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International table of glycmic index and load

International table of glycmic index and load

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Reliable tables of glycemic index (GI) com-piled from the scientific literature are instrumental in improvingthe quality of research examining the relation between GI,glycemic load,and health. The GI has proven to be a more use-ful nutritional concept than is the chemical classification of car-bohydrate (as simple or complex,as sugars or starches,or asavailable or unavailable),permitting new insights into the rela-tion between the physiologic effects of carbohydrate-rich foodsand health. Several prospective observational studies have shownthat the chronic consumption of a diet with a high glycemic load(GI
dietary carbohydrate content) is independently associatedwith an increased risk of developing type 2 diabetes,cardiovas-cular disease,and certain cancers. This revised table containsalmost 3 times the number of foods listed in the original table(first published in this Journal in 1995) and contains nearly 1300data entries derived from published and unpublished verifiedsources,representing >750 different types of foods tested withthe use of standard methods. The revised table also lists theglycemic load associated with the consumption of specifiedserving sizes of different foods.
 Am J Clin Nutr 
Glycemic index,carbohydrates,diabetes,glycemic load
Twenty years have passed since the first index of the relativeglycemic effects of carbohydrate exchanges from 51 foods waspublished by Jenkins et al (1) in this Journal. Per gram of carbo-hydrate,foods with a high glycemic index (GI) produce a higherpeak in postprandial blood glucose and a greater overall blood glu-cose response during the first 2 h after consumption than do foodswith a low GI. Despite controversial beginnings,the GI is nowwidely recognized as a reliable,physiologically based classifica-tion of foods according to their postprandial glycemic effect.In 1997 a committee of experts was brought together by theFood and Agriculture Organization (FAO) of the United Nationsand the World Health Organization (WHO) to review the avail-able research evidence regarding the importance of carbohy-drates in human nutrition and health (2). The committeeendorsed the use of the GI method for classifying carbohydrate-rich foods and recommended that the GI values of foods be usedin conjunction with information about food composition to guidefood choices. To promote good health,the committee advocatedthe consumption of a high-carbohydrate diet (
55% of energyfrom carbohydrate),with the bulk of carbohydrate-containingfoods being rich in nonstarch polysaccharides with a low GI. InAustralia,official dietary guidelines for healthy elderly peoplespecifically recommend the consumption of low-GI cereal foodsfor good health (3),and a GI trademark certification program isin place to put GI values on food labels as a means of helpingconsumers to select low-GI foods (4). Commercial GI testing of foods for the food industry is currently conducted by manylaboratories around the world,including our own. Many recentpopular diet books contain extensive lists of the GI values of individual foods or advocate the consumption of low-GI,carbo-hydrate-rich foods for weight control and good health (5).Reliable tables of GI compiled from the scientific literatureare instrumental in improving the quality of research examiningthe relation between the dietary glycemic effect and health. Thefirst edition of 
 International Tables of Glycemic Index
,publishedin this Journal in 1995 with 565 entries (6),has been cited as areference in many scientific papers. In particular,these tablesprovided the basis for the GI to be used a dietary epidemiologictool,allowing novel comparisons of the effects of differentcarbohydrates on disease risk,separate from the traditionalclassification of carbohydrates into starches and sugars. Sev-eral large-scale,observational studies from Harvard University(Cambridge,MA) indicate that the long-term consumption of adiet with a high glycemic load (GL; GI
dietary carbohydratecontent) is a significant independent predictor of the risk of developing type 2 diabetes (7,8) and cardiovascular disease (9).More recently,evidence has been accumulating that a low-GIdiet might also protect against the development of obesity (10,11),colon cancer (12),and breast cancer (13). The EURODIAB(Europe and Diabetes) study,involving >3000 subjects with type 1diabetes in 31 clinics throughout Europe,showed that the GI rat-ing of self-selected diets was independently related to bloodconcentrations of glycated hemoglobin in men and women (14)
 Am J Clin Nutr 
2002;76:5–56. Printed in USA. ©2002 American Society for Clinical Nutrition
International table of glycemic index and glycemic loadvalues: 2002
Kaye Foster-Powell, Susanna HA Holt, and Janette C Brand-Miller 
From the Human Nutrition Unit,School of Molecular and Microbial Bio-sciences,University of Sydney,Australia.
Reprints not available. Address correspondence to JC Brand-Miller,HumanNutrition Unit,School of Molecular and Microbial Biosciences (G08),Universityof Sydney,NSW 2006,Australia. E-mail:j.brandmiller@biochem.usyd.edu.au.Received November 20,2001.Accepted for publication March 26,2002.
Special Article
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and to waist circumference in men (15). In addition,higherblood HDL-cholesterol concentrations were observed in patientsconsuming low-GI diets from the northern,eastern,and westernEuropean centers participating in the study (15). Indeed,severalstudies have shown that the dietary GI is a good predictor of HDL concentrations in the healthy population,whereas theamount and type of fat are not (16–18). Thus,the GI has provento be a more useful nutritional concept than is the chemical clas-sification of carbohydrate (as simple or complex,as sugars orstarches,or as available or unavailable),providing new insightsinto the relation between foods and health.In parallel with these advances have been studies document-ing the importance of postprandial glycemia per se for all-causemortality and cardiovascular disease mortality in healthy popu-lations (19). For example,in the Hoorn study there was a signi-ficant association between the 8-y risk of cardiovascular deathand 2-h postload blood glucose concentrations in subjectswith normal fasting glucose concentrations,even after adjust-ment for known risk factors (20). Multiple mechanisms are prob-ably involved. Recurring,excessive postprandial glycemia coulddecrease blood HDL-cholesterol concentrations,increasetriglyceridemia,and also be directly toxic by increasing proteinglycation,generating oxidative stress,and causing transienthypercoagulation and impaired endothelial function (21,22). If postprandial glycemia is indeed important,then dietary treat-ment for the prevention or management of chronic diseases mustconsider both the amount and type of carbohydrate consumed.An issue that is still being debated,particularly within theUnited States,is whether the GI has practical applications for theclinical treatment of diabetes and cardiovascular disease. Threeintervention studies in adults and children with type 1 diabetesshowed that low-GI diets improve glycated hemoglobin concen-trations (23–25). In subjects with cardiovascular disease,low-GIdiets were shown to be associated with improvements in insulinsensitivity and blood lipid concentrations (23,26). In addition,evidence from both short-term and long-term studies in animalsand humans indicates that low-GI foods may be useful for weightcontrol. Laboratory studies examining the short-term satiatingeffects of foods have shown that low-GI foods are relatively moresatiating than are their high-GI counterparts (10). Compared withlow-GI meals,high-GI meals induce a greater rise and fall inblood glucose and a greater rise in blood insulin,leading to lowerconcentrations of the body’s 2 main fuels (blood glucose and fattyacids) in the immediate postabsorptive period. The reduced avail-ability of metabolic fuels may act as a signal to stimulate eat-ing (11). It is also important to emphasize that many low-GIfoods are relatively less refined than are their high-GI counter-parts and are more difficult to consume. The lower energy densityand palatability of these foods are important determinants of theirgreater satiating capacity. In obese children,the ad libitum con-sumption of a low-GI diet has been associated with greater reduc-tions in body mass indexes (27). However,some experts haveraised concerns about the difficulties of putting advice about GIvalues into practice and of the potentially adverse effects on foodchoice and fat intake. For this reason,the American DiabetesAssociation does not recommend the use of GI values for dietarycounseling. However,the European Association for the Study of Diabetes (28),the Canadian Diabetes Association (29),and theDietitians Association of Australia (30) all recommend high-fiber,low-GI foods for individuals with diabetes as a means of improv-ing postprandial glycemia and weight control.
For all clinical and research applications,reliable GI valuesare needed. Therefore,the purpose of this revised table is tobring together all the relevant data published between 1981 and2001 (
Table 1
). Unpublished figures from our laboratory andthose from others have also been included when the quality of the data could be verified on the basis of the method used [ie,themethod is in line with the principles advocated by the FAO/WHOExpert Consultation (2)]. In total,the new table contains nearly1300 separate entries,representing >750 different types of foods.This number of foods represents an increase of almost 250%over the number provided when the international tables werefirst published in 1995. As in the original tables,the GI value foreach food (with either glucose or white bread used as the refer-ence food),the type and number of subjects tested,the referencefood and time period used,and the published source of the dataare provided. For many foods there are
2 published values;therefore,the mean (
SEM) GIs were calculated and are listedunderneath the data for the individual foods. Thus,the user canappreciate the variation for any one food and,if possible,use theGI value for the food found in their country. It is hoped that thetable will reduce unnecessary repetition in the testing of individ-ual foods and facilitate wider research and application of the GI.In some cases,the GI values for different varieties of the sametype of food listed in the table indicate the glycemic-loweringeffects of different ingredients and food processing methods (eg,porridges made from rolled grains of different thicknesses andbreads with different proportions of whole grains). This infor-mation could assist food manufacturers to develop a greaterrange of low-GI processed foods.
Many people have raised concerns about the variation in pub-lished GI values for apparently similar foods. This variation mayreflect both methodologic factors and true differences in thephysical and chemical characteristics of the foods. One possibil-ity is that 2 similar foods may have different ingredients or mayhave been processed with a different method,resulting in signi-ficant differences in the rate of carbohydrate digestion and hencethe GI value. Two different brands of the same type of food,suchas a plain cookie,may look and taste almost the same,but dif-ferences in the type of flour used,in the moisture content,and inthe cooking time can result in differences in the degree of starchgelatinization and consequently the GI values. In addition,itmust be remembered that the GI values listed in the table forcommercially available processed foods may change over time if food manufacturers make changes in the ingredients or process-ing methods used.Another reason GI values for apparently similar foods vary isthat different testing methods are used in different parts of theworld. Differences in testing methods include the use of differenttypes of blood samples (capillary or venous),different experimen-tal time periods,and different portions of foods (50 g of totalrather than of available carbohydrate). Recently,7 experienced GItesting laboratories around the world participated in a study todetermine the degree of variation in GI values when the same cen-trally distributed foods were tested according to the laboratories’normal in-house testing procedures (31). The results showed thatthe 5 laboratories that used finger-prick capillary blood samples to6FOSTER-POWELL ET AL
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measure changes in postprandial glycemia obtained similar GIvalues for the same foods and less intersubject variation. Althoughcapillary and venous blood glucose values have been shown to behighly correlated,it appears that capillary blood samples may bepreferable to venous blood samples for reliable GI testing. Afterthe consumption of food,glucose concentrations change to agreater degree in capillary blood samples than in venous bloodsamples. Therefore,capillary blood may be a more relevant indi-cator of the physiologic consequences of high-GI foods.Although it is clear that GI values are generally reproduciblefrom place to place,there are some instances of wide variationfor the same food. Rice,for example,shows a large range of GIvalues,but this variation is due to inherent botanical differencesin rice from country to country rather than to methodologic dif-ferences. Differences in the amylose content could explain muchof the variation in the GI values of rice (and other foods) becauseamylose is digested more slowly than is amylopectin starch (32).GI values for rice cannot be reliably predicted on the basis of thesize of the grain (short or long grain) or the type of cookingmethod. Rice is obviously one type of food that needs to betested brand by brand locally. Carrots are another example of afood with a wide variation in published GI values; the oldeststudy showed a GI of 92
20 and the latest study a GI of 32
5.However,the results of an examination of the SEs (20 comparedwith 5) and the number of subjects tested (5 compared with 8)suggest that the latest value for carrots is more reliable,althoughdifferences in nutrient content and preparation methods con-tributed somewhat to this variation.An important reason GI values for similar foods sometimesvary between laboratories is because of the method used fordetermining the carbohydrate content of the test foods. GI test-ing requires that portions of both the reference foods and testfoods contain the same amount of available carbohydrate,typi-cally 50 or 25 g. The available or glycemic carbohydrate fractionin foods,which is available for absorption in the small intestine,is measured as the sum of starch and sugars and does not includeresistant starch. Most researchers rely on food-compositiontables or food manufacturers’data,whereas others directly meas-ure the starch and sugar contents of the foods.This difference in the accuracy of measurements of the carbo-hydrate content might explain some of the variation in reportedGI values for fruit and potatoes and other vegetables. Food labelsmay or may not include the dietary fiber content of the food inthe total carbohydrate value,leading to confusion that canmarkedly affect GI values,especially those for high-fiber foods.Consequently,researchers should obtain accurate laboratorymeasurements of the available carbohydrate content of foods asan essential preliminary step in GI testing. The available carbo-hydrate portion of test and reference foods should not includeresistant starch,but,in practice,this can be difficult to ensurebecause resistant starch is difficult to measure. There is also dif-ficulty in determining the degree of availability of novel carbo-hydrates,such as sugar alcohols,which are incompletelyabsorbed at relatively high doses.Measuring the rate at which carbohydrates in foods are digestedin vitro has been suggested as a cheaper and less time-consumingmethod for predicting the GI values of foods (33). However,onlya few foods have been subjected to both in vitroandin vivo test-ing,and it is not yet known whether the in vitro method is a reli-able indication of the in vivo postprandial glycemic effects of alltypes of foods. It is possible that some factors that significantlyaffect glycemia in vivo,such as the rate of gastric emptying,willnot change the rate of carbohydrate digestion in vitro. For exam-ple,high osmolality and high acidity or soluble fiber slow downthe gastric emptying rate and reduce glycemia in vivo,but theymay not alter the rate of carbohydrate digestion in vitro. It is dif-ficult to mimic all of the human digestive processes in a testtube. In fact,research results from our laboratory have shownthat GI values measured in vivo can be significantly different forthe same foods measured in vitro. Until we know more about thevalidity of in vitro methods,it is not recommended that they beused in clinical or epidemiologic research applications or forfood labeling purposes because of the potential for large over- orunderestimates of true GI values.
The GI values listed in the revised table represent high-qualitydata published in refereed journals or unpublished values gener-ated by Sydney University’s Glycemic Index Research Service,often as a result of contract research by industry. The foods havebeen described as unambiguously as possible by using descriptivedata about the food given in the original publication. In somecases,descriptive details were extensive,including the species orvariety of plant food,the brand name of the processed food,andthe preparation and cooking methods. In other cases,the onlydescription was a single word (eg,potatoes or apple). If the cook-ing method and cooking time were stated in the original reference,the details are given. The user should bear in mind that countriesoften have different names for the same food product or,alterna-tively,the same name for different items. For example,Kellogg’sSpecial K breakfast cereal is a very different product in NorthAmerica (Kellogg Canada Inc) than in Australia (Kellogg,Sydney,Australia),each of which has a different GI value. Similarly,foodnames may mean different things in different countries. For exam-ple,
have different meanings in NorthAmerica and in Europe. The terms used in the revised table havebeen selected to be as internationally relevant as possible.Some research laboratories continue to use white bread as thereference food for measuring GI values,whereas others use glu-cose (dextrose); therefore,2 GI values are given for each food.The first value is the GI with glucose as the reference food (GIvalue for glucose=100; GI value for white bread=70),and thesecond value is the GI for the same food with white bread as thereference food (GI value for white bread=100; GI value for glu-cose=143). When bread was the reference food used in the orig-inal study,the GI value for the food was multiplied by 0.7 toobtain the GI value with glucose as the reference food. The tablelists the reference food that was originally used to measure theGI value of each food.The foods in the table are separated into the following foodgroups:bakery products,beverages,breads,breakfast cereals andrelated products,breakfast cereal bars,cereal grains,cookies,crackers,dairy products and alternatives,fruit and fruit products,infant formula and weaning foods,legumes and nuts,meal-replacement products,mixed meals and convenience foods,nutritional-support products,pasta and noodles,snack foods andconfectionery,sports bars,soups,sugars and sugar alcohols,veg-etables (including roots and tubers),and indigenous or tradi-tional foods of different ethnic groups. Within each section,foodsare arranged in alphabetical order by common name. This classi-fication of the foods was made on a practical rather than a sci-INTERNATIONAL TABLE OF GLYCEMIC INDEX AND LOAD7
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