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Relationship of Nutrition to Blood Glucose Control

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Glycemic Index ... High Glycemic Index Carbohydrates. 18 ... On Glycemic Index. Dietary fat. Slows gastric emptying (short-term) ... – PowerPoint PPT presentation

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Title: Relationship of Nutrition to Blood Glucose Control


1
Relationship of Nutrition to Blood Glucose
Control
  • Arline McDonald, Ph.D.
  • December 4, 2001

2
Blood Glucose Responses to Diet
3
Blood Glucose Abnormalities
4
Conditions Requiring Dietary Management for Blood
Glucose Control
  • Diabetes mellitus
  • Type I
  • Type II
  • Hypertension
  • Hyperlipidemia
  • Liver disease
  • Renal disease
  • Cancer
  • Obesity
  • Trauma
  • Sepsis
  • Treatment with
  • Hydrochlorothiazide
  • Chlorpropamide
  • Propranolol
  • Prednisone
  • Sulfonylureas

5
Diabetes Prevention Program3-year Incidence of
Type II Diabetes
6
Relationship of Source of Energy to Incidence of
Type I Diabetes1



NS


140 countries ecologic data
plt0.05 plt0.01 plt0.001 plt0.0001
AJCN 2000711525-9.
7
The Postprandial Plasma Glucose Response (Glucose
Tolerance)
Area Under Curve
8
Plasma Glucose Response to Different Carbohydrate
Sources
9
Fate of Dietary Carbohydrate
10
Proposed Etiology of Diet-Induced Insulin
Resistance
11
Receptor Modification in Insulin Resistance
  • ? Receptor number
  • ? Receptor activity
  • Post-receptor defect
  • Enzyme activation
  • Glucose transporters
  • Downregulation ? dietary glycemic index ?
    dietary fat ? body fat
  • Composition of dietary fat
  • Stress Response ? counterregulatory hormones

12
Metabolic Consequences of Insulin Resistance
13
Metabolic Consequences of Hyperglycemia
14
Glycemic Index
  • Describes the incremental increase in blood
    glucose from fasting levels over a defined time
    interval following ingestion of CHO (AUC)
    relative to a standard
  • Property of food sources of digestible CHO
  • Function of efficiency of digestion and rate of
    absorption

15
Glycemic Indexes of Foods
16
Primary Determinants of Glycemic Index
  • Amount of Carbohydrate
  • Portion size
  • Energy density
  • Availability of Carbohydrate
  • Solubility
  • Digestibility
  • Extent of processing
  • Type of processing

17

High Glycemic Index Carbohydrates
  • Simple Sugars
  • highly soluble
  • liquid form
  • low fiber content
  • high energy content
  • high Na content
  • Starches
  • highly digestible
  • amylopectin gt amylose
  • amylose gt resistant starch
  • refined starch gt simple sugars with fiber

18
Effects of Soluble (Viscous) Dietary Fiber on
Blood Glucose Control
  • Direct Effects
  • decreases rate of digestion
  • impedes access to digestive enzymes
  • decreases rate of absorption
  • slows rate of diffusion across unstirred layer
  • Indirect Effects
  • decreases absorption of dietary fat
  • inds bile acids
  • regulates appetite
  • Ileal brake-second-meal effect

19
Simple Sugar (SS) with and without Soluble
Fiber (SDF)
20
Starch With and Without Soluble Dietary Fiber
(SDF)
21
Noncarbohydrate Influences On Glycemic Index
  • Dietary fat
  • Slows gastric emptying (short-term)
  • Decreases insulin clearance (long-term)
  • Dietary sodium
  • Facilitates glucose transport via Na-linked
    transporter
  • Physical Activity
  • Increases insulin sensitivity
  • improved skeletal muscle glucose transport
    kinetics

22
Effects of Dietary Fat on Blood Glucose Control
  • Total Amount
  • Determines gastric emptying
  • Inhibits insulin clearance by increased FFA in
    portal circulation
  • Contributes to body fat stores
  • Fatty Acid Composition
  • Saturated fat
  • ? membrane fluidity receptor function
  • ? number of glucose transporters
  • Monounsaturated fat
  • promotes insulin secretion
  • ?-6?3 PUFA ratio
  • membrane fluidity

23
Relationship of Fasting Insulin to Dietary
Polyunsaturated Fat-C20-22
24
Relationship of Fasting Insulin to Ratio of C204
(arachidonic) to C203 (eicosapentanoic)
25
Glucose Response to Monounsaturated Fatty Acids
CHO/Fat 6020 for starch and 4040 for MUFA
Diabetes Care 1993 141115.
26
Insulin Response to Monounsaturated Fatty Acids
CHO/Fat 6020 for starch and 4040 for MUFA
Diabetes Care 1993 141115.
27
Effects of Energy Intake onBlood Glucose Control
  • Relates to amount of carbohydrate and fat
  • Provides excess or deficiency of micronutrients
    that influence effectiveness of insulin
  • Zinc, potassium, magnesium, chromium, vitamin E
  • Contributes to body fat
  • If not balanced with expenditure
  • Preferentially deposited in abdomen (age, gender)

28
Relationship of Intake to Storage Capacity for
Dietary CHO and Fat
29
Obesity and Insulin Resistance
  • Abdominal vs Gluteal
  • high portal free fatty acid concentration
    inhibitshepatic insulin clearance
  • higher insulin level required to facilitate
    glucose uptake

30
Effects of Physical Activity on Blood Glucose
Control
  • prevents weight gain
  • increases muscle mass/fat mass ratio
  • Promotes mobilization of free fatty acids from
    abdominal adipocytes
  • reduces km of skeletal muscle glucose
    transporters
  • enhances glycogenesis for up to 48 hours
    post-activity

31
Effects of Distribution of Energy Intake on Blood
Glucose Control
32
Effects of Dietary Protein on Blood Glucose
Control
  • Minimal effect on postprandial blood glucose
    response

Glucose
33
Effects of Micronutrients on Blood Glucose
Control
  • Insulin Response
  • Chromium
  • Zinc
  • Vitamin E
  • Carbohydrate Metabolism
  • Potassium
  • Magnesium

34
Summary of Dietary Effects on Postprandial
Glucose Response
35
Summary
  • Short-term insulin response is dependent on
    amount and digestibility of CHO, food matrix, and
    other components of the meal
  • Insulin resistance can develop as an adaptive
    response to chronic intake of high glycemic loads
  • Dietary modifications can facilitate insulin
    effectiveness

36
Predicting the Postprandial Plasma Glucose
Response
37
What has been ingested?
High protein drink
Plasma Glucose mg/dL
Minutes from Ingestion
38
What has been ingested?
High energyrefined sugar starch
39
Predicting the Postprandial Plasma Glucose
Response
Plasma Glucose mg/dL
High Soluble Fiber Starch
Minutes from Ingestion
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