean adults aged ≥40 years. METHOD: Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for T2D were estimated in 8310 participants using a modified Poisson regression model. Dietary indices were averaged using repeated dietary assessments during follow-up. RESULT: After adjusting for potential confounders, a positive association between GI and T2D was found among women (IRR = 1.63, 95% CI = 1.06-2.51 in the highest tertile (T3) vs. the lowest tertile (T1) for GI, p trend = 0.0310), but not for GL and carbohydrate intake. This positive association with GI was stronger in obese women (IRR = 1.91, 95% CI: 1.15-3.19 in T3 vs. T1, p trend = 0.0137 for body mass index ≥23 kg/m2; IRR = 2.35, 95% CI: 1.01-5.48, p trend = 0.0350 for waist circumference (WC) ≥ 85 cm). In men, there was no association before stratification by obesity, but IRRs of GI (T3 vs. T1) were significant and stronger with increased WCs (IRR = 2.26, 95% CI: 1.02-4.98, p trend = 0.0439 for WC ≥ 90 cm). CONCLUSION: GI may be positively associated with the incidence of T2D in women, particularly in obese women. The association of GI with T2D incidence risk may also be positive even in men with high WC.

Dietary glycaemic index, glycaemic load and head and neck cancer risk: a pooled analysis in an international consortium.

High dietary glycaemic index (GI) and glycaemic load (GL) may increase cancer risk. However, limited information was available on GI and/or GL and head and neck cancer (HNC) risk. We conducted a pooled analysis on 8 case-control studies (4081 HNC cases; 7407 controls) from the International Head and Neck Cancer Epidemiology (INHANCE) consortium. We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) of HNC, and its subsites, from fixed- or mixed-effects logistic models including centre-specific quartiles of GI or GL. GI, but not GL, had a weak positive association with HNC (ORQ4 vs. Q1 = 1.16; 95% CI = 1.02-1.31). In subsites, we found a positive association between GI and laryngeal cancer (ORQ4 vs. Q1 = 1.60; 95% CI = 1.30-1.96) and an inverse association between GL and oropharyngeal cancer (ORQ4 vs. Q1 = 0.78; 95% CI = 0.63-0.97). This pooled analysis indicates a modest positive association between GI and HNC, mainly driven by laryngeal cancer.

Dietary Glycemic Index and Glycemic Load and the Risk of Prostate Cancer: An Updated Systematic Review and Dose-Response Meta-Analysis.

A meta-analysis in 2015 revealed no significant association between glycemic index (GI), glycemic load (GL), and prostate cancer. Moreover, until now, no study has examined the dose-response association of GI, GL, and prostate cancer yet. The online databases were searched by two independent researchers for relevant publications up to Jan. 2019, using relevant keywords. Nine studies including five prospective and four case-control studies were included in the current systematic review and meta-analysis. These studies have included 290,911 individuals. We found a significant positive dose-response association between dietary GI and prostate cancer (Pnonlinearity = 0.03). Comparing individuals in the highest category of GI with those in the lowest category, no significant association was found between GI and prostate cancer (combined effect size: 1.08, 95% CI: 0.97-1.19, P = 0.17). Furthermore, no significant association was seen between dietary GL and prostate cancer in both dose-response analysis and when comparing the highest versus lowest categories of GL (combined effect size: 1.03, 95% CI: 0.91-1.16, P = 0.65). In conclusion, we found a significant positive dose-response association between dietary GI and prostate cancer. However, significant association was not seen for dietary GL.

Lowering breakfast glycemic index and glycemic load attenuates postprandial glycemic response: A systematically searched meta-analysis of randomized controlled trials.

Low glycemic index (GI) diets are recommended to reduce the risk for chronic diseases by managing postprandial elevations in blood glucose and insulin. However, to our knowledge, a systematic review of randomized controlled trials (RCTs) to investigate this relationship and interpret its clinical relevance has yet to be performed. This review aims to assess the effect of low versus high GI breakfast meals on postprandial glycemic and insulinemic responses in adults. Two researchers independently screened 1100 articles from PubMed, CINAHL, Medline, and Cochrane databases and extracted data from 11 qualified RCTs. Meta-analyses were performed to calculate overall effect sizes of postintervention blood glucose concentration change values at different time points (60, 90, and 120 min) using a random-effects model, reporting their weighted mean differences (WMDs) and 95% confidence intervals (CIs). Low GI breakfasts significantly reduced postprandial blood glucose concentrations at all time points: 60 min (WMD: -1.32 mmol/L; 95% CIs, -1.64 to -0.99), 90 min (WMD: -0.74 mmol/L; 95% CI, -0.92 to -0.56), and 120 min (WMD: -0.44 mmol/L; 95% CI, -0.63 to -0.26). Further analyses not only indicated similar trends following the stratification of studies according to the glycemic load, but also showed a more pronounced decline in glycemic response among individuals with metabolic impairments. These results highlight the benefits of lowering breakfast meal GI to provide clinically relevant reductions in acute glucose response.

Proteomic Analysis of Plasma Reveals Fat Mass Influences Cancer-Related Pathways in Healthy Humans Fed Controlled Diets Differing in Glycemic Load.

Increased adiposity and diets high in glycemic load (GL) are associated with increased risk of many chronic diseases including cancer. Using plasma from 80 healthy individuals [40 men/40 women, 29 with DXA-derived low fat mass (FM) and 51 with high FM] in a randomized cross-over-controlled feeding trial and arrays populated with 3,504 antibodies, we measured plasma proteins collected at baseline and end of each of two 28-day controlled diets: a low GL diet high in whole grains, legumes, fruits, and vegetables (WG) and a high GL diet high in refined grains and added sugars (RG). Following univariate testing for proteins differing by diet, we evaluated pathway-level involvement. Among all 80 participants, 172 proteins were identified as differing between diets. Stratifying participants by high and low FM identified 221 and 266 proteins, respectively, as differing between diets (unadjusted P < 0.05). These candidate proteins were tested for overrepresentation in Reactome pathways, corresponding to 142 (of 291) pathways in the high-FM group and 72 (of 274) pathways in the low-FM group. We observed that the cancer-related pathways, DNA Repair, DNA Replication, and Cell Cycle, were overrepresented in the high-FM participants while pathways involved in post-translational protein modification were overrepresented in participants with either FM. Although high-GL diets are associated with increased risk of some cancers, our study further suggests that biology associated with consumption of GL diets is variable depending on an individual's adiposity and dietary recommendations related to cancer prevention be made with the additional consideration of an individual's FM.

The Effect of Low Glycemic Index and Glycemic Load Diets on Hepatic Fat Mass, Insulin Resistance, and Blood Lipid Panels in Individuals with Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease that is associated with insulin resistance and hepatic triglyceride accumulation. There is evidence to suggest that a low glycemic index (GI) diet can reduce glucose absorption, hepatic influx of glucose, and de novo lipogenesis. This review investigates the effect of low GI and glycemic load (GL) diets on hepatic fat mass, hepatic enzymes, insulin resistance, fasting blood glucose levels, and blood lipid panels in individuals with NAFLD. PubMed, Cumulative Index to Nursing and Allied Health Literature, and Web of Science were used in literature search. Search keywords included "glycemic index," "glycaemic index," "glycemic load," "glycaemic load," "nonalcoholic fatty liver disease," "NAFLD," "nonalcoholic steatohepatitis," and "NASH." Outcome measurements included hepatic fat mass, hepatic enzyme alanine transaminase (ALT), insulin resistance [homeostasis model assessment of insulin resistance (HOMA-IR)], fasting blood glucose levels, and/or blood lipid panels. Four eligible studies enrolling 281 individuals with NAFLD were included. Both hepatic fat mass and ALT showed significant reductions from baseline in both low GI and GL diets. One study showed no change, and another study showed significant reductions in HOMA-IR. No significant reduction in fasting blood glucose level, triglycerides, high-density lipoprotein-cholesterol, or low-density lipoprotein-cholesterol was observed from baseline in both low GI and GL diets. Findings from the review suggest that low GI and GL diets may reduce hepatic fat mass and ALT in individuals with NAFLD. Future research of large-scale, randomized controlled studies using isoenergetic, low GI and GL diets for long term is needed to draw conclusionary results.

Trans-fatty acids aggravate anabolic steroid-induced metabolic disturbances and differential gene expression in muscle, pancreas and adipose tissue.

AIMS: Although anabolic steroids (AS) and trans-fatty acids overload exerts systemic toxicity and are independent risk factors for metabolic and cardiovascular disorders, their interaction remains poorly understood. Thus, we investigated the impact of a diet rich in trans-fatty acids (HFD) combined with AS on glycemic control, lipid profile, adipose tissue, skeletal muscle and pancreas microstructure and expression of genes involved in energy metabolism. MAIN METHODS: Forty-eight C57BL/6 mice were randomized into 6 groups treated for 12 weeks with a standard diet (SD) or a diet rich in C18:1 trans-fatty isomers (HFD), alone or combined with 10 or 20 mg/kg testosterone cypionate (AS). KEY FINDINGS: Our results indicated that AS improved glycemic control, upregulated gene expression of Glut-4 and CPT-1 in skeletal muscle, FAS, ACC and UCP-1 in adipose tissue. AS also reduced total and LDL cholesterol in mice fed a SD. When combined with the HFD, AS was unable to induce microstructural adaptations in adipose tissue, pancreatic islets and ß-cells, but potentiated GCK and Glut-2 (pancreas) and Glut-4 and CPT-1 (skeletal muscle) upregulation. HFD plus AS also downregulated FAS and ACC gene expression in adipose tissue. Combined with HFD, AS increased triacylglycerol circulating levels, improved insulin sensitivity and glycemic control in mice. SIGNIFICANCE: Our findings indicated that HFD and AS can interact to modulates glycemic control and lipid profile by a mechanism potentially related with a reprogramming of genes expression in organs such as the pancreas, adipose tissue and skeletal muscle.

Maternal Dietary Glycemic and Insulinemic Indexes Are Not Associated with Birth Outcomes or Childhood Adiposity at 5 Years of Age in an Irish Cohort Study.

BACKGROUND: High maternal dietary glycemic index (GI) and glycemic load (GL) may be associated with adverse offspring birth and postnatal adiposity outcomes through metabolic programming, but the evidence thus far, mainly from studies conducted in high-risk pregnant populations, has been inconclusive. No study has examined the influence of maternal insulin demand [measured by food insulinemic index (II) and insulinemic load (IL)] on offspring outcomes. OBJECTIVES: We investigated associations between maternal GI, GL, II, and IL and offspring birth outcomes and postnatal adiposity in a general pregnant population. METHODS: The study was based on data from 842 mother-child pairs from the Lifeways prospective cohort study in Ireland. Through the use of standard methodology, maternal GI, GL, II, and IL were derived from dietary information obtained via a validated food-frequency questionnaire in early pregnancy (12-16 wk). Birth outcomes were abstracted from hospital records. At 5-y follow-up, children's body mass index (BMI) and waist circumference were measured. Associations were assessed through the use of multivariable-adjusted regression analysis. RESULTS: Mothers had a mean ± SD age of 30.3 ± 5.7 y and a mean BMI (kg/m2) of 23.9 ± 4.2. The mean ± SD for dietary glycemic and insulinemic indexes were: GI = 58.9 ± 4.4; GL = 152 ± 49; II = 57.4 ± 14.5; IL = 673 ± 267. After adjustment for confounders, no consistent associations were observed between maternal GI, GL, II, and IL and birth outcomes including birth weight, macrosomia, gestational age, and postterm births. Similarly, no association was observed with BMI and waist circumference z scores and childhood obesity (general and central) at 5-y follow-up. There was no evidence of a nonlinear relation between the studied indexes and outcomes. CONCLUSIONS: We observed no clear relation between maternal GI, GL, II, and IL and offspring birth outcomes and childhood obesity in a general pregnant population.

Effects of nutritional nursing intervention based on glycemic load for patient with gestational diabetes mellitus.

OBJECTIVES: To determine the effects of nutritional nursing intervention based on glycemic load (GL) for patients with gestational diabetes mellitus. MATERIAL AND METHODS: One hundred thirty-four patients diagnosed with gestational diabetes mellitus at our hospital were selected from March 2015 to March 2017 and randomly divided into the observation (n = 67) and control groups (n = 67). All of the patients in the observation and control groups received conventional nutritional nursing. In addition, the patients in the observation group received nutritional nursing intervention based on GL. The changes in blood glucose levels and pregnancy outcomes were compared between the two groups after intervention. RESULTS: There were significant differences in fasting blood glucose (FBG) and the 2h postprandial glucose (2hPG) levels between the two groups (P < 0.05). There was a lower incidence of premature delivery, fetal macrosomia, eclampsia, preg- nancy hypertension syndrome, and fetal distress in the observation group. CONCLUSIONS: Nutritional nursing intervention based on GL is more effective than traditional nutritional nursing for patients with gestational diabetes, and can effectively control the blood glucose level, reduce the incidence of pregnant complica- tions, and improve the pregnancy outcome. Thus, nutritional nursing intervention based on GL deserves to be popularized.

Dietary glycemic index and glycemic load in relation to general obesity and central adiposity among adults.

BACKGROUND & AIMS: Although the association between dietary Glycemic Index (GI), Glycemic Load (GL) and general/abdominal obesity has extensively been examined, limited data are available in this regard in developing countries. The aim of this study was to examine the association between dietary GI and GL with general and abdominal obesity. METHODS: This cross-sectional study was conducted among adults in Isfahan, Iran. Dietary GI and GL were assessed using a validated dish-based 106-item semi-quantitative food frequency questionnaire (DS-FFQ). Data regarding height, weight and waist circumference were collected using a self-reported questionnaire. Overweight or obesity was defined as body mass index ≥25 kg/m2, and abdominal obesity was defined as waist circumference ≥80 cm for women and ≥94 cm for men. RESULTS: There was no significant association between dietary GI and GL and general obesity. After adjustment for potential confounders, participants in the highest quintile of dietary GI had a higher chance for abdominal obesity (OR: 1.29; 95% CI: 1.01-1.64), compared with those in the lowest quintile. No significant association was observed between dietary GL and abdominal obesity. After adjustment for potential confounders, women in the top quintile of dietary GI had higher chance for abdominal obesity compared with those in the bottom quintile (OR: 1.48, 95% CI: 1.02-2.15). No significant association was found between dietary GI and abdominal obesity among men. We failed to find any significant association between dietary GI and general obesity in either gender [Comparing top vs. bottom quintiles, for men: OR: 0.97; 95% CI: 0.74-1.29 and for women: OR: 1.01; 95% CI: 0.75-1.40]. No significant association was found between dietary GL and general [for men: OR: 1.13; 95% CI: 0.85-1.49 and for women: OR: 1.01; 95% CI: 0.76-1.35], as well as abdominal obesity [for men: OR: 1.21; 95% CI: 0.88-1.67 and for women: OR: 1.25; 95% CI: 0.88-1.77]. CONCLUSIONS: We found a significant positive association between dietary GI and abdominal obesity. When we conducted analyses stratified by gender, we also observed such association in women, but not in men. No other significant associations were observed between dietary GI and GL with general or abdominal obesity.

Glycemic index, glycemic load, and depression: a systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: Although several studies have investigated the association between dietary Glycemic Index (GI), glycemic load (GL) and depression, results are inconsistent. This systematic review and meta-analysis was performed to summarize earlier evidence on the association between dietary GI, GL, and depression. SUBJECTS/METHODS: We searched in PubMed/Medline, ISI Web of Knowledge, Scopus, EMBASE, and Google Scholar to identify related articles published until April 2018. Publications that fulfilled the following criteria were included in the current study: (1) publications with participants aged ≥ 18 years; (2) studies that considered GI or GL as the exposure; (3) studies that considered depression as the main outcome or as one of the outcomes; and (4) publications in which odds ratios (ORs) or mean difference were reported as the effect size. Finally, 11 studies, including 6 cross-sectional studies, 2 cohort studies, and 3 clinical trials were considered for inclusion in the systematic review, and 5 cross-sectional studies, 2 cohort studies, and 2 clinical trials (out of 11 studies included in the systematic review) were included in the meta-analysis. The quality of cross-sectional and cohort studies examined by the Newcastle-Ottawa Scale (NOS) and the quality of clinical trials examined using Cochrane Collaboration Risk of Bias tool. We also assessed the quality of evidence with the GRADE system. RESULTS: Sample sizes of the included cross-sectional studies ranged from 140 to 87,618 participants, and in total 101,389 participants were included in 6 studies. In total, 85,500 participants were included in 2 cohort studies. Sample sizes of the included clinical trials ranged from 40 to 82 participants, and in total 164 participants were included in three studies. Combining seven effect sizes from five cross-sectional studies, no significant association was observed between dietary GI and odds of depression (OR: 1.01; 95% CI: 0.94, 1.08; I2 = 80.2%; n = 5). We also failed to find any significant association between dietary GL and odds of depression (OR: 0.93; 95% CI: 0.84, 1.04; I2 = 42%; n = 5). Combining two effects sizes from two cohort studies, there was a significant positive association between dietary GI and depression (HR: 1.13; 95% CI: 1.02, 1.25; I2 = 86.1%, n = 2). In addition, combining two effect sizes from two clinical trials, we found a significant change in depression score after consumption of a high-GL diet (weighted mean difference (WMD): 0.66; 95% CI: 0.28, 1.04; I2 = 0.0%, n = 2). CONCLUSIONS: Summarizing earlier findings, we found no significant association between either dietary GI or GL and odds of depression in cross-sectional studies. However, a significant positive association was observed between dietary GI and depression in cohort studies. In addition, a significant effect of a high-GL diet consumption on risk of depression was seen in clinical trials.

A randomized controlled trial of topical benzoyl peroxide 2.5% gel with a low glycemic load diet versus topical benzoyl peroxide 2.5% gel with a normal diet in acne (grades 1-3).

BACKGROUND: The improvement in insulin resistance and acne lesions on low glycemic load diets in various studies suggests that diet plays a significant role in acne pathogenesis. AIMS: To compare the efficacy of a low glycemic load diet plus topical benzoyl peroxide 2.5% gel with that of only topical benzoyl peroxide 2.5% gel in grades 1, 2 and 3 of acne vulgaris. METHODS: In a randomized controlled trial, 84 patients with grades 1, 2 and 3 acne vulgaris were divided into two groups, to receive a low glycemic load diet and no dietary intervention respectively. Acne lesions (face) were scored and graded at baseline and 4, 8 and 12 weeks. Homeostasis model assessment of insulin resistance and body mass index were measured during the first and last visits. Statistical analysis was done with Statistical Package for the Social Sciences, version 17.0. RESULTS: Both groups showed significant reduction in acne counts at 12 weeks (P = 0.931) with no statistically significant difference between the groups. The differences in body mass index and homeostasis model assessment of insulin resistance between the groups were statistically significant (P = 0.0001). Group 1 showed reductions in body mass index and homeostasis model assessment of insulin resistance values at the end of the study, whereas group 2 did not. LIMITATIONS: Application of mild topical cleanser in both the groups might have contributed to the improvement in epidermal barrier function, and topical application of 2.5% of benzoyl peroxide gel in both groups contributed to the improvement in acne counts. CONCLUSIONS: A low glycemic load diet did not result in any significant improvement in acne counts.

Acute effect of equicaloric meals varying in glycemic index and glycemic load on arterial stiffness and glycemia in healthy adults: a randomized crossover trial.

BACKGROUND/OBJECTIVES: Dietary carbohydrate quality and quantity fluctuate but it is unknown which attribute takes precedence in vascular health preservation. We investigated all four permutations of glycemic index (GI) and glycemic load (GL) on acute vascular and glycemic responses. SUBJECTS/METHODS: Twenty-one healthy adults were screened for this crossover trial. Seventeen (8 M:9 F; 26.7 ± 12.3 y; BMI 22.2 ± 2.8 kg/m2) entered randomization and completed the study, receiving four isocaloric meals, varying in GI and GL, in random order at least 3 days apart. The four meals included either chickpeas (GI = 28, GL = 14, 50 g available carbohydrates (CHO)), a small potato portion (GI = 85, GL = 14, CHO = 17 g), pasta (GI = 45, GL = 42, CHO = 94 g) or a large potato portion (GI = 85, GL = 42, CHO = 50 g) as the source of carbohydrate. Augmentation index (AIx) and central and peripheral blood pressure were measured fasting, 1, 2, 3, and 4 h post-consumption. Capillary blood glucose was analyzed fasting, 15, 30, 45, 60, 90, 120, 180, and 240 min. RESULTS: A reduction in AIx from baseline was observed 4 h following the chickpeas (low GI-low GL) (p = 0.046). The incremental area under blood glucose curves were significantly higher 2 h post-consumption following high compared with low GL meals (p < 0.001). Despite doubling carbohydrates, there was no difference in glycemic response between the large potato (high GI-high GL) and the pasta (low GI-high GL) meals. No significant differences in AIx or blood pressure were seen between meals. CONCLUSIONS: Low GI, low-carbohydrate meals may support a healthy vascular tone. Varying meal GI and GL results in different glycemic profiles, which are not necessarily predicted by carbohydrate content. Further investigations on cardiometabolic profiles to meals varying in GI and GL are warranted.