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Varga of the glycemic index and glycemic load of the diet in the glycemic control of diabetic children and teenagers. Queiroz 1I. Novato Silva 2 and R.


Evaluate the influence of the glycemic index GI and glycemic load GL of the diet in the glycemic control of children and teenagers with type 1 diabetes mellitus Indlce.

The consumed diet was evaluated using a quantitative food frequency questionnaire previously validated and tested in a pilotproject. The GL was estimated using the equation proposed by Foster-Powell et al. The glycemic control was classified as good, intermediate or poor according to the average of two HbA1c values obtained six months prior to the dietary evaluation date.

The diet consumed by The low GI diet consumed by these participants also presented higher protein content, which might have contributed to the attenuation of the postprandial glycemic response and better glycemic control of these patients. La dieta fue evaluada utilizando un cuestionario de frecuencia alimentaria cuantitativa validado y previamente probado en un proyecto piloto.

Type 1 Diabetes mellitus. Quantitative food frequency questionnaire. The achievement of an adequate glycemic control is the main objective in the treatment of DM, which is based in a balance between insulin, diet and physical activity. The diet component that has the greatest influence in the glycemia is the carbohydrate. Glucekico the quantity of carbohydrate is considered the main determinant of the postprandial glycemia, the type of carbohydrate can also affect this response.

By definition, the GI compares caega effect of the consumption of a fixed amount of available glucemjco 25 or 50 glucmeica on the glycemia, having white bread or glucose as reference food.

GI provides a measurement of the quality, but not of the quantity of the consumed carbohydrate. However, since the glycemic response is also affected by the amount of the consumed carbohydrate, the glycemic load GL has been considered as a better parameter to quantify the impact of carbohydrate in the glycemia.

The GL reflects the glycemic response obtained after the consumption of a meal containing a variable amount of carbohydrates. Despite the fact that the GL is a parameter derived from the GI, the GL reflects better the glycemic response and the insulin czrga in free living conditions, since in such conditions the amounts of carbohydrate consumed in each meal usually varies.

Results from several random clinical trials have reported that the consumption of low GI diets reduces the glycemic response in glucemia subjects. Studies of this nature are important, since they enable the glucemicca of the impact of these parameters in the glycemic control of those subjects and consequently, glucemido their quality of life.

Thus, the objective of this study was to estimate the GI and GL of the diet consumed by children and teenagers with DM1 and to verify the influence of these parameters in the glycemic control of the studied population.

The parents responsible or the interviewee himself, if over 18, signed a consent form, after full disclosure regarding the objectives of gluceemico research.

The data used in the study was obtained using a semi-structured questionnaire previously tested in a pilot-study. The complementary information was obtained from the medical files.

Body weight and height were measured according to Jelliffe 15 technique and the body mass index BMI was calculated, dividing the weight in kilograms by the height in meters squared The children and the teenagers nutritional status was classified based on the obtained BMI value, according to Himes 17 as: The glycemic control was evaluated, within six months prior to the dietary evaluation date, according to the average of two HbA1c values obtained from medical records patientsf HbA1c were assessed at each three months.


The degree of glycemic control was classified according to the criterion proposed by Chase19 dividing the patientfs HbA1c value by the upper limit of reference value for the method used to analyze it: The habitual food intake of the patients in the six months prior to the interview was assessed using a validated quantitative food frequency questionnaire QFFQ.

Standardized pictures of small, medium and large food portions were used to increase accuracy in the estimation of the consumed foods by the diabetics Monteiro et al. The GI of the diet ingested by the participants of the study was estimated from the sum of the GI values of the foods ingested daily, according to the equation described by Wolever and Jenkins 25 and recommended by FAO The available carbohydrate content was determined by subtracting the amount of ingested fiber from the total amount of carbohydrate.

The GI of each food was obtained, considering glucose as reference, using the values published in the International Table of Glycemic Index 6. When the GI of certain foods was not listed in this table, the GI of foods having similar nutritional composition and method of preparation was considered. The GL of the consumed diet was estimated multiplying the sum of the GI values of the daily ingested foods by the amount of available carbohydrate present in the diet, divided by 6: The GI and the GL of the ingested diet were classified according to the following: To evaluate the association between categorical variables the Chi- Square test was used or the Fisher Exact test, when indicated.

To compare numeric variables between independent groups the T-student and the Anova tests were adopted. Multiple comparisons between the groups were conducted using the Tukey test.

A total of glucemcio, aged From all the participants, 91 The great majority Most of the subjects Overweight was observed in 5 3. They received on average 0. Most of them The majority of the subjects consumed a medium GI The consumption of diets of low GI The majority of the subjects with good glycemic control Despite the glycemic control presented, most subjects However, in the subgroup with good control a higher proportion of subjects ingested a low GL diet The opposite was observed between the subjects with poor control.

Tabla internacional sobre indice glicemico y carga glicemica

There was a higher proportion of subjects that ingested a high GL diet Since only 3 diabetics consumed high GI diets, the analysis were made considering only the ingestion of low and medium GI diets.

It was verified that the low GI diets also presented lower GL; and were lower in carbohydrate and saturated fat, higher in protein and polyunsaturated fat than the medium GI diets table II. It was observed that In a similar manner, The dietary treatment has a fundamental role in the metabolic control of DM patients and in the prevention of micro and macrovascular complications related to the disease.

The consumption of high GI diets has been associated with more rapid progression to type 1 diabetes in children with islet autoimmunity. It was verified that the well controlled patients, besides ingesting low GI diets ingested less carbohydrate and more protein. Therefore, the better glycemic control observed cannot be attributed to the effect of the GI only. However, in a meta-analysis in which the results of 14 randomized clinical trials with a duration of about 10 weeks were analyzed, the positive association between the glycemic control and the GI of the consumed diet was independent from the ingestion of calories, protein, fat, carbohydrate and fiber.


It is worth mentioning that some authors have suggested that the GL might be capable of better reflecting the glycemic response after a given meal in daily life conditions than the GI.

However, it should be highlighted that the fiber content of the low GL diets was higher than that glcuemica by the medium and high GL diets. It is known that an increase in fiber content reduces the amount of available carbohydrate, favoring the reduction of the GL itself. It was observed, however, that the medium GI diet presented a higher saturated fat percentage and higher level of polyunsaturated fat than in the low GI diet. Many aspects related to the association between the ingestion of fats and glycemic control needs further clarifications.

It has been demonstrated that in healthy subjects the consumption of a diet high in saturated fat leads to a reduction in insulin sensibility. Some authors believe that the high intake of saturated fat can cause a modification in the cell membrane lipid profile, turning the phospholipid membrane more saturated; and consequently more resistant to insulin action. Despite the fact that most well controlled patients consumed a low Indicce diet, only This happened because, among these well controlled subjects, the high intake of available carbohydrate mean glucemmica However, although most subjects with good glycemic inice presented carbohydrate intake below or withinthe adopted recommendation range, the ingested diet was classified as medium GL.

Although the low GL diet is indicated in literature g,ucemico adequate, 36,37 the intake of a diet that meets the recommendation of carbohydrates in terms of percentage of total caloric intake can make the prescription of a diet with these characteristics difficult.

Despite the above mentioned, the results of the present study indicate that differently from what is seen indicce the effect of cargw consumption of a low GI diet in the improvements in gllucemica glycemic control, it is possible to obtain an adequate control when a medium GL diet is consumed. The results of this study illustrate the positive effects of the consumption of low GI diets in the glycemic control of children and teenagers with DM1 that have never received any instruction about the GI.

These results also indicated that it is possible for these patients to obtain an adequate glycemic control when a medium GL diet is consumed. Care of children and adolescents with type 1 diabetes. A statement of the American Diabetes Association.

Diabetes Care ; 28 1: Diabetes Mellitus Tipo 1: Scientia Medica ; 17 flucemica Review of dietary recommendations for diabetes mellitus. Diabetes Res Clin Pract ; Nutrition recommendations and interventions for diabetes.

A position statement of the American Diabetes Association. Diabetes Care ; 31 Suppl. Arq Bras Endocrinol Metab ; 52 2: International table of glycemic index and glycemic load values.

Am J Clin Nutr ; 76 1: Diabetes Care ; Burani J, Longo PJ. The Diabetes Educator ; 32 1: Meta-analysis of the helath effects of using the glycaemic index in meal-planning. Br J Nutr ; A meta-analysis of randomized controlled trials. Diabetes Care ; 26 8: Glycemic index in the diet of European outpatients with type 1 diabetes: