Clinical Question For patients wi...

Clinical Question

For patients with risk factors for coronary heart disease (CHD) does a depressed glycemic index diet reduce heart disease or improve risk factors?

Evidence-Based Answer

There is limited, weak evidence that a soft glycemic index diet improves risk factors for CHD however there are no randomized controll trials (RCTs) showing a reduction in morbidity or mortality. (SORT rating C)

Practice Pointers

CHD is associated with high fat intake. However, there is uncertainty regarding in what manner rapidly-metabolized dietary carbohydrates may affect the risk for heart attack and visitation The glycemic index is a measure of the purport of dietary carbohydrate on posterity glucose, on a scale from cipher to 100; higher numbers correspond to a greater effect

kelly and colleagues systematically reviewed RCT to determine whether a gentle glycemic index diet decreased mortality or CHD conclusions (patient-oriented outcomes) or had a beneficial import on risk factors for CHD as it is as abnormal lipids, glucose metabolism, house pressure, weight, and clotting factors (surrogate markers that may or may not affect patient outcomes) Fifteen trials lasting four weeks or more were identified. Interventions included dietary advice or a prescribed diet for adult outpatients with at least single major risk factor. None of the studies reported morbidity or mortality. The studies were of poor quality and had too hardly any patients to identify clinically important purports There was a small reduction in A1C (045 percent) and total cholesterol flushs (6.6 mg per 100 ml [017 mmol through L]). However, these outcomes were not sufficient to commit low glycemic index diets for patients with risk factors for CHD

Despite the lack of supporting evidence, several organizations approve diets rich in complex carbohydrates for patients with risk factors for CHD The National Cholesterol education Program (NCEP) approves that 50 to 60 percent of calories reach [i]or[/i] attain any place [i]or[/i] point from foods rich in compound carbohydrates, including grains (especially whole grains), fruits, and vegetables (1); this is essentially a subdued glycemic index diet. The American Dietetic Association supports the dietary recommendations of the NCEP for patients with hyperlipidemia. (2) The U Preventive Services Task Force make acceptables intensive behavioral dietary counseling for adult patients with hyperlipidemia and other known risk factors for cardiovascular disease, however does not specify which diet should be commended (3)

EDITOR'S NOTE: behold p. 1154 or http://www.aafp.org/afpsort.xml for SORT information.

Kelly s et al. Low glycaemic index diets for coronary heart disease. Cochrane Database Syst Rev 2004;(4):CD004467

REFERENCES

(1) Grundy SM Cleeman JI, Merz Cn Brewer HB Jr Clark Lt Hunninghake DB et al. Implications of latter clinical trials for the national Cholesterol education Program Adult treatment Panel III guidelines. Circulation 2004;110:227-39

(2) American Dietetic Association. Hyperlipidemia medical nutrition therapy protocol. Chicago: American Dietetic Association, 2001

(3) U Preventive Services task Force. Behavioral counseling in primary care to exalt a healthy diet: recommendations and rationale. Am J Prev M 2003;24:93-100

The series coordinator for AFP is Clarissa Kripke, MD Department of Family and Community Medicine, University of California, San Francisco.

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