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Determining the relationship between dietary carbohydrate intake and insulin resistance

  • Neville H. McClenaghan (a1)

Insulin resistance underlies type 2 diabetes, CVD and the metabolic syndrome, driven by changes in diet, lifestyle, energy over–consumption and obesity. Nutritional recommendations for insulin resistance remain an area of controversy, particularly the quantity and types of dietary carbohydrate. The present review gives an overview of insulin resistance, its relationship to impaired insulin secretion and the metabolic syndrome, research methodologies used to measure insulin action and the epidemiological and intervention studies on the relationship between dietary carbohydrate and insulin resistance. Epidemiological studies provide little evidence to suggest that total dietary carbohydrate predicts risk of type 2 diabetes, and high–carbohydrate, high–fibre diets with low–glycaemic index (GI) may even contribute to diabetes prevention. Despite inherent limitations associated with techniques used to measure insulin resistance and dietary assessment, most intervention studies reveal an increase in glucose tolerance or insulin sensitivity with high–carbohydrate, low–fat diets in non–diabetic and diabetic individuals. When energy is restricted the source or reduced content of carbohydrate does not appear to be as important as fat for body weight. Thus, low energy intake is key to weight loss and augmentation of insulin sensitivity. Given this, widespread adoption of popular low–carbohydrate high–fat diets highlights the necessity to evaluate dietary interventions regarding safety and metabolic effects. While current evidence supports FAO/WHO recommendations to maintain a high–carbohydrate diet with low–GI foods, the relationships between carbohydrate and insulin sensitivity remains an important research area. Emerging technologies should further enhance understanding of gene–diet interactions in insulin resistance, providing useful information for future nutrition policy decisions.

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Corresponding author
Corresponding author: Dr Neville H. McClenaghan, fax +44 28 7032 4965, email
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YH Abdel-Wahab , FP O'Harte , H Ratcliff , NH McClenaghan , CR Barnett & PR Flatt (1996) Glycation of insulin in the islets of Langerhans of normal and diabetic animals. Diabetes 45, 14891496.

C Abraira & J Derler (1988) Large variations of sucrose in constant carbohydrate diets in type II diabetes. American Journal of Medicine 84, 193200.

Anonymous (1997) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 20, 11831197.

JP Bantle , JE Swanson , W Thomas & DC Laine (1992) Metabolic effects of dietary fructose in diabetic subjects. Diabetes Care 15, 14681476.

JP Bantle , JE Swanson , W Thomas & DC Laine (1993) Metabolic effects of dietary sucrose in type II diabetic subjects. Diabetes Care 16, 13011305.

JC Beard , RN Bergman , WK Ward & D Porte (1986) The insulin sensitivity index in non–diabetic man: correlation between clamp–derived and IVGTT–derived values. Diabetes 35, 362369.

H Beck-Nielsen (1999) General characteristics of the insulin resistance syndrome: prevalence and heritability. European Group for the Study of Insulin Resistance (EGIR). Drugs 58, Suppl. 1, 710.

RN Bergman , R Prager , A Volund & JM Olefsky (1989) Equivalence of the insulin sensitivity index in man derived by the minimal model method and the euglycaemic glucose clamp. Journal of Clinical Investigation 79, 790800.

JE Blundell & JI MacDiarmid (1997) Fat as a risk factor for overconsumption: satiation, satiety, and patterns of eating. Journal of the American Dietetics Association 97, Suppl., S63S69.

E Bonora , P Moghetti , C Zancanaro , M Cigolini , V Cacciatori , A Corgnati & M Muggeo (1989) Estimates of in vivo insulin action in man: comparison of insulin tolerance test with euglycaemic and hyperglycaemic glucose clamp studies. Journal of Clinical Endocrinology and Metabolism 68, 374378.

M Borkman , LV Campbell , DJ Chisholm & LH Storlien (1991) Comparison of the effects on insulin sensitivity of high carbohydrate and high fat diets in normal subjects. Journal of Clinical Endocrinology and Metabolism 72, 432437.

DM Bravata , L Sanders , J Huang , HM Krumholz , I Olkin , CD Gardner & DM Bravata (2003) Efficacy and safety of low–carbohydrate diets: a systematic review. JAMA 289, 18371850.

JD Brunzell , RL Lerner , WR Hazzard , D Porte Jr & EL Bierman (1971) Improved glucose tolerance with high carbohydrate feeding in mild diabetes. New England Journal of Medicine 284, 521524.

M Chen , RN Bergman , D Porte Jr (1988) Insulin resistance and beta–cell dysfunction in aging: the importance of dietary carbohydrate. Journal of Clinical Endocrinology and Metabolism 67, 951957.

P Choudhary (2004) Review of dietary recommendations for diabetes mellitus. Diabetes Research and Clinical Practice 65, S9S15.

DL Cutler , CG Gray , SW Park , MG Hickman , JM Bell & OG Kolterman (1995) Low–carbohydrate diet alters intracellular glucose metabolism but not overall glucose disposal in exercise–trained subjects. Metabolism 44, 12641270.

S Ehtisham , TG Barrett & NJ Shaw (2000) Type 2 diabetes in UK children: an emerging problem. Diabetic Medicine 17, 867871.

EJ Feskens & D Kromhout (1990) Habitual dietary intake and glucose tolerance in euglycaemic men: the Zutphen Study. International Journal of Epidemiology 19, 953959.

DT Finegood , IM Hramiak & J Dupre (1990) A modified protocol for estimation of insulin sensitivity with minimal model glucose kinetics in patients with insulin-dependent diabetes. Journal of Clinical Endocrinology and Metabolism 70, 15381549.

ES Ford & AH Mokdad (2001) Fruit and vegetable consumption and diabetes mellitus incidence among US adults. Preventative Medicine 32, 3339.

G Frost , A Leeds , G Trew , R Margara & A Dornhorst (1998) Insulin sensitivity in women at risk of coronary heart disease and the effect of a low glycemic diet. Metabolism 47, 12451251.

G Frost , J Wilding & J Beecham (1994) Dietary advice based on the glycaemic index improves dietary profile and metabolic control in type 2 diabetic patients. Diabetic Medicine 11, 397401.

A Garg (2004) Regional adiposity and insulin resistance. Journal of Clinical Endocrinology and Metabolism 89, 42064210.

A Garg , SM Grundy & RH Unger (1992) Comparison of effects of high and low carbohydrate diets on plasma lipoproteins and insulin sensitivity in patients with mild NIDDM. Diabetes 41, 12781285.

CN Hales & DJ Barker (2001) The thrifty phenotype hypothesis. British Medical Bulletin 60, 520.

MP Hermans , JC Levy , RJ Morris & RC Turner (1999) Comparison of insulin sensitivity tests across a range of glucose tolerance from normal to diabetes. Diabetologia 42, 678687.

E Hjollund , O Pedersen , B Richelsen , H Beck-Nielsen & NS Sorensen (1983) Increased insulin binding to adipocytes and monocytes and increased insulin sensitivity of glucose transport and metabolism in adipocytes from non–insulin–dependent diabetics after a low–fat/high–starch/high–fiber diet. Metabolism 32, 10671075.

AM Hodge , J Montgomery , GK Dowse , B Mavo , T Watt & PZ Zimmet (1996) A case–control study of diet in newly diagnosed NIDDM in the Wanigela people of Papua New Guinea. Diabetes Care 19, 457462.

PD Home (1988) The OGTT: gold that does not shine. Diabetic Medicine 5, 313314.

SJ Hunter , AC Boyd , FP O'Harte , AM McKillop , MI Wiggam , MH Mooney , JT McCluskey , JR Lindsay , CN Ennis , R Gamble , B Sheridan , CR Barnett , H McNulty , PM Bell & PR Flatt (2003) Demonstration of glycated insulin in human diabetic plasma and decreased biological activity assessed by euglycaemic–hyperinsulinemic clamp technique in humans. Diabetes 52, 492498.

SJ Janket , JE Manson , H Sesso , JE Buring & S Liu (2003) A prospective study of sugar intake and risk of type 2 diabetes in women. Diabetes Care 26, 10081015.

AE Jarvi , BE Karlstrom , YE Granfeldt , IE Bjorck , NG Asp & BO Vessby (1999) Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low–glycemic index diet in type 2 diabetic patients. Diabetes Care 22, 1018.

WS Jellish , MA Emanuele & C Abraira (1984) Graded sucrose/carbohydrate diets in overtly hypertriglyceridemic diabetic patients. American Journal of Medicine 77, 10151022.

DJ Jenkins , TM Wolever , V Vuskan , F Brighenti , SC Cunnane , AV Rao , AL Jenkins , G Buckley , R Patten & W Singer (1989) Nibbling versus gorging: metabolic advantages of increased meal frequency. New England Journal of Medicine 321, 929934.

MD Jensen & CM Johnson (1996) Contribution of leg and splanchnic free fatty acid (FFA) kinetics to postabsorptive FFA flux in men and women. Metabolism 45, 662666.

HA Kahn , JB Herman , JH Medalie , HN Neufeld , E Riss & U Goldbourt (1971) Factors related to diabetes incidence: a multivariate analysis of two years observation on 10,000 men. The Israel Ischemic Heart Disease Study. Journal of Chronic Disease 23, 617629.

N Kaiser , G Leibowitz & R Nesher (2003) Glucotoxicity and beta–cell failure in type 2 diabetes mellitus. Journal of Pediatric Endocrinology and Metabolism 16, 522.

A Kashiwagi , D Mott , C Bogardus , S Lillioja , GM Reaven & JE Foley (1985) The effects of short–term overfeeding on adipocyte metabolism in Pima Indians. Metabolism 34, 364370.

H Keen , BJ Thomas , RJ Jarrett & JH Fuller (1979) Nutrient intake, adiposity, and diabetes. British Medical Journal 1, 655658.

T Kirk , N Crombie & M Cursiter (2000) Promotion of dietary carbohydrate as an approach to weight maintenance after initial weight loss: a pilot study. Journal of Human Nutrition and Dietetics 13, 277285.

NH McClenaghan & PR Flatt (1999 b) Physiological and pharmacological regulation of insulin release: insights offered through exploitation of insulin–secreting cell lines. Diabetes Obesity and Metabolism 1, 137150.

DR Matthews , JP Hosker , AS Rudenski , BA Naylor , DF Treacher & RC Turner (1985) Homeostasis model assessment: insulin resistance and beta–cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28, 412419.

M Parillo , AA Rivellese , AV Ciardullo , B Capaldo , A Giacco , S Genovese & G Riccardi (1992) A high-monounsaturated–fat/low–carbohydrate diet improves peripheral insulin sensitivity in non–insulin–dependent diabetic patients. Metabolism 41, 13731378.

DB Peterson , J Lambert , S Gerring , P Darling , RD Carter , R Jelfs & JI Mann (1986) Sucrose in the diet of diabetic patients – just another carbohydrate? Diabetologia 29, 216220.

JC Pickup & G Williams (2003) The Textbook of Diabetes, 3rd ed. Oxford, UK: Blackwell Science Limited.

MF Saad , RL Anderson , A Laws , RM Watanabe , WW Kades , YD Chen , RE Sands , D Pei , PJ Savage & RN Bergman (1994) A comparison between the minimal model and the glucose clamp in the assessment of insulin sensitivity across the spectrum of glucose tolerance. Diabetes 43, 11141121.

J Salmeron , A Ascherio , EB Rimm , GA Colditz , D Spiegelman , DJ Jenkins , MJ Stampfer , AL Wing & WC Willett (1997 a) Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 20, 545550.

SW Shen , GM Reaven & JW Farquar (1970) Comparison of impedance to insulin–mediated glucose uptake in normal subjects and in subjects with latent diabetes. Journal of Clinical Investigation 49, 21512160.

R Steele (1959) Influences of glucose loading and injected insulin on hepatic glucose output. Annals of the New York Academy of Sciences 82, 420430.

AW Thorburn , PA Crapo , K Griver , P Wallace & RR Henry (1990) Long–term effects of dietary fructose on carbohydrate metabolism in non–insulin–dependent diabetes mellitus. Metabolism: Clinical and Experimental 39, 5863.

SH Vermunt , WJ Pasman , G Schaafsma & AF Kardinaal (2003) Effects of sugar intake on body weight: a review. Obesity Reviews 4, 9199.

C Yu , Y Chen , GW Cline , D Zhang , H Zong , Y Wang , R Bergeron , JK Kin , SW Cushman , GJ Cooney , B Atcheson , MF White , EW Kraegen & GI Shulman (2002) Mechanism by which fatty acids inhibit insulin activation of insulin receptor substrate–1 (IRS–1)–associated phosphatidylinositol 3–kinase activity in muscle. Journal of Biological Chemistry 277, 5023050236.

K Zierler (1961) Theory of the use of arteriovenous concentration differences for measuring metabolism in steady and non–steady states. Journal of Clinical Investigation 40, 21112125.

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Nutrition Research Reviews
  • ISSN: 0954-4224
  • EISSN: 1475-2700
  • URL: /core/journals/nutrition-research-reviews
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