title: Glycemic index and glycemic load used in combination to characterize metabolic responses of mixed meals in healthy lean young adults.
abstract: BACKGROUND
  Glycemic index (GI) and glycemic load (GL) have been independently assessed with regard to their metabolic effects and their associations with disease risk. Because a low-GI high-carbohydrate and a high-GI low-carbohydrate food/meal can produce the same GL, we propose that these 2 concepts should be used in conjunction to characterize the carbohydrate quality of mixed meals.
  
  
  OBJECTIVE
  The aim of this study was to measure postprandial glucose, insulin, and cortisol responses of meals differing in both GI and GL over a period of 3 hours (every 15 minutes for the first hour, and every 30 minutes subsequently), and to investigate the validity of methods of calculating GI and GL by measuring the cumulative incremental area under the curve (iAUC) for glucose and insulin (0-2 hours and 2-3 hours postprandially).
  
  
  METHODS
  A total of 10 healthy lean young adults (5 males, 5 females) participated. Breakfast meals were designed to differ in terms of GI and GL based on a 2 × 2 grid with a single elaboration: low-GI high-GL (M1); high-GI high-GL (M2a) of similar GL to M1; high-GI high-GL (M2b) of similar macronutrient composition to M1 (the elaboration); low-GI low-GL (M3); and high-GI low-GL (M4). The 5 breakfast meals were administered in a double-blind randomized crossover design. Repeated measures analysis of variance was performed to investigate differences in metabolic response between low- versus high-GI and between low- versus high-GL breakfast meals (and GI × GL interactions), with GI and GL used as within-subject factors.
  
  
  RESULTS
  High-GL meals increased glucose iAUC and insulin iAUC in both immediate (0-2 hours) (p < 0.01, p < 0.001, respectively) and middle postabsorptive periods (2-3 hours) (p = 0.04, p = 0.02, respectively) compared with low-GL meals. GI meals were not associated with glucose iAUC 0 to 2 hours (p = 0.37) and 2 to 3 hours (p = 0.81) postprandially. GI meals were not associated with insulin iAUC 0 to 2 hours postprandially (p = 0.81); in contrast, high-GI meals increased insulin iAUC 2 to 3 hours postprandially (p = 0.03) compared with low-GI meals. No significant differences were noted in cortisol responses, GI × GL interactions, or effect modification by gender.
  
  
  CONCLUSIONS
  These findings highlight the need for further investigation of meals/diets differing in both GI and GL to characterize metabolic responses and potential health effects.
authors: Nutritional Sciences Research Division, King's College London, London, United Kingdom. rmicha@hsph.harvard.edu
authors: Renata
authors: R
authors: Micha
authors: Michael
authors: M
authors: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D000886:Anthropometry; D019540:Area Under Curve; D001786:Blood Glucose / Q000032:analysis; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D005260:Female; D005504:Food Analysis; D038321:Glycemic Index; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D007407:Interviews as Topic; D008297:Male; D018977:Micronutrients / Q000032:analysis; D019518:Postprandial Period; D015203:Reproducibility of Results; D057566:Self Report; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007328:Insulin; D018977:Micronutrients; D006854:Hydrocortisone