Glycemic load and hunger control -
Low-density lipoprotein LDL cholesterol levels were calculated using the Friedewald calculation. A dietitian entered the data into a customized database that incorporated the Australian food composition tables and published GI values 17 using the glucose equals scale FoodWorks Professional ; Xyris Software, Brisbane, Australia.
Additional GI data were obtained from an online database www. The study was approved by the human ethics committee of the University of Sydney, Sydney, Australia, and subjects gave written, informed consent. The primary end points were mean absolute change from baseline in body weight and fat mass at week Univariate and repeated-measures analyses of variance were used to assess the changes in weight, body composition, and blood parameters.
Changes were assessed with and without adjustment for baseline differences. Missing data were replaced with the last known value for the primary intention-to-treat analysis and excluded in the secondary analysis. A commercially available software package SPSS Version In the primary intention-to-treat analysis, all 4 diets resulted in weight reduction over 12 weeks mean change, 4.
The pattern of findings changes in weight, waist circumference, fat mass, and lean mass was unchanged in the secondary sensitivity analysis, from which subjects who had not completed the study were excluded data not shown.
In both the primary intention-to-treat analysis Table 5 and Figure 3 and the secondary sensitivity analysis data not shown , there was no differential effect of diet composition on the levels of HDL cholesterol, TG, free fatty acids, and C-reactive protein; total HDL cholesterol ratio; or glucose homeostasis.
Hence, lowering the GI resulted in a larger decrease in leptin levels when the CHO intake was high, whereas the reverse was true when the CHO intake was lower. The analysis of the food diaries showed that all 4 groups achieved their intended CHO and protein distributions Table 2.
Accordingly, the high-CHO groups ate less of each type of fat, although the ratio of saturated to unsaturated fatty acids approximately 0.
Postprandial glucose and insulin concentrations fluctuated throughout the day as predicted by the calculated GI and GL of the meals Figure 5. The findings of this study suggest that postprandial glycemia and dietary GL may be unrecognized determinants of the effectiveness of energy-restricted diets.
The conventional diet diet 1 was associated with the highest level of postprandial glycemia as well as with the slowest rate of weight loss. The low-GI, high-CHO diet diet 2 , however, produced the best clinical outcomes, reducing both fat mass and LDL cholesterol levels.
The diet 2 group achieved a higher fiber intake than the other groups approximately 7 g more , which may partly account for the favorable result. Soluble fibers intrinsic to legumes and low-GI whole grains but not to high-GI whole grains bind dietary cholesterol 20 and may be critical in the context of a high-protein diet.
Our study suggests that dietary GL may be more relevant to women than to men. Women generally lose weight more slowly and display differences in postprandial glucose and fat oxidation, which might influence the rate of fat loss. In the total group, however, there was no support for the hypothesis that the lowest GL diet 4 would be associated with the best outcomes.
Alternately, genetic or metabolic predisposition may need to be taken into account to determine the effectiveness of one diet over another. The strengths of the study include the study design, number of diets compared simultaneously, large sample size, high continuation rate, high compliance rate, provision of key foods, and detailed and repeated ascertainment of dietary measurements.
A particular strength was extensive knowledge of the GI of individual Australian foods. A further strength was that the subjects were free-living young adults who represent an important target for early intervention.
The study has limitations. Diet goals for energy distribution were not met exactly. We cannot discount the effect of these differences on study outcomes. A week period provides no information about the sustainability or long-term effects of the diets on cardiovascular function, exercise tolerance, renal function, or bone health.
In conclusion, at least in the short term, our findings suggest that dietary GL, and not just overall energy intake, influences weight loss and postprandial glycemia. Moderate reductions in GL appear to increase the rate of body fat loss, particularly in women.
Diets based on low-GI whole grain products in lieu of whole grains with a high GI maximize cardiovascular risk reduction, particularly if protein intake is high. Reassuringly, this advice can optimize clinical outcomes within current nutrition guidelines, without the concerns that apply to low-CHO diets.
Multicenter studies to evaluate weight reduction, weight maintenance, and long-term outcomes, particularly in individuals with established risk factors, are clearly warranted.
Correspondence: Jennie Brand-Miller, PhD, Human Nutrition Unit G08 , University of Sydney, Sydney, New South Wales, Australia j. brandmiller mmb. Author Contributions: Ms McMillan-Price and Drs Petocz and Brand-Miller had full access to all the data and take responsibility for the integrity and accuracy of the data analysis.
Role of the Sponsors: The funding bodies did not participate in the study design; the collection, analysis, or interpretation of the data; the writing of the manuscript; or the decision to submit the article for publication.
Acknowledgment: We thank Stephan Jacob, MD, Abdullah Omari, MD, Paul Nestel, MD, and John Miller, PhD, for comments on the manuscript and Zia Ahmed, MAppSc, for technical assistance. full text icon Full Text. Download PDF Top of Article Abstract Methods Results Comment Article Information References.
Figure 1. View Large Download. Table 1. Representative Menu for the 4 Diets Consumed on the Hour Profile Daya. Liu SWillett WCManson JEHu FBRosner BColditz G Relation between changes in intakes of dietary fiber and grain products and changes in weight and development of obesity among middle-aged women.
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The Neurovisceral Integration Model 16 posits that trait i. Brain regions of the CAN comprise those related to executive function and inhibition such as the PFC which exert inhibitory control on subcortical structures and the peripheral nervous system via the vagus nerve Recent neuroimaging studies have begun to investigate the neural underpinnings of disinhibited eating and find structural and functional changes within the CAN 12 , Taken together with the present findings it is plausible that disinhibited eaters have reduced vagal tone due to reduced activation of the PFC, although studies in disinhibited eaters combining fMRI and HRV are needed to confirm this hypothesis.
A second important finding was that those high in disinhibited eating experienced greater glucose excursions during the PPP after the high GL Fig. In line with previous research 21 , 25 , 26 these changes in BG were negatively related to vagal tone.
There are a number of possible explanations for why changes in blood glucose might be attributable to the ameliorated parasympathetic tone in disinhibited eaters. Firstly, the vagus nerve plays a major role in the inflammatory reflex: a neural reflex mechanism in which afferent vagus signalling activated by cytokines or pathogen-derived products is associated with efferent vagal output regulating cytokine production and inflammation For example, a recent study found that vagus nerve-stimulation VNS in epilepsy patients inhibits peripheral blood production of TNF, IL-1β, and IL-6 Given that inflammatory processes are thought increase allostatic load 28 and play a role in the aetiology of insulin resistance 29 , it is possible that chronically reduced vagal tone in disinhibited eaters may predispose towards insulin resistance.
The pattern of changes in BG following the high GL in disinhibited eaters would be consistent with the view that they had mild insulin resistance. Following a glucose load insulin secretion occurs in a biphasic pattern; the first phase, a rapid release that last only a few minutes, is followed by a steady sustained release second phase Loss of first phase glucose stimulated insulin release is found in the early stage of insulin resistance, while the second phase is reduced as diabetes develops 30 , 31 , The steep rise, followed by a sharp fall in BG Fig.
Notably, vagal efferent innervation of the pancreas contributes to early-phase insulin release as well as to optimizing postprandial insulin release For instance, electrical stimulation of the vagus nerve elicits insulin secretion in different species 34 , Conversely, atropine that blocks vagal action, significantly reduces basal and stimulated levels of insulin in rats 36 , primates 37 and humans In addition, crosstalk between the brain and the liver via the vagus nerve contributes significantly to BG regulation.
Vagal activation at the level of the liver inhibits enzymes involved in gluconeogenesis and activates enzymes promoting glycogen synthesis.
For instance, atropine or severance of the vagus nerve results in an increase in hepatic glucose production In return, vagal afferents in the hepatic portal contain glucagon-like peptide-1 receptors GLP-1r that convey information about peripheral glucose status back to the brain.
Taken together with the present findings it is plausible that disinhibited eaters, by virtue of reduced vagal tone, may be predisposed to inadequate BG regulation following a high GL. However, as we did not directly manipulate vagal tone causality cannot be determined.
Recently, Huang et al. A similar approach might prove fruitful in future studies examining the association between disinhibited eating, vagal activity and BG regulation. An important consideration in the present study was the contribution of habitual dietary habits. Disinhibited eaters are more likely to choose high-fat and high-salt foods, processed meat, sweet fruits and vegetables, and sweet, carbonated drinks 41 , and to report a higher intake of sweet foods, ice cream, butter and coffee This suggests that a less healthy food choice could contribute to the altered vagal tone and glucose metabolism that was observed in disinhibited eaters.
Indeed it is possible that vagal afferent signalling is altered in response to a high fat diet, even before the onset of obesity 43 , In the present study consuming a less healthy diet was associated with poorer BG regulation and reduced vagal tone, however, it did not fully account for their association with disinhibition.
This suggests that disinhibited eaters have a pre-existing disposition towards impaired vagal tone and glucose intolerance; an effect that may then be exacerbated by a poor diet. Finally, a low GL did not reduce hunger during the late postprandial period in disinhibited eaters but did in those low in disinhibition Fig.
From a homeostatic viewpoint, maintaining a stable postprandial BG level should reduce hunger and meal frequency, and thus improve weight control 6 , however this homeostatic process is often negated by the hedonic desire for food reward 9.
The interaction between these two systems is appreciated by research examining the effects of homeostatic hormones, such as insulin and leptin, on brain regions mediating the rewarding nature of food Recently, the FDA approved a technique of vagal blocking VBLOCK as a weight-loss treatment device in obesity.
However, clinical trials have yielded contradictory results 49 , 50 , 51 , In the present study we found that disinhibition was not only associated with decreased vagal tone but also an increase, rather than a decrease, in hunger during the early PPP. Based on this information we speculate that disinhibited eaters might have reduced interoceptive sensitivity leading them to rely on exteroceptive signals in order to regulate their eating behavior.
The limitations of the present study should be considered. Firstly, as a range of factors such as heart disease and medication might influence HRV, a young healthy sample was chosen for the present study: this approach, however, does limit the generalizability of the results.
Secondly, although posteriori mathematical modelling will test if the data structure is compatible with causation, it is not a proof of causation. As such future research should directly manipulate vagal tone and monitor effects.
In conclusion, we report that following a high GL disinhibited eaters have a greater glycemic response than their less inhibited counterparts. This response remained even after controlling for BMI and habitual diet; therefore, it can be viewed as an enduring individual difference that predisposes disinhibited eaters to an unfavourable postprandial environment and a range of negative health consequences.
Disinhibited eaters were characterised by reduced vagal tone HRV ; an effect associated with larger glycemic excursions in these subjects. Disinhibition also moderated the effect of glycemia on subsequent hunger; that is they appear to be less sensitive to interoceptive signals.
The moderating influence of disinhibition might shed light on the debate surrounding the efficacy of low GL diets for increasing satiety and reducing obesity 6 , 7 , 8. Future research examining the effects of GL should seek to understand its interaction with psychological factors.
Sixty six females between 18 and 29 years of age were recruited for this study and took part between the months of September and December BMI ranged from Participants were instructed to refrain from drinking alcohol and taking part in any physical activity within twenty four hours of the study and abstain from consuming any food and drink for at least twelve hours before attending the laboratory.
As this was the first study to consider the metabolic and appetite response to GL in disinhibited eaters, power analysis was not feasible. However the sample size was based on similar work that has been conducted in restrained eaters Upon entry into the laboratory, after providing their informed consent, the participants completed the disinhibition scale of the Three Factor Eating Questionnaire 54 , a food frequency questionnaire FFQ and reported their level of hunger.
Participants then had their height, weight and fasting BG measured before baseline R-R interval measurements were recorded while they rested quietly for five minutes. The random sequence was computer generated by HY who produced the solutions in sequentially numbered tumblers. Participants were allocated by HW in the order they were recruited.
The subjects and HW who met the subjects was blind as to the nature of the meals consumed. At baseline the groups were well matched for ratings of hunger, heart rate variability, fasting blood glucose, disinhibition, habitual diet and BMI Table 2.
Participants were given five minutes to consume the entire beverage following which they relaxed either reading of watching TV for thirty minutes before they again rated their hunger and a BG measurement was taken.
Over the next one hundred and twenty minutes BG measurements were taken every thirty minutes while participants relaxed. After a total of one hundred and fifty minutes a final BG measurement was taken and hunger reported.
The procedure was approved by Swansea University ethics committee All participants completed the study. The sugar free beverage was sweetened with sucralose to produce a similar sweetness to the other drinks.
The glucose and isomaltulose drinks were designed to be identical in terms of macro-nutrients and appearance but produce a different GL The glucose, isomaltulose and water drinks provided the following GLs respectively: 75, 24 and 0.
The tendency towards disinhibited eating was measured using the 16 item disinhibition subscale of the three factor eating questionnaire The European Prospective Investigation into Cancer and Nutrition Norfolk Food Frequency Questionnaire EPIC-Norfolk FFQ Mulligan et al.
Bingham, et al. It has also been validated against nutrient biomarkers FETA software was then used to further process the data. FETA uses UK based food composition databases to produce nutrient data as well as basic food groups Likewise, the skim milk fraction of whole milk counts toward the dairy constituent, but the butterfat in whole milk counts toward calories from solid fat.
From these food groups a modified version of the alternate healthy eating index AHEI score 59 was created by taking the sum of 7 component scores [1: fruit; 2: vegetable; 3: ratio of white meat seafood and poultry to red meat; 4: ratio of polyunsaturated fatty acids PUFA to saturated fatty acids9 SFA ; 5: total fiber; 6: nuts and seeds; and 7: multivitamin use].
The score ranged between 2. This approach was chosen to maintain consistency with other large UK based cohort studies that have examined the influence of dietary patterns on mental and physical health 60 and previous studies by the current authors.
Height was measured using a portable stadiometer. Blood glucose was monitored from finger pricks using an ExacTech sensor Medisense Britain Limited that using an enzymic method, coupled with microelectronic measurement, which has been shown to be accurate As an index of vagal tone heart rate variability was calculated from a R-R interval time series.
Participants were fitted with a RS Polar heart rate monitor electrode transmitter belt T61 using conductive gel as recommended by the manufacturer. This instrument has been previously validated for the accurate measurement of R-R intervals and for analysing Heart Rate Variability HRV Participants were seated comfortably and asked to relax for five minutes while the HR time series was recorded.
R-R interval data were analysed using Kubios HRV Analysis Software 2. Data were visually inspected for artefacts caused by ectopic beats, poor conductivity etc.
A very low correction threshold was chosen for artefact correction 0. Spectral analysis was conducted to transform the time series into the frequency domain.
Average spectral power was estimated within the high frequency HFpow 0. As it has previously been reported that nonlinear complexity indices capture additional information 64 sample entropy SampEn was also calculated.
Entropy refers to system randomness, regularity and predictability and allows systems to be quantified by the amount of information within the signal. A lower value of SampEn also indicates more regularity in the time series.
The computation of sample entropy depends on two parameters; the embedding dimension m and the tolerance r. See Young and Benton 64 for formulae for calculating sample entropy and for a graphical representation. The average R-R interval was calculated as a measure of basic heart rate. To determine the influence of disinhibited eating on the postprandial response to GL and to establish the consequences for subsequent hunger, moderated mediation analysis was conducted using Hayes PROCESS macro for SPSS model 59 This macro uses bootstrapped sampling to estimate the indirect mediation effect.
In the present analysis bootstrapped samples were drawn with replacement from the dataset to estimate a sampling distribution for the indirect mediation pathway. The total effect of X on Y denoted by c in Fig.
A hierarchical regression was conducted to determine the association between HRV indices and disinhibited eating after controlling for BMI: step one controlled for BMI and step two included the average RR interval, HFpow and SampEn. This did not affect the outcome of any analysis and as such no cases were excluded.
How to cite this article : Young, H. and Watkins, H. Eating disinhibition and vagal tone moderate the postprandial response to glycemic load: a randomised controlled trial.
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This hungeer assesses the feasibility of using glycemic index GI Weight loss tips Fasting window and meal timing predictor of conrol, Healthy fats for sports performance and satiety by surveying Glycemic load and hunger control Glycemoc intervention ckntrol. Ingestion of high-GI Glucemic increased hunger and lowered satiety in short-term human Glyceimc studies. This effect may be attributed to the rapid decline in conttol glucose level following a hyperinsulinemic response caused by a sharp and transient increase in blood glucose level that occurs after the ingestion of high-GI food, which is defined as the glucostatic theory. However, appetite, hunger and satiety after the ingestion of foods with varying GI were inconsistent among long-term human intervention studies. From the few relevant long-term studies available, we selected two recent well-designed examples for analysis, but they failed to elicit clear differences in glycemic and insulinemic responses between high- and low-GI meals consisting of a combination of different foods or key carbohydrate-rich foods incorporated into habitual diets. Nutrition Glycemic load and hunger control volume 9 contdol, Article number: 53 Cite this article. Metrics cintrol. Glycemic load GL is the product of glycemic index of Stress relief for students food hungre amount of Healthy fats for sports performance carbohydrate in that food divided by GL represents quality and quantity of dietary carbohydrate. Little is known about the role of GL in hunger, satiety, and food intake in preschool children. The aim of this study was to investigate the effect of two breakfast meals differing in GL on hunger, satiety, and subsequent food intake at lunch in preschool children aged y.
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