Integrating the Glycemic Index into Clinical Practice: Written Education Materials and Perceptions of Utility

Southgate, Katherine M.; Wolever, Thomas M. S.

doi:10.1016/j.jcjd.2012.05.002

Cited by 3 publications

(4 citation statements)

References 29 publications

(18 reference statements)

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“…Most, if not all, dietary advice regarding GI is based on recommending that people use low-GI foods (GI⩽55) more often and high-GI foods (GI⩾70) less often. 36 There is no good evidence from this meta-analysis that ethnicity has an effect on the results of GI testing; however, if it did, this might result in the need for ethnic-specific cut-points for defining ‘low-GI' and ‘high-GI' based not only on the ethnicity of the consumer but also of the subjects in whom GI was measured. This would have a major implication for the regulation of GI claims on food packages.…”

Section: Discussionmentioning

confidence: 89%

Effect of ethnicity on glycaemic index: a systematic review and meta-analysis

2015

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Objectives:Low glycaemic index (GI) foods are recommended to improve glycaemic control in diabetes; however, Health Canada considers that GI food labeling would be misleading and unhelpful, in part, because selected studies suggest that GI values are inaccurate due to an effect of ethnicity. Therefore, we conducted a systematic review and meta-analysis to compare the GI of foods when measured in Caucasians versus non-Caucasians.Methods:We searched MEDLINE, EMBASE and Cochrane databases for relevant articles. GI differences were aggregated using the generic inverse variance method (random effects model) and expressed as mean difference (MD) with 95% confidence intervals (95% CI). Study quality was assessed based on how well studies complied with official international GI methodology.Results:Review of 1288 trials revealed eight eligible studies, including 28 comparisons of GI among 585 non-Caucasians and 971 Caucasians. Overall, there was borderline significant evidence of higher GI in non-Caucasians than Caucasians (MD, 3.3 (95% CI, −0.1, 6.8); P=0.06) with significant heterogeneity (I2, 46% P=0.005). The GI of eight types of rice was higher in non-Caucasians than Caucasians (MD, 9.5 (95% CI, 3.7, 23.1); P=0.001), but there was no significant difference for the other 20 foods (MD, 1.0 (95% CI, −2.5, 4.6); P=0.57). MD was significantly greater in the four low-quality studies (nine comparisons) than the four high-quality studies (19 comparisons; 7.8 vs 0.7, P=0.047).Conclusions:With the possible exception of rice, existing evidence suggests that GI values do not differ when measured in Caucasians versus non-Caucasians. To confirm these findings high-quality studies using a wide range of foods are required.

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Section: Discussionmentioning

confidence: 89%

Effect of ethnicity on glycaemic index: a systematic review and meta-analysis

2015

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“…24 Reducing postprandial glucose responses by reducing diet GI without reducing carbohydrate intake improved b-cell function, 25 insulin sensitivity 26 or C-reactive protein 27 in people without diabetes; however, similar reductions in postprandial glucose achieved by reducing carbohydrate intake had no such effects. A focus on GL and/or glycaemic response, as proposed by Health Canada, also runs the risk of promoting low carbohydrate intakes, which is inconsistent with Health Canada's 11 In this study, the GI of spaghetti and potato, respectively, were 129 and 71 on the bread scale (GI of white bread ¼ 100), which get converted to 92 and 50 on the conventional scale (GI of glucose ¼ 100). The GL of spaghetti, 25, is greater than that of potato, 23, but the incremental area under curve for spaghetti is less than that for potato (89±16 vs 142±19 mmol Â min l À 1 , Po0.001).…”

Section: Would a Focus On Glycaemic Response Promote Healthy Diets?mentioning

confidence: 60%

“…Classifying foods as low-GI is arguably the most relevant way to inform consumers about GI because the most common advice given to consumers about GI is, within the same food category, to choose low-GI foods more often and high-GI foods less often. 11 Thus, the relevant question to ask in order to avoid misleading consumers is whether the GI method is precise enough to distinguish between low-and high-GI foods. Based on the normal distribution, with SD ¼ 9 there is only a 5% chance that the true GI of a food with a single measured GI value of 55 (low-GI) is actually high-GI (GIX70).…”

Section: Precisionmentioning

confidence: 99%

Glycemic index claims on food labels: review of Health Canada's evaluation

Wolever

2013

Eur J Clin Nutr

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Recently Health Canada (HC) published its opinion that including glycemic index (GI) values on food labels would be misleading and not add value to nutrition labeling and dietary guidelines to help consumers make healthier food choices. Important areas of concern were identified by HC, but the discussion of them is scientifically invalid. HC concluded that GI has poor precision for labeling purposes based on incorrect application of the standard deviation. In fact, GI methodology is precise enough to distinguish, with high probability, low-GI (GI ≤ 55) from high-GI (GI ≥ 70) foods and to pass the Canadian Food Inspection Agency Nutrition Compliance Test procedure. HC rightly concluded that GI does not respond to portion size, whereas glycemic response does, but no valid evidence was provided to support the assertion that a lower-GI food could have a higher glycemic response. HC's focus on glycemic response could promote a low-carbohydrate diet inconsistent with nutrition recommendations. HC correctly concluded that GI is unresponsive to the replacement of available- with unavailable-carbohydrate but this is irrelevant to GI labeling. HC is rightly concerned about promoting unhealthy low-GI foods; however, this could be avoided by prohibiting GI labeling on such foods. Therefore, HC has provided neither a helpful nor scientifically valid evaluation of GI for labeling purposes but has contributed to the wealth of misinformation about GI in the literature. Currently, Canadian consumers only have access to unregulated and misleading information about GI; well-crafted guidelines for GI labeling would provide consumers accurate information about GI and help them make healthier food choices.

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“…The following four barriers to GI utility have been identified by educators: (1) lack of suitable GI education tools, (2) a belief that GI is too difficult for patients to understand and (3) too difficult to apply, and (4) a desire for additional GI utility data from diverse patient populations [ 11 ]. In support of the first barrier, a Canadian-based evaluation of GI education materials, using the Suitability Assessment of Materials (SAM) instrument (by Doak et al 1996 [ 13 ]), conducted in 2011, showed that available GI education materials are “unsuitable” (SAM rating) [ 14 ]. There was, however, insufficient evidence to support or refute claims that GI is too difficult for patients to understand and apply [ 12 , 15 , 16 , 17 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Glycemic Index Education in People Living with Type 2 Diabetes: Participant Satisfaction, Knowledge Uptake, and Application

et al. 2020

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The glycemic index (GI) has been included in the Canadian clinical practice guidelines for type 2 diabetes (T2D) management since 2003, and even longer in other parts of the world (e.g., Australia). Despite this, dietitians have reported that GI is “too difficult for patients to understand and apply.” They have called for diverse GI-utility data and evidence-informed education materials. To address these concerns, we developed and evaluated a GI education workshop and supporting materials, using the Kirkpatrick Model, for a T2D population. Participants (n = 29) with T2D attended a dietitian-facilitated workshop and received education materials. A mixed-form questionnaire (GIQ) and 3-day-diet-record were used to capture patient demographics, satisfaction, knowledge, and application, prior to and immediately after the workshop, 1-week, and 4-weeks post-education. Dietary GI was significantly lower at 1 and 4 weeks post-education (mean ± SEM; both 54 ± 1), compared to pre-education (58 ± 1; p ≤ 0.001). Participants (28/29) were satisfied with the intervention. The GI knowledge score was significantly higher post-education at baseline (83.5 ± 3.4%; p ≤ 0.001), week one (87.5 ± 2.6%; p = 0.035), and week four (87.6 ± 3.8%; p = 0.011) when compared to pre-education (53.6 ± 5.1%). A significant reduction in dietary GI was achieved by participants living with T2D, after completing the workshop, and they were able to acquire and apply GI knowledge in a relatively short period.

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Integrating the Glycemic Index into Clinical Practice: Written Education Materials and Perceptions of Utility

Cited by 3 publications

References 29 publications

Effect of ethnicity on glycaemic index: a systematic review and meta-analysis

Effect of ethnicity on glycaemic index: a systematic review and meta-analysis

Glycemic index claims on food labels: review of Health Canada's evaluation

Evaluation of Glycemic Index Education in People Living with Type 2 Diabetes: Participant Satisfaction, Knowledge Uptake, and Application

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