Çocukluk Çağı Obezitesinin Beslenme Tedavisinde Yeni Bir Kavram: Besin İnsülin İndeksi

Öz

Çocukluk çağı obezitesinin tedavisinde ilk adımı, sağlıklı beslenme alışkanlıklarının kazandırılması ve fiziksel aktivite düzeyinin artırılmasını kapsayan sağlıklı yaşam tarzı değişiklikleri oluşturmaktadır. Bununla birlikte, geleneksel yaklaşımlar ile istenilen başarının elde edilememesi klinisyenleri yeni tedavi arayışlarına yöneltmiştir. Bunlar arasında en çok ilgi çeken yaklaşımlardan birisi, postprandiyal kan glukoz ve insülin düzeylerinin düzenlenmesine yönelik beslenme yaklaşımları olmuştur. Bu yaklaşımlar ile karbonhidrat içeren besinlerin glisemik yanıtlarını değerlendirmek için kullanılan glisemik indeks (Gİ) kavramı gündeme gelmiştir. Yapılan çalışmalarda, diyetin Gİ’i ile obezite arasındaki ilişkinin gösterilmesi ve düşük Gİ’li öğünler ile postprandiyal kan glukoz ve insülin düzeylerinin yanısıra açlık hissi ve besin alımının azaltılabileceğine ilişkin sonuçlar elde edilmesi obezite tedavisinde düşük Gİ’li diyetlerin yardımcı olabileceğini düşündürmüştür. Diğer taraftan, postprandiyal insülin salınımında sadece karbonhidratların değil aynı zamanda protein ve yağların da rolü olduğunun bilinmesi akılları karıştırmaktadır. Bu nedenle, postprandiyal glisemik ve insülinemik yanıtın kontrol altına alınması için Gİ’in göz önünde bulundurulması yetersiz kalmakta ve karbonhidratlar ile birlikte protein ve yağların etkisini de değerlendiren bir yönteme ihtiyaç duyulmaktadır. Bu gereksinimi karşılamak amacıyla besin insülin indeksi (Bİİ) kavramı geliştirilmiştir. Oldukça yeni bir kavram olan Bİİ ile ilgili yapılan çalışma sayısı sınırlı olmakla birlikte, postprandiyal insülin yanıt ve iştah üzerine elde edilen olumlu sonuçlar umut vaat edicidir. Sonuç olarak, çocukluk çağı obezitesinin tedavisinde düşük Gİ’li ve Bİİ’li diyetlerin kullanımı yararlı olabilir. Ancak, kesin önerilerde bulunabilmek için iyi planlanmış daha fazla kısa ve uzun dönem çalışmaya gereksinme vardır.

Anahtar Kelimeler

• çocuk,adölesan,obezite,glisemik indeks,besin insülin indeksi

A New Concept in the Nutrition Therapy of Childhood Obesity: Food Insulin Index

Öz

Kaynakça

1. 1. Lakshman R, Elks CE, Ong KK. Childhood obesity. Circulation 2012;126:1770-9.
2. 2. Sabin MA, Kiess W. Childhood obesity: Current and novel approaches. Best Pract Res Clin Endocrinol Metab 2015;29:327-38.
3. 3. Han JC, Lawlor DA, Kimm SY. Childhood obesity. Lancet 2010;375:1737-48.
4. 4. Visuthranukul C, Sirimongkol P, Prachansuwan A, Pruksananonda C, Chomtho S. Low-glycemic index diet may improve insulin sensitivity in obese children. Pediatr Res 2015;78:567-73.
5. 5. Fajcsak Z, Gabor A, Kovacs V, Martos E. The effects of 6-week low glycemic load diet based on low glycemic index foods in overweight/obese children--pilot study. J Am Coll Nutr 2008;27:12-21.
6. 6. Bao J, Atkinson F, Petocz P, Willett WC, Brand-Miller JC. Prediction of postprandial glycemia and insulinemia in lean, young, healthy adults: Glycemic load compared with carbohydrate content alone. Am J Clin Nutr 2011;93:984-96.
7. 7. Özel HG. Glisemik indeks ve yük: Gerçekler ve çelişkiler. In: Tayfur M, Ayhan NY (eds). Beslenme ve Diyetetik Güncel Konular - II. 1.Baskı. Ankara: Hatiboğlu Yayınevi; 2015. p.109-36.
8. 8. Bao J, de Jong V, Atkinson F, Petocz P, Brand-Miller JC. Food insulin index: Physiologic basis for predicting insulin demand evoked by composite meals. Am J Clin Nutr 2009;90:986-92.

9. 9. Barba G, Sieri S, Russo MD, Donatiello E, Formisano A, Lauria F, et al. Glycaemic index and body fat distribution in children: The results of the ARCA project. Nutr Metab Cardiovasc Dis 2012;22:28-34.
10. 10. Nimptsch K, Brand-Miller JC, Franz M, Sampson L, Willett WC, Giovannucci E. Dietary insulin index and insulin load in relation to biomarkers of glycemic control, plasma lipids, and inflammation markers. Am J Clin Nutr 2011;94:182-90.
11. 11. Joslowski G, Goletzke J, Cheng G, Günther AL, Bao J, Brand-Miller JC, et al. Prospective associations of dietary insulin demand, glycemic index, and glycemic load during puberty with body composition in young adulthood. Int J Obes (Lond) 2012;36:1463-71.
12. 12. Joslowski G, Halim J, Goletzke J, Gow M, Ho M, Louie JC, et al. Dietary glycemic load, insulin load, and weight loss in obese, insulin resistant adolescents: RESIST study. Clin Nutr 2015;34:89-94.
13. 13. Bell KJ, Bao J, Petocz P, Colagiuri S, Brand-Miller JC. Validation of the food insulin index in lean, young, healthy individuals, and type 2 diabetes in the context of mixed meals: An acute randomized crossover trial. Am J Clin Nutr 2015;102:801-6.
14. 14. Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM, et al. Glycemic index of foods: A physiological basis for carbohydrate exchange. Am J Clin Nutr 1981;34:362-6.
15. 15. Ludwig DS. Clinical update: The low-glycaemic-index diet. Lancet 2007;369:890-2.
16. 16. Silva KC, Neri Nobre L, Emanuelle de Castro Ferreira Vicente S, Lopes Moreira L, do Carmo Lessa A, Alves Lamounier J. Influence of glycemic index and glycemic load of the diet on the risk of overweight and adiposity in childhood. Rev Paul Pediatr 2016;34:293-300.
17. 17. Rouhani MH, Kelishadi R, Hashemipour M, Esmaillzadeh A, Azadbakht L. Glycemic index, glycemic load and childhood obesity: A systematic review. Adv Biomed Res 2014;3:47-54.
18. 18. Granot E. Childhood obesity: New paradigms on susceptibility, co-morbidities, and interventions. In: Bendich A, Deckelbaum RJ (eds). Preventive Nutrition. 5th edition. Switzerland: Springer International Publishing; 2015. p.321-34.
19. 19. Augustin LS, Kendall CW, Jenkins DJ, Willett WC, Astrup A, Barclay AW, et al. Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC). Nutr Metab Cardiovasc Dis 2015;25:795-815.
20. 20. Schwingshackl L, Hoffmann G. Long-term effects of low glycemic index/load vs. high glycemic index/load diets on parameters of obesity and obesity-associated risks: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2013;23:699-706.
21. 21. Spieth LE, Harnish JD, Lenders CM, Raezer LB, Pereira MA, Hangen SJ, et al. A low-glycemic index diet in the treatment of pediatric obesity. Arch Pediatr Adolesc Med 2000;154:947-51.
22. 22. Kirk S, Brehm B, Saelens BE, Woo JG, Kissel E, D'Alessio D, et al. Role of carbohydrate modification in weight management among obese children: A randomized clinical trial. J Pediatr 2012;161:320-7 e1.
23. 23. Parillo M, Licenziati MR, Vacca M, De Marco D, Iannuzzi A. Metabolic changes after a hypocaloric, low-glycemic-index diet in obese children. J Endocrinol Invest 2012;35:629-33.
24. 24. Kong AP, Choi KC, Chan RS, Lok K, Ozaki R, Li AM, et al. A randomized controlled trial to investigate the impact of a low glycemic index (GI) diet on body mass index in obese adolescents. BMC Public Health 2014;14:180.
25. 25. Siegel RM, Neidhard MS, Kirk S. A comparison of low glycemic index and staged portion-controlled diets in improving BMI of obese children in a pediatric weight management program. Clin Pediatr (Phila) 2011;50:459-61.
26. 26. Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, Ludwig DS. A reduced-glycemic load diet in the treatment of adolescent obesity. Arch Pediatr Adolesc Med 2003;157:773-9.
27. 27. Papadaki A, Linardakis M, Larsen TM, van Baak MA, Lindroos AK, Pfeiffer AF, et al. The effect of protein and glycemic index on children's body composition: the DiOGenes randomized study. Pediatrics 2010;126:e1143-52.
28. 28. Mirza NM, Palmer MG, Sinclair KB, McCarter R, He J, Ebbeling CB, Ludwig DS, et al. Effects of a low glycemic load or a low-fat dietary intervention on body weight in obese Hispanic American children and adolescents: A randomized controlled trial. Am J Clin Nutr 2013;97:276-85.
29. 29. Rouhani MH, Kelishadi R, Hashemipour M, Esmaillzadeh A, Azadbakht L. The effect of low glycemic index diet on body weight status and blood pressure in overweight adolescent girls: A randomized clinical trial. Nutr Res Pract 2013;7:385-92.
30. 30. Rouhani MH, Kelishadi R, Hashemipour M, Esmaillzadeh A, Surkan PJ, Keshavarz A, et al. The impact of a low glycemic index diet on inflammatory markers and serum adiponectin concentration in adolescent overweight and obese girls: A randomized clinical trial. Horm Metab Res 2016;48:251-6.
31. 31. Schwingshackl L, Hobl LP, Hoffmann G. Effects of low glycaemic index/low glycaemic load vs. high glycaemic index/ high glycaemic load diets on overweight/obesity and associated risk factors in children and adolescents: A systematic review and meta-analysis. Nutr J 2015;14:87.
32. 32. Jakubowicz D, Wainstein J, Ahrén B, Bar-Dayan Y, Landau Z, Rabinovitz HR, et al. High-energy breakfast with low-energy dinner decreases overall daily hyperglycaemia in type 2 diabetic patients: A randomised clinical trial. Diabetologia 2015;58:912-9.
33. 33. Chaput JP, Tremblay A, Rimm EB, Bouchard C, Ludwig DS. A novel interaction between dietary composition and insulin secretion: Effects on weight gain in the Quebec Family Study. Am J Clin Nutr 2008;87:303-9.
34. 34. Ball SD, Keller KR, Moyer-Mileur LJ, Ding YW, Donaldson D, Jackson WD. Prolongation of satiety after low versus moderately high glycemic index meals in obese adolescents. Pediatrics 2003;111:488-94.
35. 35. Cooper SB, Bandelow S, Nute ML, Morris JG, Nevill ME. Breakfast glycaemic index and exercise: Combined effects on adolescents' cognition. Physiol Behav 2015;139:104-11.
36. 36. Ludwig DS, Majzoub JA, Al-Zahrani A, Dallal GE, Blanco I, Roberts SB. High glycemic index foods, overeating, and obesity. Pediatrics 1999;103:E26.
37. 37. Mirza NM, Klein CJ, Palmer MG, McCarter R, He J, Ebbeling CB, et al. Effects of high and low glycemic load meals on energy intake, satiety and hunger in obese Hispanic-American youth. Int J Pediatr Obes 2011;6:e523-31.
38. 38. Zakrzewski JK, Stevenson EJ, Tolfrey K. Effect of breakfast glycemic index on metabolic responses during rest and exercise in overweight and non-overweight adolescent girls. Eur J Clin Nutr 2012;66:436-42.
39. 39. Çelik H. Eksojen Obez Adolesanların Düşük ve Yüksek Glisemik İndeksli Kahvaltıya Yanıtının Serum Glikoz, İnsülin, C-Peptid ve Lipid Düzeyleri ile Değerlendirilmesi (Uzmanlık Tezi). Edirne: Trakya Üniversitesi; 2007.
40. 40. Chang KT, Lampe JW, Schwarz Y, Breymeyer KL, Noar KA, Song X, et al. Low glycemic load experimental diet more satiating than high glycemic load diet. Nutr Cancer 2012;64:666-73.
41. 41. Warren JM, Henry CJ, Simonite V. Low glycemic index breakfasts and reduced food intake in preadolescent children. Pediatrics 2003;112:e414.
42. 42. Batista SMM, Moreira EAM, Fiates GMR, de Assis MAA, Teixeira E. Effect of low glycaemic index diets on satiety. British Food Journal 2014;116:1233-46.
43. 43. Brindal E, Baird D, Slater A, Danthiir V, Wilson C, Bowen J, et al. The effect of beverages varying in glycaemic load on postprandial glucose responses, appetite and cognition in 10-12-year-old school children. Br J Nutr 2013;110:529-37.
44. 44. Brindal E, Baird D, Danthiir V, Wilson C, Bowen J, Slater A, et al. Ingesting breakfast meals of different glycaemic load does not alter cognition and satiety in children. Eur J Clin Nutr 2012;66:1166-71.
45. 45. Rosen LA, Ostman EM, Bjorck IM. Postprandial glycemia, insulinemia, and satiety responses in healthy subjects after whole grain rye bread made from different rye varieties. J Agricl Food Chem 2011;59:12149-54.
46. 46. Kong KL, Hendrich S. Glycemic index, insulinemic index, and satiety index of kefir. J Am Coll Nutr 2012;31:280-7.
47. 47. Simmons AL, Miller CK, Clinton SK, Vodovotz Y. A comparison of satiety, glycemic index, and insulinemic index of wheat-derived soft pretzels with or without soy. Food Funct 2011;2:678-83.
48. 48. Gonzalez-Anton C, Rico MC, Sanchez-Rodriguez E, Ruiz-Lopez MD, Gil A, Mesa MD. Glycemic responses, appetite ratings and gastrointestinal hormone responses of most common breads consumed in Spain: A randomized control trial in healthy humans. Nutrients 2015;7:4033-53.
49. 49. LaCombe A, Ganji V. Influence of two breakfast meals differing in glycemic load on satiety, hunger, and energy intake in preschool children. Nutr J 2010;9:53.