**4. Glycemic index and glycemic load**

By definition, the glycemic index (GI), compares equal quantities of available carbohydrate in foods and provides a measure of carbohydrate quality. Available carbohydrate can be cal‐ culated by summing the quantity of available sugars, starch, oligosaccharides, and malto‐ dextrins. By definition, (Salmeron J. etal 1997), the glycemic load (GL) is the product of a food's GI and its total available carbohydrate content: glycemic load = [GI × carbohydrate (g)]/100.

Therefore, the GL provides a summary measure of the relative glycemic impact of a "typi‐ cal" serving of the food. Foods with a GL ≤10 have been classified as low glycemic load and those with a value ≥20 as high glycemic load (Brand-Miller JC, Holt SHA, Petocz P: Reply to R. Mendosa. Am J ClinNutr 77: 994–995, 2003). In healthy individuals, stepwise increases in GL have been shown to predict stepwise elevations in postprandial blood glucose and/or in‐ sulin levels (Brand-Miller JC et al, 2003). It can be seen from the equation that either a low-GI/high-carbohydrate food or a high-GI/low-carbohydrate food can have the same GL. However, while the effects on postprandial glycemia may be similar, there is evidence that the two approaches will have very different metabolic effects, including differences in β-cell function, triglyceride concentrations, free fatty acid levels (Wolever TMS, et al. 2002), and ef‐ fects on satiety (Ball SD, et al. 2003).

Hence, the distinction has important implications for the prevention and management of diabetes and cardiovascular disease. Our concern is that the use of the GL or "glycemic re‐ sponse" in isolation may lead to the habitual consumption of lower-carbohydrate diets.

The use of the glycemic index has been shown to provide additional benefit to glycemic con‐ trol over that observed when total carbohydrate is considered alone (Brand-Miller. et al. 2003*).* This index compares glycaemic excursions after ingestion of a carbohydrate and com‐ pares it with the glycemic excursions after an equivalent amount of the monosaccharide glu‐ cose. Thus numerical values can be ascribed to potatoes, rice, bread, etc., which give a comparative indication of glycemic consequence.

Department for Agriculture ( USDA) reveal that – 43%-47% of calories are contributed by dietary carbohydrate, whereas 36-37% of calories are contributed by dietary fat, with 13% from saturated fatty acids, 14% from monosaturated, and 7% from polyunsaturated. A re‐ duction in high dietary takes of saturated fats, trans-fatty acids and cholesterol (all of which contains cholesterol-raising fatty acids) is an important goal to reduce the risk of cardiovas‐ cular disease. Although diabetes mellitus is usually categorized as a disease of carbohydrate metabolism, abnormalities of lipoprotein metabolism and adipose tissue distribution are al‐ so common. Cardiovascular disease accounts for the majority of deaths in people with dia‐ betes. Analysis of the Multiple Risk Factor Intervention Trial data for men with diabetes matched with non-diabetic men reported relative risk of death for men with diabetes was increased at a range from 2.83 to 4.46 depending on their level of serum cholesterol. (Stamler

Approximately 70% of the carbohydrate content should be derived from complex such as

An intake of simple carbohydrates with high fiber foods - such as complex grains (bran), vegetables (beans and peas containing galactomannan) and fruit (pectin) is recommended; this combination of food slows intestinal food absorption, reduce postprandial hyperglyce‐

By definition, the glycemic index (GI), compares equal quantities of available carbohydrate in foods and provides a measure of carbohydrate quality. Available carbohydrate can be cal‐ culated by summing the quantity of available sugars, starch, oligosaccharides, and malto‐ dextrins. By definition, (Salmeron J. etal 1997), the glycemic load (GL) is the product of a food's GI and its total available carbohydrate content: glycemic load = [GI × carbohydrate

Therefore, the GL provides a summary measure of the relative glycemic impact of a "typi‐ cal" serving of the food. Foods with a GL ≤10 have been classified as low glycemic load and those with a value ≥20 as high glycemic load (Brand-Miller JC, Holt SHA, Petocz P: Reply to R. Mendosa. Am J ClinNutr 77: 994–995, 2003). In healthy individuals, stepwise increases in GL have been shown to predict stepwise elevations in postprandial blood glucose and/or in‐ sulin levels (Brand-Miller JC et al, 2003). It can be seen from the equation that either a low-GI/high-carbohydrate food or a high-GI/low-carbohydrate food can have the same GL. However, while the effects on postprandial glycemia may be similar, there is evidence that the two approaches will have very different metabolic effects, including differences in β-cell function, triglyceride concentrations, free fatty acid levels (Wolever TMS, et al. 2002), and ef‐

Hence, the distinction has important implications for the prevention and management of diabetes and cardiovascular disease. Our concern is that the use of the GL or "glycemic re‐ sponse" in isolation may lead to the habitual consumption of lower-carbohydrate diets.

starch; intake of sucrose and highly refined sugars should be limited.

mia and lowers serum cholesterol levels (Stepanović R., et al. 1991).

**4. Glycemic index and glycemic load**

fects on satiety (Ball SD, et al. 2003).

J. et al. 1993)

472 Type 1 Diabetes

(g)]/100.

Factors that affect the glycemic response of foods are feeding rate, the rate of food ingestion, food ingredients (fat, protein, fiber, starch) and methods of cooking and food processing. In‐ fluence on glycemic response and physiological mechanisms of degradation of consumed food (pre-gastric and gastric hydrolysis, gastric emptying rate, intestinal hydrolysis and re‐ action to pancreatic and intestinal hormones). Bread, crackers, grain, potatoes, millet, corn, and chips have a high GI (> 90). Bran, oatmeal, rice, buckwheat have medium glycemic in‐ dex (e.g. 70-90). Black bread, pasta, barley and cooked rice have the lowest glycemic in‐ dex(<70) (Dimitrijević- Srećković V. 2002).

A controlled study in children using the GI of foods found flexible dietary instruction based on the food pyramid and low-GI choices achieved significantly better glycemic control after 12 months than more traditional dietary advice. (Gilbertson H. et al. 2001). In their study, Miller JB et al confirmed the significant influence of the lower GI nutrition on postprandial glucose levels. However, the impact on long-term glycemic control and co-morbidity was less efficient than pharmacological treatment.

Choosing low-GI foods in place of conventional or high-GI foods has a small but clinically useful effect on medium-term glycemic control in patients with diabetes. The incremental benefit is similar to that offered by pharmacological agents that also target postprandial hy‐ perglycemia. (Jennie Brand-Miller et al. 2003)

In addition, several prospective observational studies have found that the overall GI and gly‐ cemic load (GI × g carbohydrate) of the diet, but not total carbohydrate content, are independ‐ ently related to the risk of developing type 2 diabetes (Salmeron J et al, 1997), cardiovascular disease (Liu S et al, 2000), and some cancers (Augustin L, 2001, Franceschi S et al, 2001)

Low GI carbohydrate foods (GI < 55) may lower post-prandial hyperglycemia when they are chosen to replace higher GI foods (GI > 70) (Brand-Miller J. et al. 2003) Examples of low GI food sources include wholegrain breads, pasta, temperate fruits and dairy products. (Foster-Powell K. et al. 2002) Glycemic load (GL) is another method of predicting the postprandial blood glucose response, which takes into account both the GI of the food and the portion size. (Colombani PC, 2004). There has been no assessment of its efficacy in children.

Artificial sweeteners are widely used among diabetic patients. Two kinds of sweeteners may be distinguished:nutritive sweeteners which contain calories (fructose, sorbitol, mannitol) and non-nutritive which are calories-free (saccharin, cyclamate, aspartame). Fructose has the ad‐ vantage over sucrose; for its better taste, slow absorption from the digestive system; no insulin is required for itsutilization and it causes hyperglycemia less often The fructose intake should be limited to 25g/d. Saccharin is about 500 times the sweeter than sucrose; its use may be con‐ nected to the increased risk of bladder carcinoma (Dimitrijevic-Srećković V., 2002).
