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its carbohydrate content, whereas a low-GI diet can be either high or low in carbohydrates. Second, physiological effects can be different for low-GI diets as compared with low-GL diets (Wolever et al., 1995). For example, in a study that evaluated four meals with different combinations of the GI (low or high) and carbohydrate content (low or high), the greatest contrast in effects on free fatty acid levels was found between the low-GI/high-carbohydrate meal and the low-GI/ low-carbohydrate (that is, lowest GL) meal (Wolever et al., 1995). Mechanistic studies of the GI and GL and energy balance It has been postulated that consumption of high-GI foods can lead to excess energy intake through rapid rises and rapid subsequent declines in blood glucose concentrations and associated increases in levels of counter-regulatory hormones (Ludwig, 2002). This is supported by the observation that declines in blood glucose concentrations acutely increased voluntary food intake in time-blinded volunteers (Melanson et al., 1999). Several studies have reported beneficial effects of low-GI meals on self-reported hunger and short-term energy intake (Raben, 2002; Pereira et al., 2004), but overall findings have been mixed (Raben, 2002). In addition, a greater reduction in resting energy expenditure has been observed in 39 overweight adults after a 10% weight reduction as result of a high-GL hypocaloric diet than after the same weight reduction as a result of a hypocaloric diet with a lower GL (Pereira et al., 2004). No differences in lean or fat mass were detected and the authors suggested that low postprandial circulating concentrations of metabolic substrates may have caused this difference possibly through neuroendocrinological adaptations to conserve energy (Pereira et al., 2004). It cannot be fully excluded that other differences between the diets including substantial differences in protein, fiber and micronutrients may have contributed to the observed effects. It is plausible that the effects on energy balance differ for different types of low-GI foods. For example, it has been reported that having some low-GI foods (for example, spaghetti) for breakfast reduced the glycemic response to a subsequent lunch as compared with high-GI white wheat bread, whereas having other low-GI foods for breakfast (for example, white wheat bread with added vinegar) did not (Liljeberg et al., 1999). The authors suggested that the ‘second-meal effect’ for the former foods might have resulted from the prolonged elevation of postprandial glucose concentrations and avoidance of a between-meal fasting. Furthermore, the effect of foods with a low-GI as a result of slow absorption of starches in the intestines may be different from that of foods with a low GI as a result of high fructose content. For example, slowly absorbed starches may reach the lower part of the ileum and stimulate the secretion of gut satiety hormones such as glucagon-like peptide-1 (McMillan-Price and Brand-Miller, 2006). Carbohydrate intake and obesity RM van Dam and JC Seidell Cohort studies of the GI and GL The association between the dietary GI or GL and changes in body weight has been examined in two cohort studies, and lower values were associated reductions in body weights (Spieth et al., 2000; Ma et al., 2005). However, the limited control for other dietary factors (Spieth et al., 2000; Ma et al., 2005) and substantial loss to follow-up (Spieth et al., 2000) complicate the interpretation of these results. Intervention studies of the GI and weight change Table 4 presents data on intervention studies that examined the dietary GI in relation to body weight and body fatness (Slabber et al., 1994; Tsihlias et al., 2000; Bouche et al., 2002; Wolever and Mehling, 2003; Sloth et al., 2004; Carels et al., 2005; Raatz et al., 2005). These trials had a duration ranging from 5 weeks (Bouche et al., 2002) to 12 months (Carels et al., 2005), and included only dietary advice (Slabber et al., 1994; Bouche et al., 2002; Carels et al., 2005; Raatz et al., 2005), provision of key foods (Tsihlias et al., 2000; Wolever and Mehling, 2003) or provision of foods that provided much of the total energy intake (Sloth et al., 2004; Raatz et al., 2005). The presented intervention studies tested effects of slowly absorbed carbohydrates rather than fructose-rich low-GI foods. Effects of the dietary GI on body weight may be mediated by effects on satiety/satiation and energy intake. Therefore, we did not include studies in which energy intakes were fixed. In the study by Raatz et al. (2005) the energy intake was fixed in the first phase of the study, but not in the second ‘free-living’ phase. Although the dietary advice in the Slabber et al. (1994) intervention had a specific deficit in energy intake as a target, the characteristics of the trial (no foods provided 12-week duration) implied that the energy intake of the participants could still vary widely. In one of the studies, the low-GI intervention resulted in a statistically significant reduction in weight as compared with the control intervention (Slabber et al., 1994). This study consisted of a randomized parallel trial comparing a low-GI diet (‘low insulin response’ diet) with a control diet (‘balanced diet’), where about half of the participants volunteered to subsequently switch the other diet resulting in a cross-over study (Slabber et al., 1994). Although the same trend was observed in the parallel study and the cross-over study, differences in weight loss were only statistically significant in the latter. The used cross-over study approach may result in selection bias, because volunteering to switch to the other diet may depend on the experience with the previous diet. Another limitation of this study is that it is not reported how the diets changed as a result of the provided advice. Differences in diets other than the GI may have occurred, for example the ‘low-insulin response’ advice also included the instruction not to use any snacks. In a French study, dietary advice to consume low-GI foods did not lead to a lower body weight but resulted in a 0.5 kg lower fat mass as compared with dietary advice to eat high-GI foods (Bouche et al., 2002). Fiber intake also differed substantially S89 European Journal of Clinical Nutrition
European Journal of Clinical Nutrition Table 4 Intervention studies of low GI diets and body weight Reference/country Participants a (Slabber et al., 1994) South Africa (Tsihlias et al., 2000) Canada (Bouché et al., 2002) France (Wolever and Mehling, 2003) Canada (Sloth et al., 2004) Denmark (Carels et al., 2005) US n ¼ 30 F age 3576 years, BMI 3574. No loss to follow-up. n ¼ 16 participants volunteered to switch to the other diet after completion M/F type 2 diabetes High GI: n ¼ 22, age 63, BMI 28. Low GI: n ¼ 26 age 62, BMI 28. An additional n ¼ 7 (high GI) and n ¼ 4 (low GI) were lost to follow up and not included in analyses n ¼ 11 months, age 46, BMI 28. No loss to follow-up M/F impaired glucose tolerance; low GI: n ¼ 13 age 55, BMI 30; high GI: n ¼ 11 age 59, BMI 29 Trial design a Parallel design with minimization and cross-over study Duration Intervention Control Compliance Results 12 week (2 12 weeks for cross-over study): counseling Randomized parallel 6 months: breakfast cereals (10–15% total energy intake) provided and meal plans Randomized crossover study 2 5weekand5week washout: counseling Randomized parallel 4 months: monthly counseling and key foods provided F low GI: n ¼ 23, age Randomized parallel, 29, BMI 27.6; high GI: participants blinded n ¼ 22, age 31, BMI with regard to study 27.6; another n ¼ 6 aim (low GI) and n ¼ 4 (high GI) lost to follow-up not included in primary analysis n ¼ 40 F/M. Low GI, age 43.4, BMI 38.0; high GI, age 43.5, BMI 37.2. An additional n ¼ 13 was lost to follow up and not included in the analysis 10 weeks: test foods provided (B49% of total energy) Randomized parallel 20 week with weekly group sessions and 12 months follow-up Only carbohydrate foods with low insulin response, carbohydrate foods in separate meals, no snacks Low-GI cereals provided Foods with GI o45 recommended Instructed X1 low-GI food at each meal Low-GI test foods (GI 103) ‘Balanced diet’. Both advised intervention and control diet were hypocaloric (4200–5000 kJ per day) High-GI cereals provided Foods with GI 460 recommended Instructed X1 high-GI food at each meal High-GI test foods (GI 79) Behavioral weight loss Behavioral weight program þ GI loss program only education and popular book on GI Diet records. Difference in GI not reported Diet records: low GI reported 10 point lower GI and 27 g per day higher fiber intake as compared with high GI Diet records: Low GI 30 point lower GI and 12 g per day higher fiber intake Diet records: Low GI decreased GI 4.3 points and increased fiber 12 g per day. No significant changes for high GI Test food diaries (495% used), urinary lithium recovery from the provided bread (low GI 74%, high GI 82%, P40.05), diet records Test of difference in GI knowledge, session attendance, diet records: fivepoint GI difference achieved Parallel: intervention diet 9.3 kg, control 7.4 kg, difference 1.9 kg (95% CI 0.7, 4.6; P ¼ 0.14). Crossover: intervention diet 7.4 kg, control 4.5 kg, difference 2.9 kg (95% CI 0.1, 5.8; P ¼ 0.04) No statistically significant differences in body weight (high GI B1 kg more weight loss than low GI) No statistically significant difference in body weight. Low GI lost 0.52 kg body fat, high GI 0.02 (difference 0.50 kg Po0.05) High GI: 0.49 kg, low GI 0.19 kg (difference 0.30 kg, Po0.05) Low GI: 1.9 (SE 0.5) kg, high GI 1.3 (SE 0.3) kg (difference 0.6 kg, P ¼ 0.31) body weight (intention to treat: difference 0.4 kg, P ¼ 0.57). Fat mass: low GI 1.0 (0.4) kg, high GI 0.4 (0.3) kg (P difference 0.20) After 20 weeks: low GI 7.1 kg weight loss, controls: 8.2 kg weight loss. Difference not statistically significant, also not after 12 months follow-up S90 Carbohydrate intake and obesity RM van Dam and JC Seidell
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Comision Federal de la mejora regul
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Subject: MEXICO - Comments on PROY
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Item of PROY‐ NOM‐051 A.3.1 & A
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Annex 1.1: Ziesenitz, S.C.; 1996;
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Volume 61 Supplement 1 December 200
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Volume 61, Supplement 1, December 2
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S1 S5 S19 S40 S75 S100 S112 S122 S1
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FAO/WHO Scientific Update on carboh
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cardiovascular diseases and cancer)
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REVIEW Carbohydrate terminology and
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Table 2 Energy and macronutrient in
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are inulin and fructo oligosacchari
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Table 3 Principal physiological pro
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National Academy of Sciences in 200
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product contained X25% whole grain
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Henderson L, Gregory J, Swan G (200
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REVIEW Nutritional characterization
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Table 1 Nutritional characterizatio
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Table 2 Principles of carbohydrate
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Table 4 NSP in a selection of foods
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asked to consider both the ‘plant
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Table 5 Continued Plant-rich diet a
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account for any supplemented materi
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eaction vessels, with successive tr
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similar to the situation with sugar
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company working on dietary carbohyd
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Page 78 and 79: generated through bioenergetic inef
Page 80 and 81: Table 4 cE, ME and NME, and content
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Page 94 and 95: Table 5 Effect of NSP (dietary fibr
Page 96 and 97: As already described, almost any ca
Page 98 and 99: in adolescents. Possible mechanisms
Page 100 and 101: unit, such as a grant or fellowship
Page 102 and 103: Conference on Medical Research. Ros
Page 104 and 105: Prentice AM, Poppitt SD (1996). Imp
Page 106 and 107: REVIEW Carbohydrate intake and obes
Page 108 and 109: Total carbohydrate intake Introduct
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Page 112 and 113: European Journal of Clinical Nutrit
Page 114 and 115: postmenopausal US women (Howard et
Page 116 and 117: weight loss was greater after 6 mon
Page 118 and 119: European Journal of Clinical Nutrit
Page 122 and 123: Table 4 Continued Duration Interven
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Page 126 and 127: increased physical activity has bee
Page 128 and 129: with normal glucose tolerance: the
Page 130 and 131: Westerterp KR, Verboeket-van de Ven
Page 132 and 133: especially the NSP, complicates com
Page 134 and 135: 1.21, 1.35, 1.40 and 1.64. The patt
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Page 138 and 139: carbohydrate have generated broadly
Page 140 and 141: There is no good evidence of benefi
Page 142 and 143: Meyer KA, Kushi LH, Jacobs Jr DR, S
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Page 146 and 147: Table 3 Prospective studies of diet
Page 148 and 149: of sucrose-containing foods, such a
Page 150 and 151: Acrylamide Acrylamide is a chemical
Page 152 and 153: Nicodemus KK, Jacobs Jr DR, Folsom
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Page 156 and 157: Foods having very different nutrien
Page 158 and 159: esearch activities and food selecti
Page 160 and 161: highest satiety score was boiled po
Page 162 and 163: patients: a new basis for carbohydr
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Annex 1.4: US‐FDA GRAS Notificati
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FDA/CFSAN/OFAS: Agency Response Let
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Annex 1.5: US Health Claims Regulat
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jlentini on PROD1PC65 with RULES 30
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Annex 1.6: “PalatinoseTM (isomalt
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Isomaltulose is tooth friendly, unl
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CONFIDENTIAL Regulatory Affairs & N
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CONFIDENTIAL General or usual name:
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CONFIDENTIAL Plasma glucose change
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CONFIDENTIAL Rise in blood glucose
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CONFIDENTIAL References Regulatory
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Annex 1.8: Report from Imfeld (Univ
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Annex 2.2: Roberfroid, M.B., 1999;
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Annex 3.2: “Letter of no objectio
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1 Nutrition and Health Claims (CAC/
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Annex 3.2: “Letter of no objectio
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