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AUC = Area Under the Curve
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ABSTRACT The aim of this study was to systematically
compare postprandial insulin responses to isoenergetic 1000-U
(240-kcal) portions of several common foods. Correlations with
nutrient content were determined. Thirty-eight foods separated into
six food categories (fruit, bakery products, snacks, carbohydrate
rich foods, protein-rich foods, and breakfast cereals) were fed to
groups of 11—13healthy subjects. Finger-prick blood samples were
obtained every 15 mm over 120 mm. An insulin score was calcu
lated from the area under the insulin response curve for each food
with use of white bread as the reference food (score = 100%).
Significant differences in insulin score were found both within and
among the food categories and also among foods containing a
similar amount of carbohydrate. Overall, glucose and insulin
scores were highly correlated (r = 0.70, P < 0.001, n = 38).
However, protein-rich foods and bakery products (rich in fat and
refined carbohydrate) elicited insulin responses that were dispro
portionately higher than their glycemic responses. Total carbohy
drate (r = 0.39, P < 0.05, n = 36) and sugar (r = 0.36, P < 0.05,
n = 36) contents were positively related to the mean insulin scores,
whereas fat (r —¿0.27,NS, n 36) and protein (r —¿0.24,NS,
n = 38) contents were negatively related. Consideration of insulin
scores may be relevant to the dietary management and pathogen
esis of non-insulin-dependent diabetes mellitus and hyperlipidemia
and may help increase the accuracy of estimating preprandial
insulin requirements. Am J Clin Nutr l997;66:l264—76.
KEY WORDS Insulin, glycemic index, NIDDM, non
insulin-dependent diabetes meffitus, diabetic diet, hyperlipid
emia, carbohydrate, insulin score, glucose score, area under the
curve, humans
The insulinemic effects of foods may be relevant to the
treatment and prevention of weight gain, non-insulin-depen
dent diabetes mellitus (NIDDM), and associated complications.
Recent studies have shown that carbohydrate-rich diets, which
result in high postprandial glucose and insulin responses, are
associated with undesirable lipid profiles (1, 2), greater body
fat (3—5),and the development of insulin resistance in rats (6)
and humans (7, 8). Both obesity and NJDDM are associated
with varying degrees of insulin resistance and fasting hyperin
sulinemia. Prolonged or high degrees of postprandial insuline
mia are thought to contribute to the development of insulin
resistance and associated diseases (9—17).Therefore, the clas
sification of the relative insulinemic effects of different foods
is of both theoretical and practical significance.
Postprandial blood glucose responses have been the focus of
much research because of their importance for glycemic con
trol in patients with diabetes. It is now well accepted that
different foods containing equal amounts of carbohydrate can
produce a wide range of blood glucose responses. The glyce
mic index (GI) method was developed to rank foods according
to the extent to which they increase blood glucose concentra
tions (18). Tables of GI values of common carbohydrate
containing foods are a useful guide to help people with diabetes
choose foods that produce smaller glycemic responses. How
ever, the GI concept does not consider concurrent insulin
responses and few studies have reported GI values and their
accompanying insulin responses.
The extent to which different dietary factors affect post
prandial insulinemia has not been well researched because
insulin secretion is largely assumed to be proportional to
postprandial glycemia. Furthermore, hyperglycemia is
thought to be more relevant to the secondary complications
of NIDDM because the abnormal insulin secretion or action
in people with diabetes is controlled with exogenous insulin
or medications that counteract insulin resistance. However,
knowledge of factors that influence both postprandial gly
cemia and insulin secretion in nondiabetic persons is re
quired to devise treatment strategies that will completely
normalize meal-related glycemia (19).
To explore the importance of dietary habits and postprandial
insulinemia in the etiology and treatment of NIDDM, we need
to be able to systematically rate insulin responses to common
foods. If we are to compare insulin responses to foods, what is
the best basis of comparison? Should we compare insulin
responses to portions of food representing a normal serving
size, portions containing an equal amount of carbohydrate, or
portions containing an equal amount of energy? 01 tables
represent the glycemic effects of equal-carbohydrate portions
I From the Human Nutrition Unit, Department of Biochemistry, The
University of Sydney; and the School of Mathematical Sciences, The
University of Technology, Sydney, Australia.
2 Supported by research grants from The University of Sydney and
Kellogg's Australia Pty Ltd.
3 Address reprint requests to JC Brand Miller, Human Nutrition Unit,
Department of Biochemistry 008, The University of Sydney, NSW 2006,
Received November 21, 1996.
Accepted for publication May 22, 1997.
Am J Clin Nutr 1997;66:1264—76.Printed in USA. ©1997 American Society for Clinical Nutrition
An insulinindexof foods:the insulindemandgeneratedby
1000-kJ portions of common foods13
Susanne HA Holt, Janette C Brand Miller, and Peter Petocz
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