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ORIGINAL RESEARCH COMMUNICATION |
1 From the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada (TMSW and MY), and The Human Nutrition Unit, School of Molecular and Microbial Biosciences, The University of Sydney, Sydney, Australia (XYZ, FA, and JCB-M)
Background: Recent studies have concluded that the carbohydrate content and glycemic index (GI) of individual foods do not predict the glycemic and insulinemic effects of mixed meals. We hypothesized that these conclusions may be unwarranted because of methodologic considerations.
Objective: The aim was to ascertain whether the GI and carbohydrate content of individual foods influence glucose and insulin responses elicited by realistic mixed meals in normal subjects.
Design: With the use of a crossover design, we determined the glucose and insulin responses of 6 test meals in 16 subjects in Sydney and the glucose responses of 8 test meals in 10 subjects in Toronto and then the results were pooled. The 14 different test meals varied in energy (220–450 kcal), protein (0–18 g), fat (0–18 g), and available carbohydrate (16–79 g) content and in GI (35–100; values were rounded).
Results:The glucose and insulin responses of the Sydney test meals varied over a 3-fold range (P < 0.001), and the glucose responses of the Toronto test meals varied over a 2.4-fold range (P < 0.001). The glucose responses were not related to the fat or protein content of the test meal. Carbohydrate content (P = 0.002) and GI (P = 0.022) alone were related to glucose responses; together they accounted for 88% of the variation in the glycemic response (P < 0.0001). The insulin response was significantly related to the glucose response (r = 0.94, P = 0.005).
Conclusions: When properly applied in realistic settings, GI is a significant determinant of the glycemic effect of mixed meals in normal subjects. For mixed meals within the broad range of nutrient composition that we tested, carbohydrate content and GI together explained 
90% of the variation in the mean glycemic response, with protein and fat having negligible effects.
Key Words: Humans • dietary carbohydrates • glycemic index • mixed meals • glucose • insulin
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