Skip to main content
SpringerLink
Log in

Association between dietary insulin index and load with obesity in adults

  • Original Contribution
  • Published:
European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Purpose

Hyperinsulinemia is linked to the development of various chronic diseases, especially obesity given to the role of insulin responses in body fat accumulation; hence, the current study aimed to examine the association of insulinemic potential of the diet with general and abdominal obesity among a large population of Iranian adults.

Methods

This cross-sectional study was carried out among 8691 adult participants aged 18–55 years. Dietary data were collected using a validated dish-based 106-item semi-quantitative food frequency questionnaire. Dietary insulin index (DII) was computed through considering food insulin index values published earlier. Dietary insulin load (DIL) was also calculated using a standard formula. Assessment of anthropometric measures was conducted through a self-administered questionnaire. General obesity was defined as body mass index ≥ 25 kg/m2, and abdominal obesity as waist circumference ≥ 94 cm for men and ≥ 80 cm for women.

Results

Mean age of study participants was 36.8 ± 8.1 years; 60.3% were women. Compared with the lowest quintile, women in the highest quintile of DIL were less likely to be abdominally obese (OR 0.73; 95% CI 0.57–0.92). Such significant association was not seen after controlling for potential confounders (OR 0.86; 95% CI 0.44–1.67). Neither in crude nor in adjusted models, we observed a significant association between DIL and general obesity among men and women. In terms of dietary insulin index, men in the top quintile of DII were more likely to be generally overweight or obese compared with those in the bottom quintile (OR 1.27; 95% CI 1.00–1.62). This association became non-significant after controlling for demographic characteristics (OR 1.14; 95% CI 0.84–1.56). Furthermore, in thefully adjusted model, women in the top quintile of DII were more likely to have general obesity compared with those in the bottom quintile (OR 1.40; 95% CI 1.07–1.84).

Conclusions

We found that adherence to a diet with a high DII was associated with greater odds of general obesity among women, but not in men. Although such information might help to draw conclusions on the practical relevance of the shown findings, further studies, specifically of prospective design, are warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

FII:

Food insulin index

GI:

Glycemic index

DII:

Dietary insulin index

SEPAHAN:

Studying the epidemiology of psycho-alimentary health and nutrition

DS-FFQ:

Dish-based 106-item semi-quantitative food frequency questionnaire

USDA:

US Department of Agriculture waist circumference

DIL:

Dietary insulin load

WC:

Waist circumference

BMI:

Body mass index

NCEP:

National cholesterol education program

GPPAQ:

General practice physical activity questionnaire

ANOVA:

One-way analysis of variance

ANCOVA:

Analysis of covariance

OR:

Odds ratio

References

  1. Bell SJ, Sears B (2003) Low-glycemic-load diets: impact on obesity and chronic diseases. Crit Rev Food Sci Nutr 43:357–377. https://doi.org/10.1080/10408690390826554

    Article  PubMed  Google Scholar 

  2. Salmerón J, Ascherio A, Rimm EB, Colditz GA, Spiegelman D, Jenkins DJ, Stampfer MJ, Wing AL, Willett WC (1997) Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 20:545–550. https://doi.org/10.2337/diacare.20.4.545

    Article  PubMed  Google Scholar 

  3. Liu S, Willett WC, Stampfer MJ, Hu FB, Franz M, Sampson L, Hennekens CH, Manson JE (2000) A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr 71:1455–1461. https://doi.org/10.1093/ajcn/71.6.1455

    Article  CAS  PubMed  Google Scholar 

  4. Larsson SC, Orsini N, Wolk A (2005) Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst 97:1679–1687. https://doi.org/10.1093/jnci/dji375

    Article  PubMed  Google Scholar 

  5. Giovannucci E, Michaud D (2007) The role of obesity and related metabolic disturbances in cancers of the colon, prostate, and pancreas. Gastroenterology 132:2208–2225. https://doi.org/10.1053/j.gastro.2007.03.050

    Article  CAS  PubMed  Google Scholar 

  6. Ludwig DS (2000) The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA 287:2414–2423. https://doi.org/10.1001/jama.287.18.2414

    Article  Google Scholar 

  7. Tay J, Thompson CH, Luscombe-Marsh ND, Wycherley TP, Noakes M, Buckley JD, Wittert GA, Yancy WS, Brinkworth GD (2018) Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: a 2-year randomized clinical trial. Diabetes Obes Metab 20(4):858–871. https://doi.org/10.1111/dom.13164

    Article  CAS  PubMed  Google Scholar 

  8. Papakonstantinou E, Orfanakos N, Farajian P, Kapetanakou AE, Makariti IP, Grivokostopoulos N, Ha MA, Skandamis PN (2017) Short-term effects of a low glycemic index carob-containing snack on energy intake, satiety, and glycemic response in normal-weight, healthy adults: results from two randomized trials. Nutrition 42:12–19. https://doi.org/10.1016/j.nut.2017.05.011

    Article  CAS  PubMed  Google Scholar 

  9. Ellery THP, Sampaio HAC, Carioca AAF, Silva BYDC, Alves JAG, Da Silva Costa F, Araujo Júnior E, Melo MLP (2019) Association between dietary glycemic index and excess weight in pregnant women in the first trimester of pregnancy. Rev Bras Ginecol Obstet 41(1):4–10. https://doi.org/10.1055/s-0038-1676096

    Article  PubMed  Google Scholar 

  10. Wu T, Giovannucci E, Pischon T, Hankinson SE, Ma J, Rifai N, Rimm EB (2004) Fructose, glycemic load, and quantity and quality of carbohydrate in relation to plasma C-peptide concentrations in US women. Am J Clin Nutr 80(4):1043–1049. https://doi.org/10.1093/ajcn/80.4.1043

    Article  CAS  PubMed  Google Scholar 

  11. Moghaddam E, Vogt JA, Wolever TM (2006) The effects of fat and protein on glycemic responses in nondiabetic humans vary with waist circumference, fasting plasma insulin, and dietary fiber intake. J Nutr 136:2506–2511. https://doi.org/10.1093/jn/136.10.2506

    Article  CAS  PubMed  Google Scholar 

  12. Nuttall FQ, Gannon MC (l991) Plasma glucose and insulin response to macronutrients in nondiabetic and NIDDM subjects. Diabetes Care l4:824-838.https://doi.org/10.2337/diacare.14.9.824

  13. Ranganath L, Norris F, Morgan L, Wright J, Marks V (1999) The effect of circulating non-esterified fatty acids on the entero-insular axis. Eur J Clin Invest 29(1):27-32.https://doi.org/10.1046/j.1365-2362.1999.00426.x

  14. Bao J, de Jong V, Atkinson F, Petocz P, Brand-Miller JC (2009) Food insulin index: physiologic basis for predicting insulin demand evoked by composite meals. Am J Clin Nutr 90:986-992.https://doi.org/10.3945/ajcn.2009.27720

  15. Bell KJ, Petocz P, Colagiuri S, Brand-Miller JC (2016) Algorithms to improve the prediction of postprandial insulinaemia in response to common foods. Nutrients 8(4):210. https://doi.org/10.3390/nu8040210

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Bell KJ, Bao J, Petocz P, Colagiuri S, Brand-Miller JC (2015) 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 102:801–806. https://doi.org/10.3945/ajcn.115.112904

    Article  CAS  PubMed  Google Scholar 

  17. Nimptsch K, Brand-Miller JC, Franz M, Sampson L, Willett WC, Giovannucci E (2011) Dietary insulin index and insulin load in relation to biomarkers of glycemic control, plasma lipids, and inflammation markers. Am J Clin Nutr 94(1):182–190. https://doi.org/10.3945/ajcn.110.009555

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Rummo P, Kanchi R, Perlman S, Elbel B, Trinh-Shevrin C, Thorpe L (2018) Change in obesity prevalence among New York City adults: the NYC health and nutrition examination survey, 2004 and 2013–2014. J Urban Health. https://doi.org/10.1007/s11524-018-0310-2

    Article  PubMed  PubMed Central  Google Scholar 

  19. World Health Organization (2016) WHO Media center. Obesity and overweight. World Health Organization, Geneva. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

  20. Kilpi F, Webber L, Musaigner A, Aitsi-Selmi A, Marsh T, Rtveladze K, McPherson K, Brown M (2013) Alarming predictions for obesity and non-communicable diseases in the Middle East. Public Health Nutr 17(5):1078–1086. https://doi.org/10.1017/S1368980013000840

    Article  PubMed  Google Scholar 

  21. Adibi P, Keshteli AH, Esmaillzadeh A, Afshar H, Roohafza H, Bagherian-Sararoudi R, Daghaghzadeh H, Soltanian N, Feinle-Bisset C, Boyce PH et al (2012) The study on the epidemiology of psychological, alimentary health and nutrition (SEPAHAN): overview of methodology. J Res Med Sci 17:292–298

    Google Scholar 

  22. Fung TT, Hu FB, Pereira MA, Liu S, Stampfer MJ, Colditz GA, Willett WC (2002) Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. Am J Clin Nutr 76(3):535–540. https://doi.org/10.1093/ajcn/76.3.535

    Article  CAS  PubMed  Google Scholar 

  23. Willett W (2013) Nutritional epidemiology. Oxford University Press, Oxford

    Google Scholar 

  24. Keshteli AH, Esmaillzadeh A, Rajaie S, Askari G, Feinle-Bisset CH, Adibi P (2014) A dish based semi-quantitative food frequency questionnaire for assessment of dietary intakes in epidemiologic studies in Iran: design and development. Int J Prev Med 5(1):29–36

    PubMed  PubMed Central  Google Scholar 

  25. Ghaffarpour M, Houshiar-Rad A, Kianfar H (1999) The manual for household measures, cooking yields factors and edible portion of foods. Nashre Olume Keshavarzy, Tehran

    Google Scholar 

  26. Kimura Y, Wada T, Okumiya K, Ishimoto Y, Fukutomi E, Kasahara Y, Chen W, Sakamoto R, Fujisawa M, Otsuka K, Matsubayashi K (2012) Eating alone among community-dwelling Japanese elderly: association with depression and food diversity. J Nutr Health Aging 16:728–731. https://doi.org/10.1007/s12603-012-0067-3

    Article  CAS  PubMed  Google Scholar 

  27. Salehi-Abargouei A, Esmaillzadeh A, Azadbakht L, Keshteli AH, Feizi A, Feinle-Bisset CH, Adibi P (2016) Nutrient patterns and their relation to general and abdominal obesity in Iranian adults: findings from the SEPAHAN study. Eur J Nutr 55(2):505–518. https://doi.org/10.1007/s00394-015-0867-4

    Article  PubMed  Google Scholar 

  28. Holt S, Miller J, Petocz P (1997) An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods. Am J Clin Nutr 66(5):1264–1276. https://doi.org/10.1093/ajcn/66.5.1264

    Article  CAS  PubMed  Google Scholar 

  29. Lean ME, Han TS, Morrison CE (1995) Waist circumference as a measure for indicating need for weight management. BMJ 311:158–161. https://doi.org/10.1136/bmj.311.6998.158

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. National Cholesterol Education Program Expert Panel on Detection E, Treatment of High Blood Cholesterol in A (2002) Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 106:3143–3421

    Article  Google Scholar 

  31. Department of Health (2006) The general practice physical activity questionnaire. Department of Health, London. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_063812

  32. Sung KC, Lee MY, Kim YH, Huh JH, Kim JY, Wild SH, Byrne CD (2018) Obesity and incidence of diabetes: effect of absence of metabolic syndrome, insulin resistance, inflammation and fatty liver. Atherosclerosis 275:50–57. https://doi.org/10.1016/j.atherosclerosis.2018.05.042

    Article  CAS  PubMed  Google Scholar 

  33. Seino Susumu, Shibasaki Tadao, Minami Kohtaro (2011) Dynamics of insulin secretion and the clinical implications for obesity and diabetes. J Clin Invest 121:2118–2125. https://doi.org/10.1172/JCI45680

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Joslowski G, Goletzke J, Cheng G, Günther AL, Bao J, Brand-Miller JC, Buyken AE (2012) Prospective associations of dietary insulin demand, glycemic index, and glycemic load during puberty with body composition in young adulthood. Int J Obes (Lond) 36(11):1463–1471. https://doi.org/10.1038/ijo.2011.241

    Article  CAS  Google Scholar 

  35. Prescott J, Bao Y, Viswanathan AN, Giovannucci EL, Hankinson SE, De Vivo I (2014) Dietary insulin index and insulin load in relation to endometrial cancer risk in the Nurses’ Health Study. Cancer Epidemiol Biomark Prev 23(8):1512–1520. https://doi.org/10.1158/1055-9965.EPI-14-0157

    Article  CAS  Google Scholar 

  36. Bao Y, Nimptsch K, Wolpin BM, Michaud DS, Brand-Miller JC, Willett WC, Giovannucci E, Fuchs CS (2011) Dietary insulin load, dietary insulin index, and risk of pancreatic cancer. J Clin Nutr 94(3):862–868. https://doi.org/10.3945/ajcn.110.011205

    Article  CAS  Google Scholar 

  37. Xu H, Barnes GT, Yang Q, Tan G, Yang D, Chou CJ, Sole J, Nichols A, Ross JS, Tartaglia LA et al (2003) Chronic inflammation in fat plays a crucial role in the development of obesity-related insulin resistance. J Clin Invest 112(12):1821–1830. https://doi.org/10.1172/JCI19451

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Mirmiran P, Esfandiari S, Bahadoran Z, Tohidi M, Azizi F (2016) Dietary insulin load and insulin index are associated with the risk of insulin resistance: a prospective approach in tehran lipid and glucose study. J Diabetes Metab Disord 20:15–23. https://doi.org/10.1186/s40200-016-0247-5

    Article  CAS  Google Scholar 

  39. Bao Y, Nimptsch K, Meyerhardt JA, Chan AT, Ng K, Michaud DS et al (2010) Dietary insulin load, dietary insulin index, and colorectal cancer. Cancer Epidemiol Biomark Prev 19:3020–3026. https://doi.org/10.1158/1055-9965

    Article  CAS  Google Scholar 

  40. Bahreynian M, Esmaillzadeh A (2012) Quantity and quality of carbohydrate intake in Iran: a target for nutritional intervention. Arch Iran Med 15:648–649

    PubMed  Google Scholar 

  41. Lovejoy JC, Sainsbury A, Stock Conference Working G (2009) Sex differences in obesity and the regulation of energy homeostasis. Obes Rev 10:154–167. https://doi.org/10.1111/j.1467-789X.2008.00529.x

    Article  CAS  PubMed  Google Scholar 

  42. Pelletier G, Li S, Luu-The V, Labrie F (2007) Oestrogenic regulation of pro-opiomelanocortin, neuropeptide Y and corticotrophin-releasing hormone mRNAs in mouse hypothalamus. J Neuroendocrinol 19:426–431. https://doi.org/10.1111/j.1365-2826.2007.01548.x

    Article  CAS  PubMed  Google Scholar 

  43. Clegg DJ, Brown LM, Zigman JM, Kemp CJ, Strader AD, Benoit SC, Woods SC, Mangiaracina M, Geary N (2007) Estradiol-dependent decrease in the orexigenic potency of ghrelin in female rats. Diabetes 56:1051–1058. https://doi.org/10.2337/db06-0015

    Article  CAS  PubMed  Google Scholar 

  44. Adamczak M, Rzepka E, Chudek J, Wiecek A (2005) Ageing and plasma adiponectin concentration in apparently healthy males and females. Clin Endocrinol (Oxf) 62(1):114–118. https://doi.org/10.1111/j.1365-2265.2004.02182.x

    Article  CAS  Google Scholar 

  45. Kahn SE, Hull RL, Utzschneider KM (2006) Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature 444(7121):840–846. https://doi.org/10.1038/nature05482

    Article  CAS  PubMed  Google Scholar 

  46. Hellström PM (2013) Satiety signals and obesity. Curr Opin Gastroenterol 29(2):222–227. https://doi.org/10.1097/MOG.0b013e32835d9ff8

    Article  CAS  PubMed  Google Scholar 

  47. Llewellyn CH, Trzaskowski M, van Jaarsveld CHM, Plomin R, Wardle J (2014) Satiety mechanisms in genetic risk of obesity. JAMA Pediatr 168(4):338–344. https://doi.org/10.1001/jamapediatrics.2013.4944

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ostman EM, Liljeberg Elmstahl HG, Bjorck IM (2001) Inconsistency between glycemic and insulinemic responses to regular and fermented milk products. Am J Clin Nutr 74:96–100. https://doi.org/10.1093/ajcn/74.1.96

    Article  CAS  PubMed  Google Scholar 

  49. Flint A, Møller BK, Raben A, Pedersen D, Tetens L, Holst JJ et al (2004) The use of glycaemic index tables to predict glycaemic index of composite breakfast meals. Br J Nutr 91:979–989. https://doi.org/10.1079/BJN20041124

    Article  CAS  PubMed  Google Scholar 

  50. Ezcurra M, Reimann F, Gribble FM, Emery E (2013) Molecular mechanisms of incretin hormone secretion. Curr Opin Pharmacol 13:922–927. https://doi.org/10.1016/j.coph.2013.08.013

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Chaumontet Catherine, Azzout-Marniche Dalila, Blais Anne, Chalvon-Dermersay Tristan et al (2015) Rats prone to obesity under a high-carbohydrate diet have increased post-meal CCK mRNA expression and characteristics of rats fed a high-glycemic index diet. Front Nutr 9:22. https://doi.org/10.3389/fnut.2015.00022

    Article  CAS  Google Scholar 

  52. Bryzgalova G, Gao H, Ahren B, Zierath JR, Galuska D, Steiler TL, Dahlman-Wright K et al (2006) Evidence that oestrogen receptor-alpha plays an important role in the regulation of glucose homeostasis in mice: insulin sensitivity in the liver. Diabetologia 49:588–597. https://doi.org/10.1007/s00125-005-0105-3

    Article  CAS  PubMed  Google Scholar 

  53. Moulton CD, Pickup JC, Ismail K (2015) The link between depression and diabetes: the search for shared mechanisms. Lancet Diabetes Endocrinol 3:461–471. https://doi.org/10.1016/S2213-8587(15)00134-5

    Article  PubMed  Google Scholar 

  54. Aminianfar A, Saneei P, Nouri M, Shafiei R, Keshteli AH, Esmaillzadeh A, Adibi P. The validity of self-reported height, weight, body mass index and waist circumference in Iranian adults. Int J Prev Med (In press)

Download references

Funding

The study was financially supported by National Institute for Medical Research Development (977045).

Author information

Authors and Affiliations

  1. Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Javad Anjom-Shoae & Omid Sadeghi

  2. Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P. O. Box 14155-6117, Tehran, Iran

    Javad Anjom-Shoae, Omid Sadeghi, Hamed Pouraram & Ahmad Esmaillzadeh

  3. Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Ammar Hassanzadeh Keshteli

  4. Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Hamid Afshar

  5. Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Ahmad Esmaillzadeh

  6. Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran

    Ahmad Esmaillzadeh

  7. Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Peyman Adibi

Authors
  1. Javad Anjom-Shoae
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ammar Hassanzadeh Keshteli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Omid Sadeghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hamed Pouraram
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hamid Afshar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ahmad Esmaillzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peyman Adibi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JAS, OS and AE contributed to the conception and design of the study, data collection, and statistical analysis and drafting of the manuscript; AHK, HA and PA contributed in data collection and manuscript drafting. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ahmad Esmaillzadeh.

Ethics declarations

Conflict of interest

None of the authors declared any personal or financial conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anjom-Shoae, J., Keshteli, A.H., Sadeghi, O. et al. Association between dietary insulin index and load with obesity in adults. Eur J Nutr 59, 1563–1575 (2020). https://doi.org/10.1007/s00394-019-02012-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00394-019-02012-6

Keywords

Search

Navigation