BEYONDGLYCEMICINDEX: NEWFOODINSULININDEX

LauraSampsonKent* MaryFranz* JennieBrandMiller** WalterWillett*

*DepartmentofNutrition,HarvardSchoolofPublicHealth **UniversityofSydney Acknowledgement: This research was funded by grant CA55075, National Cancer Institute, National Institutes of Health.

RELEVANCEOFINSULINSECRETION
Preventionandmanagementofweightgain Hyperlipidemia Noninsulindependentdiabetesmellitus(NIDDM) Longtermexposuretohighinsulinconcentrations may ybeassociatedwithincreasedriskofcancer

WHATISFOODINSULININDEX(FII)?
Directlyquantifiesthepostprandialinsulin responsetoanisoenergeticportionofa testfoodincomparisontoareference food Allowstestingoffoodswithnoorlow carbohydratecontent FIIhas h been b shown h topredict d the h relative l insulindemandevokedbymixedmeals

FOODINSULININDEX(FII)
Measuresbloodinsulinresponsetoafood comparedtoareferencefoodglucose(FII=100) Measuresincrementalinsulinareaunderthe curve(AUC)overtwohoursinresponseto consumptionofa1000kJportionofthetest fooddividedbytheAUCafteringestionofa 1000kJportionofthereferencefood

HowisFIIDifferentfromGlycemicIndex?
FOODINSULININDEX Measurespostprandial increaseininsulin secretion ofawhole food Dependent d on carbohydrate,quantityand quality q yofp proteinandfat andtheirinteractions GLYCEMICINDEX Measureseffectof carbohydratecontaining foodsonpostprandial increaseinbloodglucose levels GIisnotalways proportionaltotheinsulin response

METHODS
APPROXIMATELY100FOODSAND16CEREALS WEREANALYZEDUSINGGLUCOSEASTHE REFERENCEFOOD 407FOODS,147MARGARINES,58OILS,111 CEREALSWEREIMPUTEDUSINGVARIOUS ALGORITHMS 166FOODSAND89CEREALSWERERECIPE DERIVED 44FOODSWEREASSUMEDTOBE0

FOODSSENTTOUNIVERSITYOFSYDNEY

MUFFINMIXES READYMADE SWEETROLL

SunMaidhoneyraisin branmuffinmix Duncan D Hi Hinesbl blueberry b muffinmix Krusteaz Kr stea fatfree blueberrymuffinmix Entenmanncinnamon buns

CakeMix PancakeMix Cookies

BettyCrockergoldencakew/ BettyCrockerchocfrosting AuntJemimapancakemix ChipsAhoyregularchocolatechip ChipsAhoyreducedfatchocolate chip Archwayfatfreeoatmealraisin CapeCodreducedfatpotato chips Snickerscandybars Hershey ycandy ybars

Chips p CandyBars

U.S.AnalyzedCereals CEREALS
Cheerios ShreddedWheat CornFlakes Quaker100%Natural CracklinOatBran L k Ch Lucky Charms FrostedFlakes GreatGrains HoneyBunchesofOats Wheaties

MatchingU.S.FoodsPurchasedinSydney
Dairy
Creamcheese Lowfatcheddarcheese Lowfatprocessedcheese Lowfatcottagecheese Lowfaticecream Sherbet 1%milk Butter

Meat,fish,mixeddishes
Tacos Lasagna Roastchicken Shrimp Tofu Tunainoil Bacon

F it orfruit Fruits f itdrinks di k

Peachescannedinjuice Peachescannedinsyrup Orange g j juice Prunes Punch

Miscellaneousitems
Oliveoil Navybeans Raspberryjam Pretzels Walnuts Corntortillas Jatzcrackers(similartoRitz)

Cereals
Kashi K hi7grain i puffs ff RiceBubbles

RecipederivedFIIValues
Usedanalyzedfoodsasingredients Usedingredientsthatwereimputedfrom analyzed y foods. Example:applebutterFII=52 Derived df fromrecipeusingapple, l a.j.,and d sugarasingredients(allanalyzedfoods)

IMPUTEDORCALCULATEDFIIVALUES
FOODS Cerealgrains,bakedgoods, sweetsandsnackfoods, beverages fruits, beverages, fruits anddairy CALCULATION Similaranalyzedfoodsanda carb/1000kjadjustment carb/1000kjimputedfood xFII carb/1000kjanalyzedfood Breakfastcereals Usedanalyzedcerealsadjustingfor carbohydrate/amount Directlyfromsimilaranalyzedfoods

Meats,fish,andpoultry

IMPUTEDFIIVEGETABLEVALUES
VEGETABLES NONSTARCHY CALCULATIONS Recipefromavocadousingan h2oratio Recipefrompotatoesor carrotsusingfiberratios Recipefrombeansusingan fiberratio

STARCHY

PEASandLIMABEANS

FIIPUBLICATIONS
Bao J, ,deJong g V, ,AtkinsonF, ,Petocz P, ,BrandMiller JC.Foodinsulinindex:physiologicbasisfor predictinginsulindemandevokedbycomposite meals AmJClin Nutr 2009;90:986992. meals. 992
HoltSH, SH MillerJC JC,&Petocz P. P Aninsulinindexoffoods: theinsulindemandgeneratedby1000kJportionsof commonfoods.AmJClin Nutr,66:126467;1997.

RESULTSofthemixedmealstudy:
A
500 Insulin (pmol/L) 400 300 200 100 0 0 15 30 45 60 90 120 Tim e (m in)

Group 1

M1 M2 M3 M4 M5 M6 White Bread

B
500 400 300 200 100 0 0 15

Group 2

M7 M8 M9 M10 M11 M12 M13 White Bread

30

45

60

90

120

Tim e (m in)

Bao J et al. Am J Clin Nutr 2009;90:986-992.

RESULTS:Correlations
A
Obse rved insulin respons se (Rela tive white bread =10 0)

140 r = 0.78, P = 0.0016 120 100 80 60 40 20 0 0 20 40 60 80 100 120 Insulin demand predicted by Food Insulin Index

RESULTS:Correlations
B
Observe ed insulin n response e (Relativ ve white br read =100) ) 140 r = 0.53, P = 0.064 120 100 80 60 40 20 0 0 20 40 60 80 100 Available a ab e ca carbohydrate bo yd ate co content te t (g)

HighestversusLowestFIIValues
HighestanalyzedFII JellyBeans(120) Pancakes(112) HoneydewMelon(95) Potatoes(90) BreakfastCereals(70113) LowestanalyzedFII OliveOil(3) Avocado(5) Walnuts(6) Tuna(16) Chicken(20)

MEANANALYZEDVSMEANIMPUTEDFIIDATA
100 90 80 70 60 50 40 30 20 10 0
ES IR Y N FR UI T S TS SW EE GU M PR OT FO RE AL S DA OD EI

NU TS & LE

KF AS T CE

CH Y

ST

AR

ANALYZED IMPUTED

BR EA

LIMITATIONS
AlthoughimputedFIIdataaresimilarto analyzeddata,algorithmsusedforimputing FIIhavenotbeenvalidated. FIIvariabilitywithinsomefoodgroups complicatestheassignmentofimputed values.Forexample,analyzedFIIfordairy foodsrangefrom18forcreamcheeseto86 forfruitedyogurt.

CONCLUSION
Mostvegetables g p producenegligible g g insulinresponse, p , asmeasuredbyFII. Evenfats,andproteinsourcesproducelargely variableinsulinresponses,asmeasuredbyFII. ImputedFIIvaluestrackcloselytoanalyzedvalues. Refinedcereals,sweets,andpotatoesproducethe greatestinsulinresponse,asmeasuredbyFII.

DERIVEDINSULINLOAD
InsulinLoad,Glucose=(calories*FII)/100 the th i individual di id laveragei insulinogenic li i l load d (IL)duringthepastyearwasestimated f from FFQs FFQ by b multiplying lti l i the th FIIof feach h foodbyitsenergycontentandthe consumption ti frequency f and dsumming i overallreportedfooditems.

DIETARYINSULIN INDEX, INDEX DII

TheaveragedietaryDIIwas calculatedbydividingthe averageInsulin I li Load, L d IL, IL by b the th totaldailyenergyintake. intake

RESULTSFROMCOHORTSTUDIES
MEN WOMEN

MedianILwas840 MedianILwas677 MedianDIIwas41.7 MedianDIIwas42.7

TOP8FOODSCONTRIBUTINGTOIL
MEN WOMEN

ColdCereal(6.1%) Potatoes(5 (5.7%) 7%) DarkBread(4.4%) SkimmedMilk(3.2%) (3 2%) Bananas(3.2%) EnglishMuffin(3.1%) (3 1%) WhiteBread(2.9%) OrangeJuice(2.8%)

MashedPotatoes(6.2%) SkimmedMilk(5.7%) (5 7%) ColdCereal(5.3%) D kBread Dark B d(4.6%) (4 6%) Beef(3.6%) Y Yogurt (3 (3.3%) 3%) WhiteBread(3.1%) EnglishMuffin(2.7%)

TOP4FFQITEMSexplainingtheinter individual d d lvariationof finsulin l l load d MEN 49% LIQUOR COLDCEREAL BEER WINE WOMEN 45% LIQUOR WINE YOGURT COLDCEREAL

COHORTSTUDYRESULTS
Inmultivariateadjustedregressionmodels,dietaryIIandILwerenot significantly i ifi tl associated i t dwith ithplasma l Cpeptide. tid ParticipantsinthehighestquintileofbothIIandILhad26%higher triacylglycerolconcentrationsthanparticipantsinthelowest quintile(ptrend <0.0001). ThepositiveassociationbetweenIIandILandplasmatriacylglycerol wasstrongestinobese(BMI30kg/m2)participants(difference highestversuslowestquintileinII=72%,ptrend=0.01). AninverseassociationbetweenDIIandHDLcholesterolwasobserved amongobeseparticipants(difference=22%,ptrend=0.01forII). DIIandILwerenotassociatedwithLDLcholesterol,CRPorIL6.

CONCLUSION
DII and IL were not associated with markers of glycemic control control, at least in the fasting state, but may be physiologically relevant to plasma lipids lipids, especially in the obese obese.