Glycemic response and health - A systematic review and meta-analysis: The database, study characteristics, and macronutrient intakes

Abstract

Background: Reduction of dietary glycemic response has been proposed as a means of reducing the risk of diabetes and coronary heart disease. Its role in health maintenance and management, alongside unavailable carbohydrate (eg, fiber), is incompletely understood. Objective: We aimed to assess the evidence relating the glycemic impact of foods to a role in health maintenance and management of disease. Design: We searched the literature for relevant controlled dietary intervention trials on glycemic index (GI) according to inclusion and exclusion criteria, extracted the data to a database, and synthesized the evidence via meta-analyses and meta-regression models. Results: Among literature to January 2005, 45 relevant publications were identified involving 972 subjects with good health or metabolic disease. With small reductions in GI (<10 units), increases in available carbohydrate, energy, and protein intakes were found in all studies combined. Falling trends in energy, available carbohydrate, and protein intakes then occurred with progressive reductions in GI. Fat intake was essentially unchanged. Unavailable carbohydrate intake was generally higher for intervention diets but showed no trend with GI (falling or rising). Among studies reporting on GI, variation in glycemic load was approximately equally explained by variation in GI and variation in available carbohydrate intake. An exchange of available and unavailable carbohydrate (≈1 g/g) was evident in these studies. Conclusions: Among GI studies, observed reductions in glycemic load are most often not solely due to substitution of high for low glycemic carbohydrate foods. Available carbohydrate intake is a confounding factor. The role of unavailable carbohydrate remains to be accounted for. © 2008 American Society for Nutrition.