BEYONDGLYCEMICINDEX: NEWFOODINSULININDEX

LauraSampsonKent* MaryFranz* JennieBrandMiller** WalterWillett*

*DepartmentofNutrition,HarvardSchoolofPublicHealth **UniversityofSydney Acknowledgement: This research was funded by grant CA55075, National Cancer Institute, National Institutes of Health.

RELEVANCEOFINSULINSECRETION
Preventionandmanagementofweightgain Hyperlipidemia Noninsulindependentdiabetesmellitus(NIDDM) Longtermexposuretohighinsulinconcentrations maybeassociatedwithincreasedriskofcancer y

WHATISFOODINSULININDEX(FII)? WHAT IS FOOD INSULIN INDEX (FII)?

Directlyquantifiesthepostprandialinsulin Directly quantifies the postprandial insulin responsetoanisoenergeticportionofa testfoodincomparisontoareference test food in comparison to a reference food Allowstestingoffoodswithnoorlow Allows testing of foods with no or low carbohydratecontent FIIhasbeenshowntopredicttherelative h b h d h l insulindemandevokedbymixedmeals

FOODINSULININDEX(FII) FOOD INSULIN INDEX (FII)

Measures blood insulin response to a food Measuresbloodinsulinresponsetoafood comparedtoareferencefoodglucose(FII=100) Measuresincrementalinsulinareaunderthe curve(AUC)overtwohoursinresponseto curve (AUC) over two hours in response to consumptionofa1000kJportionofthetest fooddividedbytheAUCafteringestionofa food divided by the AUC after ingestion of a 1000kJportionofthereferencefood

HowisFIIDifferentfromGlycemicIndex? How is FII Different from Glycemic Index?

FOODINSULININDEX FOOD INSULIN INDEX Measurespostprandial increaseininsulin secretion ofawhole food Dependenton d carbohydrate,quantityand q qualityofproteinandfat y p andtheirinteractions GLYCEMICINDEX GLYCEMIC INDEX Measureseffectof carbohydratecontaining foodsonpostprandial increaseinbloodglucose levels levels GIisnotalways proportionaltotheinsulin response

METHODS
APPROXIMATELY 100 FOODS AND 16 CEREALS APPROXIMATELY100FOODSAND16CEREALS WEREANALYZEDUSINGGLUCOSEASTHE REFERENCEFOOD 407FOODS,147MARGARINES,58OILS,111 CEREALSWEREIMPUTEDUSINGVARIOUS ALGORITHMS 166FOODSAND89CEREALSWERERECIPE DERIVED 44FOODSWEREASSUMEDTOBE0

FOODSSENTTOUNIVERSITYOFSYDNEY FOODS SENT TO UNIVERSITY OF SYDNEY

MUFFINMIXES READYMADE READY MADE SWEETROLL

SunMaidhoneyraisin branmuffinmix D DuncanHinesblueberry Hi bl b muffinmix Kr stea fat free Krusteazfatfree blueberrymuffinmix Entenmann cinnamon Entenmanncinnamon buns

CakeMix Cake Mix PancakeMix Cookies

BettyCrockergoldencakew/ BettyCrockerchocfrosting AuntJemimapancakemix ChipsAhoyregularchocolatechip Chips Ahoy reduced fat chocolate ChipsAhoyreducedfatchocolate chip Archwayfatfreeoatmealraisin CapeCodreducedfatpotato chips Snickerscandybars Hersheycandybars y y

Chips p CandyBars

U.S.AnalyzedCereals U.S. Analyzed Cereals CEREALS

Cheerios ShreddedWheat CornFlakes Quaker100%Natural CracklinOatBran LuckyCharms L k Ch FrostedFlakes GreatGrains Great Grains HoneyBunchesofOats Wheaties

MatchingU.S.FoodsPurchasedinSydney
Dairy
Creamcheese Lowfatcheddarcheese Lowfatprocessedcheese Lowfatcottagecheese Lowfaticecream Sherbet 1%milk Butter

Meat,fish,mixeddishes
Tacos Lasagna Roastchicken Shrimp Tofu Tunainoil Tuna in oil Bacon

Fruitsorfruitdrinks F it f it d i k
Peachescannedinjuice Peachescannedinsyrup Orangejuice g j Prunes Punch

Miscellaneousitems
Oliveoil Navybeans Raspberryjam Pretzels Walnuts Corntortillas Jatzcrackers(similartoRitz)

Cereals
Kashi7grainpuffs K hi i ff RiceBubbles

Recipe derivedFIIValues Recipederived FII Values

Usedanalyzedfoodsasingredients Usedingredientsthatwereimputedfrom analyzedfoods. y Example:applebutterFII=52 Derivedfromrecipeusingapple,a.j.,and df l d sugarasingredients(allanalyzedfoods)

IMPUTEDORCALCULATEDFIIVALUES IMPUTED OR CALCULATED FII VALUES

FOODS Cerealgrains,bakedgoods, sweetsandsnackfoods, beverages,fruits,anddairy beverages fruits and dairy CALCULATION Similaranalyzedfoodsanda carb/1000kjadjustment carb/1000kjimputedfood xFII carb/1000kjanalyzedfood Breakfastcereals Usedanalyzedcerealsadjustingfor carbohydrate/amount Directlyfromsimilaranalyzedfoods

Meats,fish,andpoultry

IMPUTEDFIIVEGETABLEVALUES IMPUTED FII VEGETABLE VALUES

VEGETABLES NONSTARCHY CALCULATIONS Recipefromavocadousingan h2oratio Recipefrompotatoesor carrotsusingfiberratios carrots using fiber ratios Recipefrombeansusingan fiberratio

STARCHY

PEASandLIMABEANS

FIIPUBLICATIONS FII PUBLICATIONS

Bao J,deJong V,AtkinsonF,Petocz P,BrandMiller , g , , , JC.Foodinsulinindex:physiologicbasisfor predictinginsulindemandevokedbycomposite meals.AmJClin meals Am J Clin Nutr 2009;90:986 992 2009;90:986992.
HoltSH,MillerJC,&Petocz P.Aninsulinindexoffoods: Holt SH Miller JC & Petocz P An insulin index of foods: theinsulindemandgeneratedby1000kJportionsof commonfoods.AmJClin Nutr,66:126467;1997.

RESULTSofthemixedmealstudy:
A
500 Insulin (pmol/L) 400 300 200 100 0 0 15 30 45 60 90 120 Tim e (m in)

Group 1

M1 M2 M3 M4 M5 M6 White Bread

B
500 400 300 200 100 0 0 15

Group 2

M7 M8 M9 M10 M11 M12 M13 White Bread

30

45

60

90

120

Tim e (m in)

Bao J et al. Am J Clin Nutr 2009;90:986-992.

RESULTS:Correlations
A
Obse rved insulin respons se (Rela tive white bread =10 0)

140 r = 0.78, P = 0.0016 120 100 80 60 40 20 0 0 20 40 60 80 100 120 Insulin demand predicted by Food Insulin Index

RESULTS:Correlations
B
Observe insulin response ed n e (Relativ white br ve read =100) ) 140 r = 0.53, P = 0.064 120 100 80 60 40 20 0 0 20 40 60 80 100 Available ca bo yd ate co te t (g) a ab e carbohydrate content

HighestversusLowestFIIValues Highest versus Lowest FII Values

Highest analyzed FII HighestanalyzedFII JellyBeans(120) Pancakes(112) Pancakes (112) HoneydewMelon(95) Potatoes(90) Potatoes (90) BreakfastCereals(70113) Lowest analyzed FII LowestanalyzedFII OliveOil(3) Avocado(5) Avocado (5) Walnuts(6) Tuna(16) Tuna (16) Chicken(20)

MEANANALYZEDVSMEANIMPUTEDFIIDATA
100 90 80 70 60 50 40 30 20 10 0
ES IR Y N FR UI T S TS SW EE GU M PR OT FO RE AL S DA OD EI

NU TS & LE

KF AS T CE

CH Y

ST

AR

ANALYZED IMPUTED

BR EA

LIMITATIONS
AlthoughimputedFIIdataaresimilarto Although imputed FII data are similar to analyzeddata,algorithmsusedforimputing FIIhavenotbeenvalidated. FIIvariabilitywithinsomefoodgroups FII variability within some food groups complicatestheassignmentofimputed values.Forexample,analyzedFIIfordairy foodsrangefrom18forcreamcheeseto86 forfruitedyogurt.

CONCLUSION
Mostvegetablesproducenegligibleinsulinresponse, g p g g p , asmeasuredbyFII. Evenfats,andproteinsourcesproducelargely variableinsulinresponses,asmeasuredbyFII. ImputedFIIvaluestrackcloselytoanalyzedvalues. Refinedcereals,sweets,andpotatoesproducethe greatestinsulinresponse,asmeasuredbyFII.

DERIVEDINSULINLOAD DERIVED INSULIN LOAD

InsulinLoad,Glucose=(calories*FII)/100 th i di id l theindividualaverageinsulinogenicload i li i l d (IL)duringthepastyearwasestimated fromFFQsbymultiplyingtheFIIofeach f FFQ b lti l i th FII f h foodbyitsenergycontentandthe consumptionfrequencyandsumming ti f d i overallreportedfooditems.

DIETARYINSULIN INDEX,DII DIETARY INSULIN INDEX DII

TheaveragedietaryDIIwas calculatedbydividingthe averageInsulinLoad,IL,bythe I li L d IL b th totaldailyenergyintake. total daily energy intake

RESULTSFROMCOHORTSTUDIES RESULTS FROM COHORT STUDIES

MEN WOMEN

Median IL was 840 MedianILwas840 Median IL was 677 MedianILwas677 MedianDIIwas41.7 MedianDIIwas42.7

TOP8FOODSCONTRIBUTINGTOIL TOP 8 FOODS CONTRIBUTING TO IL

MEN WOMEN

ColdCereal(6.1%) Potatoes(5.7%) Potatoes (5 7%) DarkBread(4.4%) SkimmedMilk(3.2%) Skimmed Milk (3 2%) Bananas(3.2%) EnglishMuffin(3.1%) English Muffin (3 1%) WhiteBread(2.9%) OrangeJuice(2.8%) Orange Juice (2.8%)

MashedPotatoes(6.2%) SkimmedMilk(5.7%) Skimmed Milk (5 7%) ColdCereal(5.3%) DarkBread(4.6%) D k B d (4 6%) Beef(3.6%) Yogurt(3.3%) Y (3 3%) WhiteBread(3.1%) EnglishMuffin(2.7%)

TOP4FFQITEMSexplainingtheinter individualvariationofinsulinload d d l f l l d MEN 49% LIQUOR COLDCEREAL BEER WINE WOMEN 45% LIQUOR WINE YOGURT YOGURT COLDCEREAL

COHORTSTUDYRESULTS COHORT STUDY RESULTS

Inmultivariateadjustedregressionmodels,dietaryIIandILwerenot significantlyassociatedwithplasmaCpeptide. i ifi tl i t d ith l C tid ParticipantsinthehighestquintileofbothIIandILhad26%higher triacylglycerolconcentrationsthanparticipantsinthelowest triacylglycerol concentrations than participants in the lowest quintile(ptrend <0.0001). ThepositiveassociationbetweenIIandILandplasmatriacylglycerol The positive association between II and IL and plasma triacylglycerol wasstrongestinobese(BMI30kg/m2)participants(difference highestversuslowestquintileinII=72%,ptrend=0.01). AninverseassociationbetweenDIIandHDLcholesterolwasobserved amongobeseparticipants(difference=22%,ptrend=0.01forII). DIIandILwerenotassociatedwithLDLcholesterol,CRPorIL6.

CONCLUSION
DII and IL were not associated with markers of glycemic control at least in the fasting control, state, but may be physiologically relevant to plasma lipids especially in the obese lipids, obese.