Curs optional

Alimentaia n bolile metabolice

Alimentatia & Patologia

nutritionala si metabolica
Conf. Dr. Gabriela Roman
UMF Iuliu Haieganu
Centrul Clinic de Diabet, Nutriie, Boli metabolice
groman@umfcluj.ro

Centrul Clinic de
Diabet, Nutriie,
Boli metabolice
Cluj-Napoca

Cuprins

Nutriie

Generalitati

Definirea termenilor

Contextul alimentaie stil de via

Nutrigenomica

Patologia metabolic

Epidemiologie

Factori de risc

Riscul cardiometabolic al alimentaiei

Grasimile alimentare

Junk-food

Indexul glicemic

Nutriie

Dpdv biologic - nutriia - procesele fiziologice prin care

organismul metabolizeaz i asimileaz hrana pentru cretere,
meninere, repararea uzurilor i dezvoltare.

Nutriie - tiina care studiaz procesul prin care organismele

vii preiau, metabolizeaz i utilizeaz hrana pentru meninerea
vieii, cretere, funcionare a organelor i esuturilor,
reproducere i producere de energie, precum i rolul i

necesarul nutrienilor n organism pentru meninerea sntii.

Nutriia clinic - componenta practic prin care rezultatele

cercetrii i evidenele sunt aplicate la nivel individual n

condiiile existenei unei patologii induse de alimentaie sau a

unui risc crescut pentru aceasta.

Nutriionist persoana care

aplic tiina nutriiei pentru promovarea sntii, prevenirea i

controlul bolilor,

coordoneaz programe de cercetare, supraveghere i analiz

nutriionale,

Programe de depistare i control ale problemelor nutriionale

comunitare

Coordoneaz programe de instruire

Pregtire - program structurat, riguros i aprofundat de studiu a

nutriiei, nutrienilor, fiziologiei i fiziopatologiei nutriionale, n
cadrul nvmntului medical

n Romnia - dietetician sau asistent dietetician sau de nutriie, a

cror pregtire este reglementat n cadrul studiilor universitare.
Termenul de nutriionist i semnificaia tiinific i medical ce deriv
din acesta se regsete n cadrul specializrii medicale de diabet,
nutriie, boli metabolice.

Nutriie si Nutrieni

Nutrientul - substana chimic sau biologic activ de care

organismul are nevoie pentru supravieuire i cretere.
Nutrienii sunt inclui n proporii i cantiti variate n
diferitele alimente i rezult din metabolizarea acestora la
nivelul organismului, alimentele fiind astfel un important vector
prin care se realizeaz legtura dintre mediul exterior i
organism.
Nutrienii:

glucide, lipide, proteine, vitamine, minerale, ap i oxigen,

Diet, Dietetic si Dietoterapie

Termenul de diet provine din latinescul diaeta, sau mod de

via i definete modul de alimentaie a unei persoane, a unei
colectiviti a unei populaii.
In mod eronat i datorat unor preocupri i concepte la mod,
termenul de diet este utilizat doar n contextul alimentaiei
hipocalorice pentru prevenia sau tratamentul obezitii, sau
uneori n sens mai larg, n contextul unei alimentaii modificate
specific pentru tratamentul unei boli (de exemplu diabet
zaharat, obezitate).
Termenul de diet - similar cu alimentaie sau nutriie.
Dietetica, este o ramur a medicinei care se ocup cu studiul i
stabilirea regimurilor alimentare.

Terapia medical nutriional, sau dietoterapia

parte din practica medical alopat curent - metod de

tratament, prin modificri specifice n alimentaie.

Este o component esenial a managementului clinic al bolilor,

att al celor acute ct mai ales al celor cronice, innd cont de

faptul c n multe situaii poate fi singura metod de
tratament, n celelalte fiind asociat farmacoterapiei sau
chirurgiei.

Recomandrile pentru nutriia optim se refer la:

cantitatea alimentelor consumate,

la calitatea lor i

la modul lor de pregtire i consumare.

Nutrigenomica

Relaia dintre substanele bioactive din alimente i organism,

prin interaciunea cu genomul uman:

Substanele coninute n alimente (micro- i macro-nutrieni)

pot afecta direct sau indirect genomul uman prin modificri
ale structurii i expresiei genice

Dieta poate fi un factor de risc important pentru unele boli

Unele gene reglate de substane active din alimente pot juca

un rol crucial n apariia, incidena, progresia i severitatea
bolii.

Gradul n care dieta influeneaz echilibrul dintre sntate

i boal depinde de construcia genetic a individului.

Nutrigenomica

Interveniile nutriionale se bazeaz pe cunoaterea statusului

i nevoilor nutriionale ale individului dar i a genotipului
(nutriie individualizat) i se poate folosi pentru prevenirea sau

vindecarea bolilor cronice.

Diverse alimente pot interaciona cu anumite gene determinnd

creterea riscului pentru unele boli cronice, cum sunt diabetul
zaharat tip 2, obezitatea, cancerul, bolile cardiovasculare.

Ex. - este dovedit faptul c dieta matern n cursul sarcinii

este un factor important de programare metabolic prin
modularea homeostaziei ftului.

Stil de via Alimentaie - Risc de boal

Codul epigenetic
- informaii bazate pe nivelul de expresie al genelor
Programare epigenetic
- fetal
- postnatal, datorit unei nutriii inadecvate materne
sau n momentele critice ale dezvoltrii
Thrifty phenotype exprimare a genelor

Catherine Gallou-Kabani, Claudine Junien.

Nutritional Epigenomics of Metabolic Syndrome: New Perspective Against the Epidemic.
Diabetes, 2005, 54(7):1899-1906

Alterri epigenetice precoce

Mediul nutriional din perioada fetal sau din primii ani

influeneaza susceptibilitatea pt obezitate

procese epigenetice alterate prin subnutriie sau

supranutriie matern

Genele care controlez metabolismul lipidic, glucidic

Genele implicate n reglarea balanei apetit-aport caloric
la nivel central

International Journal of Obesity (2011) 35, 7283

Alterri epigenetice precoce

International Journal of Obesity (2011) 35, 7283

AMBIENTUL I NUTRIIA

Alimentaia se afl sub puternice influene i

determinri ale mediului:
cantitatea

i calitatea alimentelor,

comportamentul

alimentar, att la nivel

individual ct i comunitar

AMBIENTUL I NUTRIIA

Mediul i determinarea alimentaiei la nivel comunitar sunt:

Geografia i clima loco-regional

Modalitile i facilitile de producere i obinere a

hranei

Religia, obiceiurile, tradiia

Situaia politic, economic, social

La nivel individual - situaia financiar, social i

profesional a individului, de preferine, de cunotine i
de conceptele de via i sntate pe care le are.

AMBIENTUL I NUTRIIA
Factori generali de
mediu

Factori individuali cu efecte

directe i indirecte

Factori cu efect direct asupra

comportamentului nutriional

Alimente

Cost, aspect, gust, ofert,

valoare nutriional

Promovare

Tehnologie

Producia industrial de
alimente, procesarea
alimentelor, echiparea
buctriei

Costuri

Norme, valori, obiceiuri

religioase

Dieta vegetarian

Religie
coal
Cultur

Societate

Alimentaia din cantinele

colare, educaie nutriionl
Tradiii, educaie, experien,
caracteristici etnice

Norme, valori, nevoi,

publicitate, tendine,
comunicare, informare

Oferta
Disponibilitate

Posturile

Obiceiuri alimentare,

Oferta n cantine i
restaurante,

Exemplul celor din jur

AMBIENTUL I NUTRIIA
Factori generali de
mediu

Factori individuali cu efecte

directe i indirecte

Factori cu efect direct asupra

comportamentului nutriional

Familie

Numr membrii, obiceiuri,

mese n familie

Reete, mod de preparare

Factori
geografici,
climaterici

Relief, eficiena culturilor, Disponibilitate

creterea animlelor

Factori socioeconomici

Locul, timpul de preparare

i consum

Meniul de la cantine sau

restaurante

Stare de
sntate

Sntate, boal, dispoziie

psihic

Diete specifice

Genetici

Fenotipuri

Factori
fiziologici

Foame, sete, saietate,

Status

Ras, vrst, sex, greutate

Ocupaie

Loc de munc, activitate

fizic, timp liber

Apetit, preferine, aversiuni

Venit, posibiliti financiare

AMBIENTUL I NUTRIIA

Relaia alimentaie ambient se manifest la toate vrstele

i are un impact deosebit asupra dezvoltrii individului, strii
de sntate, speranei de via.

La nivel populaional acest impact se reflect n:

media de vrst a populaiei,

gradul de fertilitate i natalitate,

rata mortalitii la diverse vrste

n cauzele de mortalitate.

AMBIENTUL I NUTRIIA Evolutie

Industrializare, urbanizare, globalizarea pieelor, dezvoltare

economic i tiinific - impact semnificativ asupra stilului de
via, strii nutriionale i sntii populaiei.

Cresterea ponderii alimentelor cu coninut crescut de grsimi, n

principal saturate, dulciuri concentrate, proteine.

Scderea activitii fizice aport caloric excesiv

AMBIENTUL I NUTRIIA Evolutie

Westernizarea alimentaiei, indus de globalizarea pieelor, a

avut drept efect preluarea tot mai extins a alimentaiei de tip
fast-food, cu influene puternice asupra culturii alimentare i
a tradiiilor multor comuniti.

AMBIENTUL I NUTRIIA Evolutie

Alimentaia de tip West este cunoscut i ca alimentaie

carne-dulciuri (meat-sweet) i se caracterizeaz prin:

consum crescut i prioritar de alimente dense caloric:

carne roie,

produse lactate bogate n grsimi,

dulciuri

buturi dulci,

grsimi

cereale intens procesate

AMBIENTUL I NUTRIIA Evolutie

Curentul i conceptul fast-food este rezultatul transformrilor

sociale i industrializrii masive ce a necesitat asigurarea unei
alimentaii facile, rapide i ieftine:

prepararea alimentelor prin procesare intens

coninut crescut de calorii, provenite n principal din grsimi

i mai ales grsimi trans, de regul meniul coninnd carne
roie de tip burger, cartofi prjii i buturi carbogazoase
dulci.

n timp, coninutul caloric mare s-a amplificat prin creterea

continu a poriilor .

AMBIENTUL I NUTRIIA Evolutie

Bogia caloric, n grsimi trans i n dulciuri rafinate:

- insulinorezistena
- obezitate abdominala
- sindrom metabolic,
- DZ 2
- patologie cardiovasculara.

1972, M. Jacobson, directorul Center for Science in the Public

Interest din S.U.A., a denumit acest tip de alimentaie junk
food, respectiv alimentaia nesntoas, bogat caloric i fr
valoare nutritiv, ce conine cantiti mari de zahr rafinat,
faina alb, grsimi trans i polinesaturate, sare, aditivi
(glutamat de monosodiu, tartrazine, etc.), n acelai timp fiind
ns srac n proteine, vitamine i fibre.

AMBIENTUL I NUTRIIA Evolutie

Alimentaia nesntoas:

bogat caloric

fr valoare nutritiv,

cantiti mari de zahr rafinat,

faina alb,

grsimi trans

sare,

aditivi

srac n proteine, vitamine i fibre.

-

insulinorezistena
obezitate abdominala
sindrom metabolic,
DZ 2
DLP
patologie cardiovasculara.

AMBIENTUL I NUTRIIA Evolutie

Ca i rspuns la curentul fast-food, Carlo Petrini formeaz n

1986, n Italia, micarea slow food, ce are drept obiective
majore:

prezervarea buctriei i tradiiilor locale i naionale

promovarea alimentaiei nutritive, bazat pe produse

organice, fructe i legume proaspete, netratate i carne
provenit de la animale din ferme ecologice.

Micarea slow-food se opune la tot ceea ce nseamn modificare

genetic, tratarea culturilor cu pesticide, procesare excesiv a
alimentelor, utilizare de aditivi i arome artificiale, etc.

AMBIENTUL I NUTRIIA Evolutie

Eficientizarea produciei alimentare - intervenii calitative

- creteri suplimentare i rapide,
- inducerea rezistenei crescute la diversele boli
- procesri menite s prelungeasc valabilitatea produselor:

alimentele modificate genetic,

tratate cu diverse substane sintetice,

intens procesate,

cu coninut crescut de aditivi, unele din acestea fiind incriminate

ca surs de mbolnvire.

Echivalentul optim al acestora este reprezentat de alimentele

naturale, organice - BIO

Mediu TOXIC

Stil de via
Alimentaie

Riscant
Cardio-metabolic

Protectiv
Cardio-metabolic

Stil de via
cu risc crescut:
Expuneri
multiple la
Factori de
mediu,
ambientali

Susceptibilitate
genetic

Obezitate

IR
Sindrom metabolic
Ateroscleroz
DLP, inflamatie, tromboz
DZ 2

Ateroscleroz
Boal cardiovascular

Patologia metabolic
RCV & BCV
DZ 2
Sindrom metabolic
Obezitate (abdominal)
DLP, HTA
Factori
Mediu

Inflamatie & Tromboz &

Disf. Endoteliala
Insulinorezistena

Factori genetici
Iceberg B 15 - the world's largest recorded

Obezitate

DZ 2
SM
BCV

Age-adjusted Percentage of U.S. Adults Who

Were Obese or Who Had Diagnosed Diabetes
Obesity (BMI 30 kg/m2)
Obezitate
1994

No Data

<14.0%

2008

2000

14.0-17.9%

18.0-21.9%

22.0-25.9%

>26.0%

Diabetes

DZ 2

1994

No Data

2008

2000

<4.5%

4.5-5.9%

6.0-7.4%

7.5-8.9%

>9.0%

CDCs Division of Diabetes Translation. National Diabetes Surveillance System available at

http://www.cdc.gov/diabetes/statistics

Patologia cardio-metabolic

Bolile cardiovasculare I cauz de mortalitate

17.1 milioane decese de cauz CV 29% - 2004

ri afectate srace i n curs de dezvoltare - 82% decese

CV

2030 - 23.6 mil. Decese de cauz CV.

BCV cauza primar de deces zona Asiei de SE

WHO 2009

WHO: Preventing Chronic Diseases. A Vital Investment, Geneva, World

Health Organization, 2005.

Deaths in 2000 attributable to selected

leading risk factors in the world

Patologia cardio-metabolic
Factorii de risk pentru BCV i AVC?

Stilul de via nesntos

diet nesntoas

Sedentarism

Fumat

80 %

Factori de risc asociai SV nesntos

HTA

Hiperglicemie

Dislipidemie

Obezitate
WHO 2009

BCV in Romania

Incidena deceselor CV n Romania:

47% din totalul deceselor la brbai

51% n cazul femeilor

Romania - locul 3 n lume la mortalitatea din cauze

cardiovasculare

Speranta de viata < 10 ani

Asocierea ntre stilul de via nesntos

i patologia CV - Dovezi

Seven Countries Study

1950 - the Seven Countries Study designed to investigate relations between diet
and cardiovascular diseases.

Finland, Greece, Italy, Japan, The

Netherlands, United States, and Yugoslavia.
The study is marking approximately four
decades of prospective investigation.

Design and methods

During the base-line survey ~ 13 000 men,

aged 40-59 y, were medically examined.
Information on diet was collected in random
samples from each cohort by use of the
record method -The average daily
consumption per person of food groups
The base-line survey was followed-up after 5
and 10 years by repeat surveys.

Results

Results

Consum de grsimi saturate - Nivel colesterol

Mortalitate coronarian

Ancel Keys
1958 1970,
brbai (40-59 ani)

Results

Sugar products

Low in Yugoslavia

High in Finland and The Netherlands

Pastries

Low in Yugoslavia, Greece, and Japan

High in USA

In Finland the intake of milk, potatoes, edible fats, and sugar

products was very high.
In Italy the consumption of cereals and alcoholic drinks were
high.

Greece -high intake of olive oil and fruit.

Japan - a lot of fish, rice and soy products were consumed.

Yugoslavia high cereal products and egg consumption

Forty-Year Follow-Up of Coronary Heart Disease Mortality and

Its Predictors: The Corfu Cohort of the Seven Countries Study

529 brbai din zona rural - (40-59 ani) nrolai 1961 in

Corfu
120 (26%) din 461 decese atribuite Bolilor cardiovasculare
Factori predicitivi pentru mortalitatea CV :
vrst
fumat
Greutate, IMC
Colesterol
Supravieuitorii dup 40 ani :
activitate fizic
optimisti,
Nefumtori
Consum ulei de msline, pete, fructe, vegetale

Alimentaia

=
Cartofi
(1 porie / zi)
Cartofi prjii
(2 porii / sptmn)
nlocuirea unei porii de
cereale

Incidena DZ 2

Nurses Health Study:

- 84.555 femei
- 20 ani

Thomas L Halton. Potato and french fry consumption and risk of type 2 diabetes in
women. Am J Clin Nutr 2006;83:28490.

The Europe-wide EPIC Study

(European Prospective Investigation
into Cancer)

Impactul dietei asupra

sntii pe termen lung

Peste 500.000 persoane

/ 10 ri

Informatii

Chestionar de diet, activitate fizic i stil

de via;
Msurtori: greutate, IMC, circumferina
taliei;
Determinri biochimice

The EPIC-Norfolk Study:

fruit and vegetable intake and
population HbA1c levels

Obiective: raportarea consumului de fructe i vegetale i

asociarea cu HbA1c la cei fr diabet zaharat

Consumul de fructe i vegetale :

Concluzii:

5 porii pe zi - Rol protectiv pentru diabet

HbA1c mai mare la cei care consumau rar fructe i legume

The EPIC-Norfolk Study

Fat Consumption and HbA1c Levels

Objective: relationship between total dietary fat and the

pattern of fat intake, and HbA1c
Research design and methods:
2759 men and 3464 women (40-78 y) without type 2
diabetes
Semiquantitative food frequency questionnaire
Results:

HbA1c

negatively associated
lower saturated fat intake

positively associated
total fat intake

The EPIC-Norfolk Study

Fat Consumption and HbA1c Levels

Conclusion:

Independent association between HbA1c and total

fat intake

Saturated and monounsaturated fat intakes:

highly correlated with HbA1c

Dietary fat = risk factor for type 2 diabetes

Positive associations

Negative associations

(increased risk)
Total fat intake
Saturated & animal
fat and meat intake

(reduced risk)
Increased vegetable
fat intake
Polyunsaturated fat
(U.S.Nurses Health
Study)
Fish (rich in n-3
polyunsaturated fat)

A Recent EPIC-Norfolk Study

HbA1c: continuous risk factor for all-cause mortality

in men
Reduction in HbA1c of 0,1% = fall in excess
mortality of 5%
Lower HbA1c associated with low total fat intake
and high dietary P:S ratio

Atherosclerosis Risk in Communities (ARIC) study

1992 - 2008
DZ 2

B. coronariana

Stroke

Mortalitate

HbA1c DZ 2

EPIC-Norfolk: Concluzii

SV sntos poate aduga 14 ani de via :

Fara fumat
Activit fizic zilnic (minim 1 or) =>20% reducere risc de
deces CV
Consum de fructe i legume (5 porii)
Alcool moderat
Controlul stresului reduce riscul de AVC cu 24% pe 7 ani
Consumul de mic dejun :
IMC mai mic

EPIC-Norfolk: Key Findings

Dietary sodium and potassium intake and blood pressure:

Consuming the least salt (about 5 g daily)

=> lower average blood pressure

compared with

=> 50% risk of having hypertension

10 g/day

High intake of potassium (fruit and vegetables) protects

against hypertension

Bowel cancer: high dietary fibre protects against effects of

high meat intake

Alimentaia
EPIC-Heart project
- 141.233 brbai
- 316.078 femei

- 4,8 ani

Consumul zilnic de carne rosie risc de IM

European Prospective Investigation into Cancer and Nutrition

The Multiethnic Cohort - Dietary Patterns

and Risk for Diabetes

OBJECTIVE

The high diabetes incidence among Japanese Americans and

Native Hawaiians cannot be explained by BMI.

Influence of three dietary patterns of

fat and meat,

vegetables,

fruit and milk on diabetes risk in the Hawaii component

of the Multiethnic Cohort with 29,759 Caucasians,
35,244 Japanese Americans, and 10,509 Native
Hawaiians.

RESEARCH DESIGN AND METHODS

baseline food frequency questionnaire

14 years of follow-up

The Multiethnic Cohort - Dietary Patterns

and Risk for Diabetes

RESULTS

Fat and meat - significantly associated with diabetes risk in

men (hazard ratio 1.40 [95% CI 1.231.60], Ptrend <
0.0001) and women (1.22 [1.061.40], Ptrend = 0.004)

Vegetables lowered diabetes risk in men (0.86 [0.770.95],

Ptrend = 0.004)

fruit and milk seemed to be more beneficial in women (0.85

[0.760.96], Ptrend = 0.005)

CONCLUSIONS. Foods high in meat and fat appear to confer a

higher diabetes risk in all ethnic groups, whereas the effects
of other dietary patterns vary by sex and ethnicity.

The 5-year incidence of cardiovascular disease (CVD) in relation to

dietary habits, among men and women from Greece, was
evaluated.
Methods:
From May 2001 to December 2002, 1514 men and 1528 women (>18
years) without any clinical evidence of CVD, living in the Attica
area, Greece, were enrolled in the ATTICA study.

increased risk of CVD

HR per 1 unit = 1.26

lower risk of developing CVD

Rezultate

Dietary pattern that was - cereals, small fish, olive oil intake,
was associated with lower CVD risk

Pattern - fruits, vegetables intake and olive oil use in daily

cooking was associated with lower CVD risk

Patterns - sweets, red meat, margarine, salty nuts intake, and

hard cheese, as well as alcohol intake- higher CVD risk

THE INTERHEART Study

Potentially modifiable risk factors
associated with myocardial infarction
in 52 countries

Introduction
Aim of the study was:

to investigate the relation between risk factors and first

myocardial infarction

to estimate the importance of risk factors for acute

myocardial infarction for all regions of the world

Measured factors

Smoking (current smokers, former smokers)

Diabetes
Regular alcohol consumption
ApoB/ApoA1 ratio
WHR (abdominal obesity)
Hypertension
Consumption of fruit and vegetables
Physical activity
Psychosocial factors:
Depression
Locus of control (perceived ability to control life
circumstances)
Perceived stress (at work, at home, financial stress)
Life events

Methods

Study participants:

52 countries (in Africa, Asia, Australia, Europe, North and

South America and the Middle East)

262 centers (coronary care unit; cardiology ward)

15152 incident cases of AMI

14820 controls (no history of heart disease)

Methods

Procedures:
Study questionnaire:
Demographic factors (country of origin, first language)
Socioeconomic status (education, occupation, income)
Lifestyle (tobacco use, physical activity, diet)
Personal and family history of CVD and risk factors
(self-reported diabetes and hypertension)
Physical examination:
Height
Weight
Waist and hip circumference
Heart rate
Blood sample: total cholesterol, HDL-cholesterol, apoB and
apoA1

Results

The strongest risk predictor:

1. apoB/apoA1 ratio
2. Current smoking
3. Diabetes
4. Hypertension
5. Psychological factors

90% of the PAR

(population attributable risk)
in men and 94% in women.

Protective factors:
Fruit and vegetables
Exercises
Moderate consumption of alcohol

Macronutrienii i inflamaia

Nurses Health Study

Dieta Western
- carne roie,
- lipide saturate,

- dulciuri,
- cartofi prjii

PCR
E-selectin
IL-6,
sICAM-1,
sVCAM-1,
IMC

Esther Lopez-Garcia. Major dietary patterns are related to plasma concentrations of

markers of inflammation and endothelial dysfunction. Am J Clin Nutr 2004;80:1029 35

Macronutrienii caloriile i inflamaia

Aportul crescut de alimente bogate energetic (glucoz, lipide)

stress oxidativ
Perioada perinatal

efect pro-inflamator

Copilrie

Genele stimulate de aportul caloric crescut acut

activate n obezitate n condiii bazale

Reducerea cu 1000 kcal a aportului caloric

reducerea stressului oxidativ i a mediatorilor
inflamaiei

Undurti N. Pathopysiology of metabolic syndrome and its links to the perinatal period.
Nutrition, 2005, 21 (6):762-773

Glycemic Index and risk for developing

type 2 diabetes,
obesity and
cardiovascular disease

INDEX GLICEMIC

Indexul glicemic (GI)

caracterizeaz

alimentele din punct de vedere a

capacitii lor de a determina creterea glicemiei

i gradul acestei creteri.

GI - estimeaz puterea i gradul n care alimentele

vor determina creterea nivelului sanguin al glucozei.

INDEX GLICEMIC

GI este definit ca fiind

rspunsul glicemic la dou ore,

exprimat prin aria de sub curb (AUC) a nivelului sanguin al

glucozei,

determinat de alimentul-test consumat n condiii standard

de ctre un individ

exprimat procentual fa de efectul alimentului de referin

cu aceeai cantitate de glucide, consumat de acelai individ
n alt zi.

INDEX GLICEMIC

Ca aliment de referin se utilizeaz de obicei 50 g glucoz, a

crui index glicemic este de 100.

Astfel alimentele se clasific n trei categorii:

- cu index glicemic mic: GI 55
- cu index glicemic mediu: GI = 55-69
- cu index glicemic mare: GI 70

Pinea alb poate fi i ea utilizat ca referin, n acest caz

modificndu-se setul de valori ale indexului glicemic: dac GI
pine alb = 100, atunci GI glucoz = 140.

INDEX GLICEMIC

Clasificarea alimentelor n funcie de indexul glicemic (GI)

Nivel mic GI < 55 (Nivel de referin glucoza)

Majoritatea fructelor i legumelor:
castravetele,
conopida,
vinetele,
spanacul,
sparanghelul,
brocoli,
cireele,
piersicile,
merele,
perele,
prunele,
kiwi,
Grapefruit

Laptele,
Cerealele (orzul, orezul integral,
grul)
Alimentele cu coninut sczut de
glucide (petele, carnea alb)

INDEX GLICEMIC

Clasificarea alimentelor n funcie de indexul glicemic (GI)

Nivel mediu GI = 55-69 (Nivel de referin glucoza)

Portocalele,
Cerealele integrale, pinea neagr,
Cartofii dulci,
Orezul brun,
Iaurtul,
Ciocolata neagr cu un coniunt de cacao mai mare de 70%,
Fructele roii,
Soia

INDEX GLICEMIC

Clasificarea alimentelor n funcie de indexul glicemic (GI)

Nivel mare GI > 70 (Nivel de referin glucoza)

pinea alb,
produsele de patiserie,
cartofii, cartofii prjii,
orezul alb,
pizza,
ngheat,
Fructe: smochinele, bananele, strugurii, ananasul,
pepenele galben, pepenele verde, morcovii, sucul de
portocale, fructele n sirop, dulceaa,
ciocolata alb i cea cu lapte,
chipsurile,
pastele,
pop corn

Alimentele cu index glicemic mare hiperinsulinemie

Hiper trigliceride
LDL colesterol crescut
HDL cholesterol sczut
HTA
Insulino-rezisten
Inflamaie (prot C reactiv)
Apetit crescut
obezitate
Risc de diabet tip 2

INDEX GLICEMIC

Alimentele cu index glicemic mic:

Controlul ponderal

Reduc insulinorezistena

Reducerea riscului cardiovascular

Reducerea colesterolului

Reducerea senzaiei de foame pe o perioad mai mare

Susinerea prelungit a unei activiti fizice de de

rezisten

The consumption of
high-glycemic index foods

sharp decrease in blood

glucose levels (hypoglycemia)

higher and more rapid increases

in blood glucose levels

signals to the beta-cells of the

pancreas to increase insulin secretion

The consumption of lowglycemic index foods

lower but more sustained

increases in blood glucose

lower insulin demands

on pancreatic beta-cells

Glycemic index and Type 2 Diabetes Mellitus

In the Nurses Health Study (NHS), women with the highest
dietary glycemic loads were 37% more likely to develop type 2
DM over a 6-year period than women with the lowest dietary
glycemic loads.

Women with high-glycemic load diets that were low in cereal

fiber were more than twice as likely to develop type 2 DM than
women with low-glycemic load diets that were high in cereal
fiber. * *

*Willett W, Manson J, Liu S. Glycemic index, glycemic load, and risk of type 2 diabetes. Am J Clin Nutr.
2002;76(1):274S-280S. (PubMed)
* * Salmeron J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC. Dietary fiber, glycemic load,
and risk of non-insulin-dependent diabetes mellitus in women. JAMA. 1997;277(6):472-477. (PubMed)

Glycemic index and Type 2 Diabetes Mellitus

The foods that were most consistently associated with

increased risk of type 2 DM:

carbonated beverages

potatoes (cooked or French-fried),

white rice,

white bread.

In the American Cancer Society Cancer Prevention Study II,

which followed 124,907 men and women for nine years, high
glycemic load was associated with a 15% increased risk of type
2 DM**

Glycemic index and Cardiovascular Disease

In the NHS cohort, women with the highest dietary glycemic

loads had a risk of developing coronary heart disease (CHD)
over the next ten years that was almost twice as high as those
with the lowest dietary glycemic loads.*

The relationship between dietary glycemic load and CHD risk

was more pronounced in overweight women, suggesting that
people who are insulin resistant may be most susceptible to the

adverse cardiovascular effects of high dietary glycemic loads.**

*Liu S, Willett WC, Stampfer MJ, et al. A prospective study of dietary glycemic load, carbohydrate
intake, and risk of coronary heart disease in US women. Am J Clin Nutr. 2000;71(6):14551461. (PubMed)
**Liu S, Willett WC. Dietary glycemic load and atherothrombotic risk. Curr Atheroscler Rep.
2002;4(6):454-461. (PubMed)

Glycemic index and Obesity

Voluntary energy intake after the high-GI meal

was 53% greater than after the medium-GI meal (3.8 mJ),

81% greater than after the low-GI meal (3.2 mJ).

The high-GI meal resulted in higher serum insulin levels, lower

plasma glucagon levels, lower postabsorptive plasma glucose and
serum fatty acids levels, and elevation in plasma epinephrine.
The conclusion of the study that the rapid absorption of
glucose after consumption of high-GI meals induces a sequence
of hormonal and metabolic changes that promote excessive food
intake in obese subjects.

Ludwig DS, Majzoub JA, Al-Zahrani A, Dallal GE, Blanco I, Roberts SB, High glycemic index foods, overeating, and obesity.
Pediatrics. 1999 Mar;103(3):E26

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