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      Reducing postprandial glucose in dietary intervention studies and the magnitude of the effect on diabetes-related risk factors: a systematic review and meta-analysis

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          Reducing postprandial hyperglycemia has beneficial effects on diabetes-related risk factors, but the magnitude of the reduction needed to achieve such an effect is unknown. The purpose of the study was to quantify the relationship of acute glucose and insulin postprandial responses with longer-term effects on diabetes-related risk factors by performing a systematic review and meta-analysis of dietary intervention studies.


          We systematically searched EMBASE and MEDLINE. Dietary intervention studies among any human population aiming to reduce postprandial glycemia, with actual measures of postprandial glucose (PPG) and/or insulin (PPI) as acute exposures (incremental area under the curve, iAUC) as well as markers of glucose metabolism (fasting glucose, HbA1c) and insulin sensitivity (fasting insulin, HOMA-IR) after at least 4 weeks of diet intervention as outcomes were included. Meta-analyses were performed for the effects on acute exposures and on diabetes-related risk factors. The relationship between changes in acute exposures and changes in risk factor outcomes was estimated by meta-regression analyses.


          Out of the 13,004 screened papers, 13 papers with 14 comparisons were included in the quantitative analysis. The dietary interventions acutely reduced mean PPG [mean difference (MD), − 0.27 mmol/l; 95% CI − 0.41 to − 0.14], but not mean PPI (MD − 7.47 pmol/l; 95% CI − 16.79 to 1.86). There were no significant overall effects on fasting glucose and insulin. HbA1c was reduced by − 0.20% (95% CI − 0.35 to − 0.05). Changes in acute PPG were significantly associated with changes in fasting plasma glucose (FPG) [per 10% change in PPG: β = 0.085 (95% CI 0.003, 0.167), k = 14], but not with fasting insulin [ β = 1.20 (95% CI − 0.32, 2.71), k = 12]. Changes in acute PPI were not associated with changes in FPG [per 10% change in PPI: β = − 0.017 (95% CI − 0.056, 0.022), k = 11].


          Only a limited number of postprandial glucose-lowering dietary intervention studies measured acute postprandial exposures to PPG/PPI during the interventions. In this small heterogeneous set of studies, an association was found between the magnitude of the acute postprandial responses and the change in fasting glucose, but no other outcomes. More studies are needed to quantify the relationship between acute postprandial changes and long-term effects on risk factors.

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          The online version of this article (10.1007/s00394-020-02240-1) contains supplementary material, which is available to authorized users.

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          Most cited references 37

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          The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

          Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate
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            Dietary Fiber, Glycemic Load, and Risk of NIDDM in Men

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              Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women.

              Increasing evidence suggests an important role of carbohydrate quality in the development of type 2 diabetes. Our objective was to prospectively examine the association between glycemic index, glycemic load, and dietary fiber and the risk of type 2 diabetes in a large cohort of young women. In 1991, 91249 women completed a semiquantitative food-frequency questionnaire that assessed dietary intake. The women were followed for 8 y for the development of incident type 2 diabetes, and dietary information was updated in 1995. We identified 741 incident cases of confirmed type 2 diabetes during 8 y (716 300 person-years) of follow-up. After adjustment for age, body mass index, family history of diabetes, and other potential confounders, glycemic index was significantly associated with an increased risk of diabetes (multivariate relative risks for quintiles 1-5, respectively: 1, 1.15, 1.07, 1.27, and 1.59; 95% CI: 1.21, 2.10; P for trend = 0.001). Conversely, cereal fiber intake was associated with a decreased risk of diabetes (multivariate relative risks for quintiles 1-5, respectively: 1, 0.85, 0.87, 0.82, and 0.64; 95% CI: 0.48, 0.86; P for trend = 0.004). Glycemic load was not significantly associated with risk in the overall cohort (multivariate relative risks for quintiles 1-5, respectively: 1, 1.31, 1.20, 1.14, and 1.33; 95% CI: 0.92, 1.91; P for trend = 0.21). A diet high in rapidly absorbed carbohydrates and low in cereal fiber is associated with an increased risk of type 2 diabetes.

                Author and article information

                Eur J Nutr
                Eur J Nutr
                European Journal of Nutrition
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                10 April 2020
                10 April 2020
                : 60
                : 1
                : 259-273
                [1 ]GRID grid.16872.3a, ISNI 0000 0004 0435 165X, Department of Epidemiology & Biostatistics, , Amsterdam UMC – location VUmc, Amsterdam Public Health Research Institute, ; Amsterdam, The Netherlands
                [2 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, Department of Human Biology, NUTRIM, School of Nutrition and Translational Research in Metabolism, , Maastricht University, ; Maastricht, The Netherlands
                [3 ]GRID grid.419905.0, ISNI 0000 0001 0066 4948, Nestlé Institute of Health Sciences, Nestlé Research, ; Lausanne, Switzerland
                [4 ]GRID grid.425211.1, ILSI Europe a.I.S.B.L., ; Avenue E. Mounier 83, Box 6, 1200 Brussels, Belgium
                [5 ]Nutrition Department, Mondelez International R&D, Saclay, France
                [6 ]GRID grid.7692.a, ISNI 0000000090126352, Julius Center for Health Sciences and Primary Care, , University Medical Center Utrecht, ; Utrecht, The Netherlands
                [7 ]GRID grid.5475.3, ISNI 0000 0004 0407 4824, Department of Nutritional Sciences, , University of Surrey, ; Guildford, UK
                [8 ]Unilever Research and Development, Vlaardingen, The Netherlands
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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                © Springer-Verlag GmbH Germany, part of Springer Nature 2021

                Nutrition & Dietetics

                glucose, insulin, glycemic index, glycemic load, hba1c


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