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Insulin Index

Insulin Index

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insulin index
insulin index

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ABSTRACTTheaimofthisstudywastosystematically
comparepostprandialinsulinresponsestoisoenergetic1000-U
(240-kcal)portionsofseveralcommonfoods.Correlationswithnutrientcontentweredetermined.Thirty-eightfoodsseparatedinto
sixfoodcategories(fruit,bakeryproducts,snacks,carbohydraterichfoods,protein-richfoods,andbreakfastcereals)werefedto
groupsof11—13ealthysubjects.Finger-prickbloodsampleswereobtainedevery15mmover120mm.Aninsulinscorewascalculatedfromtheareaundertheinsulinresponsecurveforeachfood
withuseofwhitebreadasthereferencefood(score=100%).
Significantdifferencesininsulinscorewerefoundbothwithinandamongthefoodcategoriesandalsoamongfoodscontaininga
similaramountofcarbohydrate.Overall,glucoseandinsulin
scoreswerehighlycorrelated(r=0.70,P<0.001,n=38).
However,protein-richfoodsandbakeryproducts(richinfatandrefinedcarbohydrate)elicitedinsulinresponsesthatweredispro
portionatelyhigherthantheirglycemicresponses.Totalcarbohy
drate(r=0.39,P<0.05,n=36)andsugar(r=0.36,P<0.05,
n=36)contentswerepositivelyrelatedtothemeaninsulinscores,
whereasfat(râ¿0.27,S,n36)andprotein(râ¿0.24,S,
n=38)contentswerenegativelyrelated.Considerationofinsulin
scoresmayberelevanttothedietarymanagementandpathogenesisofnon-insulin-dependentdiabetesmellitusandhyperlipidemia
andmayhelpincreasetheaccuracyofestimatingpreprandialinsulinrequirements.AmJClinNutrl997;66:l264—76.
KEYWORDSInsulin,glycemicindex,NIDDM,non
insulin-dependentdiabetesmeffitus,diabeticdiet,hyperlipidemia,carbohydrate,insulinscore,glucosescore,areaunderthe
curve,humans
INTRODUCTION
Theinsulinemiceffectsoffoodsmayberelevanttothetreatmentandpreventionofweightgain,non-insulin-dependentdiabetesmellitus(NIDDM),andassociatedcomplications.Recentstudieshaveshownthatcarbohydrate-richdiets,whichresultinhighpostprandialglucoseandinsulinresponses,areassociatedwithundesirablelipidprofiles(1,2),greaterbodyfat(€”5),ndthedevelopmentofinsulinresistanceinrats(6)andhumans(7,8).BothobesityandNJDDMareassociatedwithvaryingdegreesofinsulinresistanceandfastinghyperinsulinemia.Prolongedorhighdegreesofpostprandialinsulinemiaarethoughttocontributetothedevelopmentofinsulin
resistanceandassociateddiseases(9â17).Therefore,theclas
sificationoftherelativeinsulinemiceffectsofdifferentfoods
isofboththeoreticalandpracticalsignificance.Postprandialbloodglucoseresponseshavebeenthefocusofmuchresearchbecauseoftheirimportanceforglycemiccontrolinpatientswithdiabetes.Itisnowwellacceptedthat
differentfoodscontainingequalamountsofcarbohydratecanproduceawiderangeofbloodglucoseresponses.Theglyce
micindex(GI)methodwasdevelopedtorankfoodsaccording
totheextenttowhichtheyincreasebloodglucoseconcentrations(18).TablesofGIvaluesofcommoncarbohydrate
containingfoodsareausefulguidetohelppeoplewithdiabetes
choosefoodsthatproducesmallerglycemicresponses.However,theGIconceptdoesnotconsiderconcurrentinsulin
responsesandfewstudieshavereportedGIvaluesandtheir
accompanyinginsulinresponses.Theextenttowhichdifferentdietaryfactorsaffectpostprandialinsulinemiahasnotbeenwellresearchedbecauseinsulinsecretionislargelyassumedtobeproportionaltopostprandialglycemia.Furthermore,hyperglycemiaisthoughttobemorerelevanttothesecondarycomplications
ofNIDDMbecausetheabnormalinsulinsecretionoraction
inpeoplewithdiabetesiscontrolledwithexogenousinsulin
ormedicationsthatcounteractinsulinresistance.However,
knowledgeoffactorsthatinfluencebothpostprandialglycemiaandinsulinsecretioninnondiabeticpersonsisrequiredtodevisetreatmentstrategiesthatwillcompletely
normalizemeal-relatedglycemia(19).
ToexploretheimportanceofdietaryhabitsandpostprandialinsulinemiaintheetiologyandtreatmentofNIDDM,weneed
tobeabletosystematicallyrateinsulinresponsestocommonfoods.Ifwearetocompareinsulinresponsestofoods,whatisthebestbasisofcomparison?Shouldwecompareinsulinresponsestoportionsoffoodrepresentinganormalservingsize,portionscontaininganequalamountofcarbohydrate,orportionscontaininganequalamountofenergy?01tablesrepresenttheglycemiceffectsofequal-carbohydrateportions
IFromtheHumanNutritionUnit,DepartmentofBiochemistry,The
UniversityofSydney;andtheSchoolofMathematicalSciences,TheUniversityofTechnology,Sydney,Australia.
2SupportedbyresearchgrantsfromTheUniversityofSydneyand
Kellogg'sAustraliaPtyLtd.
3AddressreprintrequeststoJCBrandMiller,HumanNutritionUnit,
DepartmentofBiochemistry008,TheUniversityofSydney,NSW2006,Australia.ReceivedNovember21,1996.AcceptedforpublicationMay22,1997.1264
AmJClinNutr1997;66:1264—76.PrintedinUSA.©1997AmericanSocietyforClinicalNutrition
Aninsulinindexoffoods:theinsulindemandgeneratedby
1000-kJportionsofcommonfoods13
SusanneHAHolt,JanetteCBrandMiller,andPeterPetocz
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FoodVariety,manufacturer,orplaceofpurchasePreparation
INSULININDEXOFFOODS1265
TABLE!
Descriptionandpreparationofthetestfoods
Fruit
BlackgrapesApplesOrangesBananasBakeryproductsCroissantsChocolatecakewithfrostingDoughnutswithcinnamonsugarChocolatechipcookiesWatercrackersSnackfoodsandconfectioneryMarsBarYogurtIcecreamJellybeans(assortedcolors)PeanutsPotatochips
Popcorn
Protein-richfoodsCheeseEggs
Lentils
Bakedbeans
Beefsteak
Whitefish
Carbohydrate-richfoodsWhitebread
Whole-mealbreadGrainbreadWhiterice
BrownriceWhitepastaBrownpastaPotatoesWalthamcross
Reddelicious
NavelCavendishFresh,stemremoved,servedwholeFresh,unpeeled,cutintoeightsegmentsFresh,peeled,cutintoeightsegmentsFresh,peeled,cutintoquartersDefrosted,reheatedat180°Cor6mm,andservedwarmPreparedaccordingtomanufacturer'sdirections,storedat4°Cpto2dbeforeservingatroomtemperaturePreparedbysupermarketfromstandardrecipe,defrostedovernight,reheatedat180°Cor5mm,andservedwarmServedcrispatroomtemperature,storedinairtightcontainerServedcrispatroomtemperatureCutintofourstandardpiecesandservedatroomtemperatureStoredat4°C,ervedcoldStoredfrozenandservedcoldServedatroomtemperature,storedinairtightcontainerServedatroomtemperature,storedinairtightcontainerServedfromfreshlyopenedpacketPreparedaccordingtomanufacturer'sdirectionsimmediatelybeforeserving
Allservingscutfromsamelargeblock,storedat4°C,
servedcoldPoachedthedaybeforeserving,storedat4°Cvernight,
reheatedinmicrowaveovenfor1.5mmimmediately
beforeservingPreparedinbulkaccordingtorecipe,storedat4°Corupto2d,reheatedinamicrowaveovenfor2mm
immediatelybeforeserving
Heatedonstovefor5mmimmediatelybeforeservingGrilledthedaybeforeserving,cutintostandardbite-sizedpieces,andstoredat4°Cvernight;reheatedinmicrowaveovenfor2mmimmediatelybeforeservingSteamedthedaybeforeserving,storedat4°Cvernight,cutintobite-sizedpieces,andreheatedinmicrowaveovenfor2miiiimmediatelybeforeservingServedfreshandplainatroomtemperatureServedfreshandplainatroomtemperatureServedfreshandplainatroomtemperatureBoiled12miiiandstoredovernightat4°C,eheatedinmicrowaveovenfor1.5mmimmediatelybeforeservingBoiled12mmandstoredovernightat4°C,eheatedinmicrowaveovenfor1.5mmimmediatelybeforeserving
Boiled8mmandstoredovernightat4°C
Reheatedinmicrowaveovenfor1.5mmimmediately
beforeserving
Peeled,boiledfor20mm,andstoredat4°Cvernight;
reheatedinamicrowaveovenfor2mmimmediatelybeforeserving
Purchasedinbulkfromsupermarketandstoredfrozen
WhiteWingsFoods,Smithfield,Sydney,AustraliaPurchasedinbulkfromsupermarketandstoredfrozenAnion'sBiscuitsLtd.Homebush,Sydney,AustraliaGroceryWholesalersLtd,Yennora,AustraliaMarsConfectionaryAustralia,Ballarat,AustraliaStrawberryfruityogurt;AustralianCo-operativeFoods,'WetherillPark,Sydney,AustraliaVanillaicecream;DairyBell,Camperdown,Sydney,
Australia
GroceryWholesalersLtdSaltedroastedpeanuts;GroceryWholesalersLtdCrinklecutchips;Smith'sSnackfoodCompany,Chatswood,Sydney,AustraliaMicrowavecookedpopcorn;UncleToby'sCompanyLtd,Wahgunyah,Australia
Maturecheddarcheese;GroceryWholesalersLtd
PoachedhenseggsServedintomatosauce2Cannednavybeansintomatosauce;Franklins,Chullora,Sydney,Australia
Leantopsidebeeffilletsboughtinbulkfrom
supermarket,trimmedandstoredfrozenLingfishifiletsboughtinbulkfromSydneyfishmarkets,trimmedandstoredfrozenFreshslicedwheat-flourbread;QualityBakersAustraliaLtd.Eastwood,Sydney,AustraliaFreshslicedbreadmadefromwhole-mealwheatflour;RigaBakeries,Moorebank,Sydney,AustraliaFreshslicedryebreadcontaining47%kibbledrye;Tip
TopBakeries,Chatswood,Sydney,Australia
Cairoserice(Sunwhite),Ricegrowers'Co-operativeLtd.Leeton,AustraliaCalroserice(Sunbrown),Ricegrowers'Co-operativeLtdSpirals
Whole-mealspirals;SanRemoPastaCompany,
Auburn,Sydney,AustraliaRussetpotatoes
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FoodVariety,manufacturer,orplaceofurchasePreparationFrenchfriesPrefriedoven-bakedFrenchfries;McCain'sFoods
(Australia),CastleHill,Sydney,AustraliaStored
frozen,cookedinconventionalovenfor15mmimmediatelybeforeervingBreakfast
cereals3CornflakesKellogg's
AustraliaPtyLtd,Pagewood,Sydney,Australia—SpecialKToastedflakesmadefromwheatandriceflour,highinprotein;Kellogg'sAustraliaPlytd—HoneysmacksPuffedwhole-wheatgrainswithahoney-basedcoating;Kellogg'sAustraliaPlytd—SustainAmixtureofwheat,corn,andriceflakes;rolledoats;driedfruit;andflakedalmonds;Kellogg'sAustralia
Ptytd—All-BranA
high-fibercerealmadefromwheatbran;Kellogg'sAustraliaPtytd—NaturalmuesliBasedonrawrolledoats,wheatbran,driedfruit,nuts,andsunflowerseeds;UncleToby'sCompanyLtd.Wahgunyah,ustralia—PorridgeUncleToby'sCompanyLtd.Wahgunyah,AustraliaRawrolledoatscookedinamicrowaveovenaccordingto
manufacturer'sdirectionsandservedwithoutsweetener
1266
HOLTETAL
TABLE1
Continued
1NowDairyFarmer's.
2Recipe:15mLoliveoil,350gdriedgreenlentils,410gcannedtomatoes,120gonion,1clovegarlic,and1tsppepper.
3Allcerealswereservedfreshwith125mLfat-reduced(1.5%fat)milk.
offoods.However,carbohydratesnottheonlystimulusfor
insulinsecretion.Protein-richfoodsortheadditionofprotein
toacarbohydrate-richmealcanstimulateamodestrisein
insulinsecretionwithoutincreasingbloodglucoseconcentrations,particularlyinsubjectswithdiabetes(2€”22).Similarly,addingalargeamountoffattoacarbohydrate-richmealincreasesinsulinsecretioneventhoughplasmaglucoseresponsesarereduced(23,24).Thus,postprandialinsulinresponsesarenotalwaysproportionaltobloodglucoseconcentrationsortoameal'stotalcarbohydratecontent.Severalinsulinotropicfactorsareknowntopotentiatethestimulatoryeffectofglucoseandmediate
postprandialinsulinsecretion.Theseincludefructose,certainaminoacidsandfattyacids,andgastrointestinalhormonessuch
asgastricinhibitorypeptide,glucagon,andcholecystokiin
(25,26).Thus,protein-andfat-richfoodsmayinducesubstan
tialinsulinsecretiondespiteproducingrelativelysmallbloodglucoseresponses.Wethereforedecidedthatcomparingthe
insulinemiceffectsoffoodsonanisoenergeticbasiswasa
logicalandpracticalapproach.Theaimofthisstudywastosystematicallycomparepostprandialinsulinresponsestoisoenergeticportionsofarangeof
commonfoods.Aninsulinscore(IS)wascalculatedforeach
foodonthebasisofitsinsulinemiceffectrelativetoareference
food.Thirty-eightfoods,categorizedintosixdifferentfoodgroups,werestudiedtodeterminewhichfoodswithinthesamefoodgroupweremostinsulinogenic.Wehypothesizedthat
postprandialinsulinresponsesarenotcloselyrelatedtothe
carbohydratecontentorglycemiceffectsofsomefoods.SUBJECTSANDMETHODSTestfoodsThirty-eightfoodsweretestedandweregroupedintosixfoodcategories:1)fruit:grapes,bananas,apples,andoranges;
2)bakeryproducts:croissants,chocolatecakewithicing,
doughnutswithcinnamonsugar,chocolatechipcookies,and
watercrackers;3)snackfoodsandconfectionery:MarsBar
candybar(MarsConfectionaryAustralia,Ballarat,Australia),strawberryyogurt,vanillaicecream,jellybeans,saltedroastedpeanuts,plainpotatochips,andplainpopcorn;4)protein-rich
foods:cheddarcheese,poachedeggs,boiledlentilsinatomato
sauce,bakedbeansinatomatosauce,grilledbeefsteak,and
steamedwhitefish;5)carbohydrate-richfoods:whitebread,whole-mealbread,rye-grainbread,whiterice,brownrice,whitepasta,brownpasta,boiledpotatoes,andoven-baked
Frenchfries;and6)breakfastcereals:Cornflakes(Kellogg'sAustraliaPtyLtd.Pagewood,Australia),SpecialK(Kellogg'sAustraliaPtyLtd),Honeysmacks(Kellogg'sAustraliaPty
Ltd),Sustain(Kellogg'sAustraliaPtyLtd),All-Bran
(Kellogg'sAustraliaPtyLtd),naturalmuesli,andoatmealporridge.Eachfoodwasservedplainasa1000-Uportionwith220mLwater.Whitebreadwasusedasthereferencefoodforeach
foodgroup.Thefoodswereselectedtorepresentarangeof
naturalandprocessedfoodscommonlyeateninindustrializedsocieties.DetailsofthefoodsandtheirpreparationmethodsarelistedinTable1.Foodswereboughtinbulktominimizevariationsincompositionandwereservedinstandard-sizedpieces.Thenutritionalcompositionofeachfoodper1000Uas
calculatedfromAustralianfoodtablesormanufacturers'data
isshowninTable2.Subjects
Separategroupsofhealthysubjects(n=1€”13)wererecruitedtotesteachcategoryoffoods.Volunteerswereexcludediftheyweresmokersortakingprescriptionmedications,hadafamilyhistoryofdiabetesorobesity,weredieting,orhadirregulareatinghabits.Intotal,41subjectsparticipated.One
subjectconsumedallofthetestfoodsand15othersubjects
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