Acute effect of meal glycemic index and glycemic load on blood glucose and insulin responses in humans

Objective: Foods with contrasting glycemic index when incorporated into a meal, are able to differentially modify glycemia and insulinemia. However, little is known about whether this is dependent on the size of the meal. The purposes of this study were: i) to determine if the differential impact on blood glucose and insulin responses induced by contrasting GI foods is similar when provided in meals of different sizes, and; ii) to determine the relationship between the total meal glycemic load and the observed serum glucose and insulin responses. Methods: Twelve obese women (BMI 33.7 +/- 2.4 kg/m(2)) were recruited. Subjects received 4 different meals in random order. Two meals had a low glycemic index (40-43%) and two had a high-glycemic index (86-91%). Both meal types were given as two meal sizes with energy supply corresponding to 23% and 49% of predicted basal metabolic rate. Thus, meals with three different glycemic loads (95, 45-48 and 22 g) were administered. Blood samples were taken before and after each meal to determine glucose, free-fatty acids, insulin and glucagon concentrations over a 5-h period. Results: An almost 2-fold higher serum glucose and insulin incremental area under the curve (AUC) over 2 h for the high-versus low-glycemic index same sized meals was observed (p < 0.05), however, for the serum glucose response in small meals this was not significant (p = 0.38). Calculated meal glycemic load was associated with 2 and 5 h serum glucose (r = 0.58, p < 0.01) and insulin (r = 0.54, p < 0.01) incremental and total AUC. In fact, when comparing the two meals with similar glycemic load but differing carbohydrate amount and type, very similar serum glucose and insulin responses were found. No differences were observed for serum free-fatty acids and glucagon profile in response to meal glycemic index. Conclusion: This study showed that foods of contrasting glycemic index induced a proportionally comparable difference in serum insulin response when provided in both small and large meals. The same was true for the serum glucose response but only in large meals. Glycemic load was useful in predicting the acute impact on blood glucose and insulin responses within the context of mixed meals.