ReviewCarbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group
Section snippets
Introduction: carbohydrates, insulin resistance, and clinical nutrition
Carbohydrates in the diet provide an essential metabolic fuel, commonly in the form of glucose. While necessary for life, excess or rapidly changing levels of glucose in the blood can lead to several health problems and contribute to the development of obesity, insulin resistance, and type 2 diabetes mellitus (T2D). Furthermore, poorly controlled glucose levels in critically ill patients or in those recovering from surgery can lead to glucose variability with hyper- and hypoglycemia, conditions
Glucose metabolism in the organs
Advances in research have shed light on the ways in which glucose interacts with a number of organ systems. Excess exposure of these organs to glucose as a result of hyperglycemia, as well as uncontrolled spiking of glucose levels after meals, can contribute to the deterioration of an individual's condition by causing metabolic derangements such as oxidative stress, tissue and systemic inflammation, and insulin resistance. This section summarizes the impact of glucose on major organs involved
Diet and lifestyle
Obesity and excess adiposity can lead to the development of glucose insensitivity, impaired insulin action, and inability to properly regulate glycemic variations. Although dietary recommendations aimed at weight loss have recently emphasized the importance of inducing energy deficits, at least in part independently of diet composition, high GI and GL foods are associated with metabolic disease risk and health complications [3], [4], [5]. Lowering dietary GI and GL may conversely improve these
Summary and conclusions
While carbohydrates, which provide glucose to the body to support metabolism, are crucial to the diet, inappropriate intake can lead to hyperglycemia, hypoglycemia, and glycemic fluctuations that are harmful to health outcomes (Fig. 2).
Excess glucose ingestion interacts with the gut and its microbiome and ultimately affects a number of organs including skeletal muscle, adipose tissue, and the liver. Excess glucose availability may induce expansion of adipose tissue and may favor ectopic fat
Conflict of interest
None.
Acknowledgment
The authors thank Dr. Cecilia Hofmann (C. Hofmann & Associates, Western Springs, IL, USA) for her capable assistance with writing, reference management, and editing the manuscript.
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