Low Glycemic Index Diets for Subjects With Diabetes by Minimizing Glycemic Load of Individual Foods

Low Glycemic Index Diets for Subjects With Diabetes by Minimizing Glycemic Load of Individual Foods

Maximino Navarro Mentado (Faculty of Engineering, UNAM, México City, Mexico) and Esther Segura Pérez (Faculty of Engineering, UNAM, México City, Mexico)
DOI: 10.4018/IJPHIM.2019010101

Abstract

In this article, the authors develop and analyze a linear programming model to obtain an ideal diet for individuals with diabetes by setting the glycemic load as the objective function. Additionally, a standardized system is used in order to facilitate the substitutability of foods present in a diet since those are classified according to their macronutrient content (proteins, lipids, and carbohydrates) and these values are, on average, very similar. Finally, the diet glycemic index is calculated with the model's outcome to corroborate that it is indeed a diet with low glycemic index and that, at the same time, it complies with the nutrient restrictions, which proves that the model can be a useful tool both to generate low glycemic index diets and to restrict certain nutrients from the diet.
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Introduction

Diabetes is an epidemic disease recognized by the World Health Organization (WHO) as a global threat (Pérez, 2016). This condition is the leading cause of death in most developed countries and has become a serious situation in many developing countries. Mexico is in a rather unfavorable position for in November 2016, the Federal Ministry of Health issued two declarations of health emergency regarding diabetes and obesity due to the serious public health problem that these chronic diseases represent (Sin Embargo, 2016).

Physical activity, healthy eating and weight control are still the cornerstones of favorable diabetic control. However, recent studies have shown that there is a strong relationship between high levels of glucose after meals (postprandial glucose) and the risk of diabetic complications. Consuming a healthy, low-fat diet that includes fruit, vegetables and whole foods can not only help to reduce postprandial glucose levels, but it also helps improve blood pressure and cholesterol levels (Ceriello & Colagiuri, 2007). For this purpose, the Mexican Institute of Social Security (IMSS, in its acronym in Spanish) made available the Guide to Clinical Practice (Diet Therapy and Food: Patient with Diabetes Mellitus) (Navarrete, Sánchez, Zárate, Monterde, & Sandoval, 2015) as a guiding tool in making clinical decisions based on the best feasible evidences, with the intention of standardizing national actions regarding:

  • Therapeutic diet prescription in the patient with diabetes mellitus (DM);

  • Knowledge of the foods that the patient should ideally consume in relation to their Glycemic Index (GI) and Glycemic Load (GL);

  • Usage of the Mexican System of Equivalent Foods (MSEF) as a tool for diet therapeutic prescription.

These actions aim to improve the metabolic control of the patient with DM and to reduce the possible complications due to high levels of postprandial glucose, through the dietary controls. However, even though this work addresses the dietary control of diabetes, this measure will not be sufficient if it is not combined with other methods such as oral medication and physical activity, and these measures should be adapted to the treatment plan and level of glycemic control of each person.

General Objectives

  • Building a mathematical model that serves to optimize the glycemic load of individual foods using a standardized food system;

  • Generating a real diet of low glycemic index that can be prescribed as a viable and healthy alternative for patients with diabetes, based on the evidence regarding the benefits of low glycemic index foods in the dietary control of diabetes mellitus.

Specific Objectives

  • Showing the advantages of increasing computational power in solving complex problems of linear programming in the field of health;

  • Designing a model that is adaptable to the energy and nutritional requirements of each person;

  • Laying out the foundations for the design of increasingly sophisticated tools which help nutritionists in the adaptation of diets with a view to the new physiological classification of carbohydrates with which the concepts of glycemic index and glycemic load arise.

Thus, this work focuses on the development of a mathematical model that involved the MSEF available tables, the GI and GL values of individual foods. The proposed model is a variation of the diet problem (a well-known problem within the operation research discipline) since the objective is not to minimize the cost of food (as in the original problem of diet) but mainly to minimize the GI of mixed meals (GIMM) using the GL of the individual foods according to the portion suggested in the MSEF in order to generate the objective function. The purpose of this model will be to generate food combinations (diets) that meet the ideal nutritional and energy restrictions of a diet for individuals with diabetes, based on the evidence about the benefits of meals with low-GI on the dietary control of DM and obesity. This work was developed before being aware of the need to standardize the national actions mentioned in the Clinical Practice Guideline; therefore, it could be positioned within the advances in the field of therapeutic diet for patients with diabetes in disease management and healthcare.

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