GDM: Protein (2001)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:
To review the information on the metabolic response in people with NIDDM to ingested individual macronutrients.
Inclusion Criteria:
Article inclusion criteria not specified.
Exclusion Criteria:
Article exclusion criteria not specified.
Description of Study Protocol:

Recruitment:  Article search strategies not described. 

Design:  Narrative review

Blinding used (if applicable):  not applicable 

Intervention (if applicable):  not applicable 

Statistical Analysis

Statistical analysis not completed.

 

Data Collection Summary:

Timing of Measurements:  not applicable 

Dependent Variables:  not applicable

Independent Variables:  not applicable 

Control Variables:  not applicable

 

Description of Actual Data Sample:

Initial N: 117 references included

Attrition (final N):  117

Age:  not mentioned

Ethnicity:  not mentioned

Other relevant demographics:

Anthropometrics:

Location:  Worldwide studies

 

Summary of Results:

Other Findings

The major absorbed products of carbohydrate-containing foods are glucose, fructose and galactose and the quantitative effect of these on the plasma glucose and insulin response is different for each.

In addition, data indicate that the glucose and particularly the insulin response is different from that in nondiabetic people.

The quantitative effect of dietary proteins and fats on the circulating glucose and insulin concentrations in nondiabetic and NIDDM subjects has also been reviewed, and neither has a significant effect on the glucose concentration. 

Protein stimulates insulin secretion, and this is relatively more prominent in people with NIDDM.

A strong synergistic interaction with glucose on insulin secretion is present, but this is absent in nondiabetic people.

Ingested fat does not independently stimulate insulin secretion.

However, when ingested with carbohydrate, it may have a considerable effect on the plasma glucose and/or insulin response to that carbohydrate, and the responses are different in nondiabetic and NIDDM subjects, which is probably not due to altered carbohydrate absorption.

Intestinal hormones undoubtedly play a large role in the insulin secretory response in all of these studies but this remains to be completely elucidated.

 

Author Conclusion:
The studies reviewed indicate that the quantitative insulin response to various absorbed nutrients differs considerably in people with mild to moderately severe NIDDM compared with healthy people.  The reasons for these differences are incompletely understood.  Because of the differences, some caution should be exercised when applying information obtained in healthy subjects to NIDDM subjects.
Funding Source:
Government: Veterans Administration
Industry:
National Dairy Council
Commodity Group:
University/Hospital: VA Medical Center, University of Minnesota
Reviewer Comments:

Searching strategy not described and research quality not assessed.

Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes