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Clin Nutr. 2017 Apr;36(2):355-363. doi: 10.1016/j.clnu.2016.09.010. Epub 2016 Sep 19.

Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group.

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Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy. Electronic address:
Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA.
Department of Medical, Surgical and Health Sciences, Internal Medicine, University of Trieste, Trieste, Italy.
Department of Nutritional Medicine/Prevention, University of Hohenheim, Stuttgart, Germany.
Department of Clinical Nutrition, CHU de Clermont-Ferrand, CRNH, Université d'Auvergne, Clermont-Ferrand, France.
Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Sweden; Department of Geriatric Medicine, Uppsala University Hospital, Sweden.
Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Department, Université Catholique de Louvain, Brussels, Belgium.
Department of Medicine, Complutense University, Madrid, Spain.
Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden.
Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
Nutrition Unit, Geneva University Hospital, Geneva, Switzerland.
Department of Intensive Care, Erasme University Hospital, Brussels, Belgium.
Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
Department of Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel.
Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland.
Gastroenterology Service, Hospital Erasme, Brussels, Belgium.
Internal Medicine Unit and Center for the Study and Integrated Treatment of Obesity, Department of Medicine, Padua University, Padua, Italy.
Faculty of Medicine, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom.


Growing evidence underscores the important role of glycemic control in health and recovery from illness. Carbohydrate ingestion in the diet or administration in nutritional support is mandatory, but carbohydrate intake can adversely affect major body organs and tissues if resulting plasma glucose becomes too high, too low, or highly variable. Plasma glucose control is especially important for patients with conditions such as diabetes or metabolic stress resulting from critical illness or surgery. These patients are particularly in need of glycemic management to help lessen glycemic variability and its negative health consequences when nutritional support is administered. Here we report on recent findings and emerging trends in the field based on an ESPEN workshop held in Venice, Italy, 8-9 November 2015. Evidence was discussed on pathophysiology, clinical impact, and nutritional recommendations for carbohydrate utilization and management in nutritional support. The main conclusions were: a) excess glucose and fructose availability may exacerbate metabolic complications in skeletal muscle, adipose tissue, and liver and can result in negative clinical impact; b) low-glycemic index and high-fiber diets, including specialty products for nutritional support, may provide metabolic and clinical benefits in individuals with obesity, insulin resistance, and diabetes; c) in acute conditions such as surgery and critical illness, insulin resistance and elevated circulating glucose levels have a negative impact on patient outcomes and should be prevented through nutritional and/or pharmacological intervention. In such acute settings, efforts should be implemented towards defining optimal plasma glucose targets, avoiding excessive plasma glucose variability, and optimizing glucose control relative to nutritional support.


Carbohydrates; Clinical nutrition; Insulin resistance

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