Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group.
Growing evidence underscores the important role of glycemic control in health and recovery from illness. Carbohydrate ingestion in the diet or administration in nutritional support is mandatory, but carbohydrate intake can adversely affect major body organs and tissues if resulting plasma glucose becomes too high, too low, or highly variable. Plasma glucose control is especially important for patients with conditions such as diabetes or metabolic stress resulting from critical illness or surgery. These patients are particularly in need of glycemic management to help lessen glycemic variability and its negative health consequences when nutritional support is administered. Here we report on recent findings and emerging trends in the field based on an ESPEN workshop held in Venice, Italy, 8-9 November 2015. Evidence was discussed on pathophysiology, clinical impact, and nutritional recommendations for carbohydrate utilization and management in nutritional support. The main conclusions were: a) excess glucose and fructose availability may exacerbate metabolic complications in skeletal muscle, adipose tissue, and liver and can result in negative clinical impact; b) low-glycemic index and high-fiber diets, including specialty products for nutritional support, may provide metabolic and clinical benefits in individuals with obesity, insulin resistance, and diabetes; c) in acute conditions such as surgery and critical illness, insulin resistance and elevated circulating glucose levels have a negative impact on patient outcomes and should be prevented through nutritional and/or pharmacological intervention. In such acute settings, efforts should be implemented towards defining optimal plasma glucose targets, avoiding excessive plasma glucose variability, and optimizing glucose control relative to nutritional support.
Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy. Electronic address: barazzon@units.it.
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Barazzoni
Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA.
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Deutz
Department of Medical, Surgical and Health Sciences, Internal Medicine, University of Trieste, Trieste, Italy.
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Biolo
Department of Nutritional Medicine/Prevention, University of Hohenheim, Stuttgart, Germany.
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Bischoff
Department of Clinical Nutrition, CHU de Clermont-Ferrand, CRNH, Université d'Auvergne, Clermont-Ferrand, France.
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Boirie
Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Sweden; Department of Geriatric Medicine, Uppsala University Hospital, Sweden.
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Cederholm
Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Cuerda
Department, Université Catholique de Louvain, Brussels, Belgium.
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Delzenne
Department of Medicine, Complutense University, Madrid, Spain.
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Leon Sanz
Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden.
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Ljungqvist
Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
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Muscaritoli
Nutrition Unit, Geneva University Hospital, Geneva, Switzerland.
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Pichard
Department of Intensive Care, Erasme University Hospital, Brussels, Belgium.
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Preiser
Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Sbraccia
Department of Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel.
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Singer
Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
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Tappy
Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland.
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Thorens
Gastroenterology Service, Hospital Erasme, Brussels, Belgium.
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Van Gossum
Internal Medicine Unit and Center for the Study and Integrated Treatment of Obesity, Department of Medicine, Padua University, Padua, Italy.
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Vettor
Faculty of Medicine, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom.
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Calder
D001786:Blood Glucose / Q000378:metabolism; D050260:Carbohydrate Metabolism; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000009:adverse effects*; D019317:Evidence-Based Medicine; D038321:Glycemic Index; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000628:therapy; D007003:Hypoglycemia / Q000209:etiology / Q000628:therapy; D007333:Insulin Resistance; D007558:Italy; D018673:Nutrition Policy; D009751:Nutritional Requirements; D018529:Nutritional Support; D012307:Risk Factors; D012958:Societies, Scientific
D001786:Blood Glucose; D004040:Dietary Carbohydrates
Carbohydrates; Clinical nutrition; Insulin resistance