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

Barazzoni, R.; Deutz, N.E.P.; Biolo, G.; Bischoff, S.; Boirie, Y.; Cederholm, T.; Cuerda, C.; Delzenne, N.; Leon Sanz, M.; Ljungqvist, O.; Muscaritoli, M.; Pichard, C.; Preiser, J.C.; Sbraccia, P.; Singer, P.; Tappy, L.; Thorens, B.; Van Gossum, A.; Vettor, R.; Calder, P.C.

doi:10.1016/j.clnu.2016.09.010

Cited by 112Hyperglycemia and glycemic control in critically ill and hospitalized patientsClinical Nutrition and GastroenterologyDiet, Metabolism, and Disease

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

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Barazzoni, R., Deutz, N.E.P., Biolo, G., Bischoff, S., Boirie, Y., Cederholm, T., Cuerda, C., Delzenne, N. +12 more·2017·Clinical Nutrition

DOI 10.1016/j.clnu.2016.09.010

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Abstract

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.

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Diabetic-specific enteral formula may have clinical and economic impact in ICU patients with Type 2 Diabetes Mellitus.
“The use of diabetic-specific enteral formula in ICU patients suffering from Type 2 Diabetes Mellitus seems to improve the glucose profile (190,191) and may have clinical and economic impact (192).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [192]

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Vernochet, C., Damilano, F., Mourier, A., Bézy, O., Mori, M. A., Smyth, G., Rosenzweig, A., Larsson, N., & Kahn, C. R. (2014) · The FASEB Journal · doi:10.1096/fj.14-253971 · Cited by 170 · see citing works
Bifidobacterium adolescentis supplementation ameliorates visceral fat accumulation and insulin sensitivity in an experimental model of the metabolic syndrome
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Insulin sensitizers may attenuate lean mass loss in older men with diabetes
Lee, C. G., Boyko, E. J., Barrett-Connor, E., Miljkovic, I., Hoffman, A. R., Everson-Rose, S. A., Lewis, C. E., Cawthon, P. M., Strotmeyer, E. S., Orwoll, E. S., et al. (2011) · Diabetes Care · doi:10.2337/dc11-1032 · Cited by 168 · see citing works
A.S.P.E.N. Clinical Guidelines
McMahon, M. M., Nystrom, E. M., Braunschweig, C. A., Miles, J., Compher, C. W., & the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors (2012) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607112452001 · Cited by 163 · see citing works
Exercise training boosts eNOS-dependent mitochondrial biogenesis in mouse heart: role in adaptation of glucose metabolism
Vettor, R., Valerio, A., Ragni, M., Trevellin, E., Granzotto, M., Olivieri, M., Tedesco, L., Ruocco, C., Fossati, A., Fabris, R., et al. (2014) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00617.2013 · Cited by 132 · see citing works
Self-citation
International recommendations for glucose control in adult non diabetic critically ill patients
Ichai, C., Preiser, J.-C., (SFAR), F. T. S. F. D.-R., & Société de Réanimation de langue Française (SRLF) and the Experts group (2010) · Critical Care · doi:10.1186/cc9258 · Cited by 127 · see citing works
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Increased muscle protein breakdown in chronic hemodialysis patients with type 2 diabetes mellitus
Pupim, L. B., Flakoll, P. J., Majchrzak, K. M., Guy, D. L. A., Stenvinkel, P., & Ikizler, T. A. (2005) · Kidney International · doi:10.1111/j.1523-1755.2005.00605.x · Cited by 126 · see citing works
Novel findings on the metabolic effects of the low glycaemic carbohydrate isomaltulose (Palatinose™)
Holub, I., Gostner, A., Theis, S., Nosek, L., Kudlich, T., Melcher, R., & Scheppach, W. M. (2010) · British Journal Of Nutrition · doi:10.1017/s0007114509993874 · Cited by 126 · see citing works
Irisin: a new molecular marker and target in metabolic disorder
Chen, J., Huang, Y., Gusdon, A. M., & Qu, S. (2015) · Lipids in Health and Disease · doi:10.1186/1476-511x-14-2 · Cited by 123 · see citing works
Hyperglycemia and Perioperative Glucose Management
Duncan, A. E. (2012) · Current Pharmaceutical Design · doi:10.2174/138161212803832236 · Cited by 119 · see citing works
Untitled work
Singer (2009) · doi:10.1016/j.clnu.2013.12.004 · Cited by 118 · see citing works
Self-citation
Interventions to lower the glycemic response to carbohydrate foods with a low-viscosity fiber (resistant maltodextrin): meta-analysis of randomized controlled trials
Livesey, G., & Tagami, H. (2008) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2008.26842 · Cited by 115 · see citing works
Postoperative Changes in Fecal Bacterial Communities and Fermentation Products in Obese Patients Undergoing Bilio-Intestinal Bypass
Patrone, V., Vajana, E., Minuti, A., Callegari, M. L., Federico, A., Loguercio, C., Dallio, M., Tolone, S., Docimo, L., & Morelli, L. (2016) · Frontiers in Microbiology · doi:10.3389/fmicb.2016.00200 · Cited by 115 · see citing works
Polyunsaturated Fatty Acid Pattern in Liver and Erythrocyte Phospholipids from Obese Patients
Elizondo, A., Julia Araya, A., Rodrigo, R., Poníachik, J., Csendes, A., Maluenda, F., Díaz, J. C., Signorini, C., Sgherri, C., Comporti, M., et al. (2007) · Obesity · doi:10.1038/oby.2007.518 · Cited by 114 · see citing works
Nutrition and Healthy Ageing: Calorie Restriction or Polyphenol-Rich “MediterrAsian” Diet?
Pallauf, K., Giller, K., Huebbe, P., & Rimbach, G. H. (2013) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2013/707421 · Cited by 114 · see citing works
Fatty acids acutely enhance insulin-induced oxidative stress and cause insulin resistance by increasing mitochondrial reactive oxygen species (ROS) generation and nuclear factor-κB inhibitor (IκB)–nuclear factor-κB (NFκB) activation in rat muscle, in the absence of mitochondrial dysfunction
Barazzoni, R., Zanetti, M., Cappellari, G. G., Semolic, A., Boschelle, M., Codarin, E., Pirulli, A., Cattin, L., & Guarnieri, G. (2011) · Diabetologia · doi:10.1007/s00125-011-2396-x · Cited by 109 · see citing works
Self-citation
Influence of enteral versus parenteral nutrition on blood glucose control in acute pancreatitis: A systematic review
Petrov, M. S., & Загайнов, В. Е. (2007) · Clinical Nutrition · doi:10.1016/j.clnu.2007.04.009 · Cited by 103 · see citing works
Type 2 Diabetes Is Associated with Altered NF-κB DNA Binding Activity, JNK Phosphorylation, and AMPK Phosphorylation in Skeletal Muscle after LPS
Andreasen, A. S., Kelly, M., Berg, R. M. G., Møller, K., & Pedersen, B. K. (2011) · PLoS ONE · doi:10.1371/journal.pone.0023999 · Cited by 102 · see citing works
Diabetes-specific enteral nutrition formula in hyperglycemic, mechanically ventilated, critically ill patients: A prospective, open-label, blind-randomized, multicenter study
Mesejo, A., Montejo-González, J. C., Vaquerizo-Alonso, C., Lobo-Tamer, G., Zabarte-Martinez, M., Herrero-Meseguer, J. I., Acosta-Escribano, J., Blesa-Malpica, A., & Martinez-Lozano, F. (2015) · Critical Care · doi:10.1186/s13054-015-1108-1 · Cited by 94 · see citing works
Hepatic n-3 Polyunsaturated Fatty Acid Depletion Promotes Steatosis and Insulin Resistance in Mice: Genomic Analysis of Cellular Targets
Pachikian, B. D., Essaghir, A., Demoulin, J., Neyrinck, A. M., Catry, É., Backer, F. C. D., Dejeans, N., Dewulf, E. M., Sohet, F. M., Portois, L., et al. (2011) · PLoS ONE · doi:10.1371/journal.pone.0023365 · Cited by 91 · see citing works
Self-citation
Intensive insulin treatment in critically ill trauma patients normalizes glucose by reducing endogenous glucose production
Thorell, A., Rooyackers, O., Myrenfors, P., Soop, M., Nygren, J., & Ljungqvist, O. H. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1118 · Cited by 90 · see citing works
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The development of probiotic treatment in obesity: a review
Mekkes, M. C., Weenen, T. C., Brummer, R. J., & Claassen, E. (2014) · Beneficial Microbes · doi:10.3920/bm2012.0069 · Cited by 87 · cited 1× · see citing works
“In particular, dietary fibers interact with the gut microbiota and may reduce inflammation and unfavorable metabolic responses, thereby also reducing hepatic steatosis [41,62].”
Background
The effects of probiotic bacteria on glycaemic control in overweight men and women: a randomised controlled trial
Ivey, K. L., Hodgson, J. M., Kerr, D. A., Lewis, J. R., Thompson, P. L., & Prince, R. (2014) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2013.294 · Cited by 87 · see citing works
Glycemic Control in the ICU
Egi, M., Finfer, S. R., & Bellomo, R. (2011) · CHEST Journal · doi:10.1378/chest.10-1478 · Cited by 84 · see citing works
Clinical Evidence for Pharmaconutrition in Major Elective Surgery
Braga, M., Wischmeyer, P. E., Drover, J., & Heyland, D. K. (2013) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607113494406 · Cited by 82 · see citing works
Brain glucose sensing in homeostatic and hedonic regulation.
Steinbusch, L., Labouèbe, G., & Thorens, B. (2015) · Trends in endocrinology and metabolism · doi:10.1016/j.tem.2015.06.005 · Cited by 81 · see citing works
Self-citation
Sensing of Glucose in the Brain
Thorens, B. (2011) · Handbook of experimental pharmacology · doi:10.1007/978-3-642-24716-3_12 · Cited by 79 · see citing works
Self-citation
A Diabetes-Specific Enteral Formula Improves Glycemic Variability in Patients with Type 2 Diabetes
Alish, C. J., Garvey, W. T., Maki, K. C., Sacks, G. S., Hustead, D. S., Hegazi, R. A. F., & Mustad, V. A. (2010) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2009.0185 · Cited by 79 · see citing works
Low Glucose but Not Galactose Enhances Oxidative Mitochondrial Metabolism in C2C12 Myoblasts and Myotubes
Elkalaf, M., Anděl, M., & Trnka, J. (2013) · PLoS ONE · doi:10.1371/journal.pone.0070772 · Cited by 75 · see citing works
Inpatient Management of Diabetes and Hyperglycemia
Bogun, M. M., & Inzucchi, S. E. (2013) · Clinical Therapeutics · doi:10.1016/j.clinthera.2013.04.008 · Cited by 61 · see citing works
Associations between dietary patterns and kidney function indicators in type 2 diabetes
Hsu, C., Jhang, H., Chang, W., Lin, C.-H., Shin, S., Hwang, S., & Huang, M. (2013) · Clinical Nutrition · doi:10.1016/j.clnu.2013.04.010 · Cited by 61 · see citing works
Glucose management in critically ill adults and children
Mesotten, D., Preiser, J., & Kosiborod, M. (2015) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(15)00223-5 · Cited by 60 · see citing works
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Evaluation of the Role of Enteral Nutrition in Managing Patients with Diabetes: A Systematic Review
Ojo, O., & Brooke, J. M. (2014) · Nutrients · doi:10.3390/nu6115142 · Cited by 59 · see citing works
Management of Hyperglycemia and Enteral Nutrition in the Hospitalized Patient
Davidson, P., Kwiatkowski, C. A., & Wien, M. (2015) · Nutrition in Clinical Practice · doi:10.1177/0884533615591057 · Cited by 57 · see citing works
Summary of Revisions: Standards of Medical Care in Diabetes—2022
American Diabetes Association Professional Practice Committee (2021) · Diabetes Care · doi:10.2337/dc22-srev · Cited by 55 · see citing works
Effect of High Sugar Intake on Glucose Transporter and Weight Regulating Hormones in Mice and Humans
Ritze, Y., Bárdos, G., D’Haese, J. G., Ernst, B., Thurnheer, M., Schultes, B., & Bischoff, S. C. (2014) · PLoS ONE · doi:10.1371/journal.pone.0101702 · Cited by 54 · see citing works
Self-citation
Increasing the protein to carbohydrate ratio in yogurts consumed as a snack reduces post-consumption glycemia independent of insulin
Khoury, D. T. D. E., Brown, P., Smith, G., Berengut, S., Panahi, S., Kubant, R., & Anderson, G. H. (2013) · Clinical Nutrition · doi:10.1016/j.clnu.2013.03.010 · Cited by 53 · see citing works
Diurnal postprandial responses to low and high glycaemic index mixed meals
Gibbs, M. A., Harrington, D., Starkey, S., Williams, P., & Hampton, S. M. (2013) · Clinical Nutrition · doi:10.1016/j.clnu.2013.09.018 · Cited by 53 · see citing works
Tube feeding with a diabetes-specific feed for 12 weeks improves glycaemic control in type 2 diabetes patients
Vaisman, N., Lansink, M., Rouws, C., van Laere, K. M., Segal, R., Niv, E., Bowling, T. E., Waitzberg, D. L., & Morley, J. E. (2009) · Clinical Nutrition · doi:10.1016/j.clnu.2009.05.004 · Cited by 50 · see citing works
Glucose Variability is an Independent Predictor of Mortality in Hospitalized Patients Treated with Total Parenteral Nutrition
Farrokhi, F., Chandra, P., Smiley, D. D., Pasquel, F. J., Peng, L., Newton, C. A., & Umpierrez, G. E. (2013) · Endocrine Practice · doi:10.4158/ep13131.or · Cited by 48 · see citing works
Hyperglycemia is associated with relatively lower lean body mass in older adults
Kalyani, R. R., Tra, Y., Egan, J. M., Ferrucci, L., & Brancati, F. (2014) · The journal of nutrition health & aging · doi:10.1007/s12603-014-0445-0 · Cited by 46 · see citing works
The effect of different nutritional feeds on the postprandial glucose response in healthy volunteers and patients with type II diabetes
Hofman, Z., Drunen, J. D. E. V., de Later, C., & Kuipers, H. (2004) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1602007 · Cited by 46 · see citing works
Alteration of plasma phospholipid fatty acid profile in patients with septic shock
Rival, T., Cinq-Frais, C., Sifontes, S. S., Garcia, J., Riu, B., Salvayre, R., Genestal, M., & Caspar‐Bauguil, S. (2013) · Biochimie · doi:10.1016/j.biochi.2013.08.006 · Cited by 44 · see citing works
Slowly Digestible Carbohydrate Sources Can Be Used to Attenuate the Postprandial Glycemic Response to the Ingestion of Diabetes-Specific Enteral Formulas
Vanschoonbeek, K., Lansink, M., Laere, K. M. J. V., Senden, J. M., Verdijk, L. B., & van Loon, L. J. C. (2009) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721709335466 · Cited by 43 · see citing works
Ghrelin forms in the modulation of energy balance and metabolism
Cappellari, G. G., & Barazzoni, R. (2018) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-018-0599-6 · Cited by 40 · see citing works
Self-citation
Higher dextrose delivery via TPN related to the development of hyperglycemia in non-diabetic critically ill patients
Lee, H., Koh, S. O., & Park, M. S. (2011) · Nutrition Research and Practice · doi:10.4162/nrp.2011.5.5.450 · Cited by 37 · see citing works
Dietary glycemic load, insulin load, and weight loss in obese, insulin resistant adolescents: RESIST study
Joslowski, G., Halim, J. A., Goletzke, J., Gow, M. L., Ho, M. M., Louie, J. C. Y., Buyken, A. E., Cowell, C. T., & Garnett, S. P. (2014) · Clinical Nutrition · doi:10.1016/j.clnu.2014.01.015 · Cited by 37 · see citing works
Glycemic index, glycemic load and their association with glycemic control among patients with type 2 diabetes
Farvid, M. S., Homayouni, F., Shokoohi, M., Fallah, A., & Farvid, M. (2014) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2013.288 · Cited by 33 · see citing works
Postprandial glucose, insulin and gastrointestinal hormones in healthy and diabetic subjects fed a fructose-free and resistant starch type IV-enriched enteral formula
García-Rodríguez, C. E., Mesa, M. D., Olza, J., Buccianti, G., Pérez, M., Moreno‐Torres, R., de la Cruz, A. P., & Gil, Á. (2012) · European Journal of Nutrition · doi:10.1007/s00394-012-0462-x · Cited by 32 · see citing works
Administration of a new diabetes-specific enteral formula results in an improved 24h glucose profile in type 2 diabetic patients
Ceriello, A., Lansink, M., Rouws, C., Laere, K. M. J. V., & Frost, G. S. (2009) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2009.02.013 · Cited by 32 · see citing works
Duodenojejunal Bypass Leads to Altered Gut Microbiota and Strengthened Epithelial Barriers in Rats
Yang, P., Yang, W., Nien, H., Chen, C., Lee, P., Yu, L. C., & Lin, M. (2015) · Obesity Surgery · doi:10.1007/s11695-015-1968-0 · Cited by 31 · see citing works
The incretin effect in critically ill patients: a case–control study
Nielsen, S. T., Janum, S., Krogh‐Madsen, R., Solomon, T. P. J., & Møller, K. (2015) · Critical Care · doi:10.1186/s13054-015-1118-z · Cited by 30 · see citing works
Role of a prudent breakfast in improving cardiometabolic risk factors in subjects with hypercholesterolemia: A randomized controlled trial
Adamsson, V., Reumark, A., Marklund, M., Larsson, A. O., & Risérus, U. (2014) · Clinical Nutrition · doi:10.1016/j.clnu.2014.04.009 · Cited by 30 · see citing works
Continuing controversy in the intensive care unit: why tight glycemic control, nutrition support, and nutritional pharmacology are each necessary therapeutic considerations
Berger, M. M., & Mechanick, J. I. (2010) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0b013e328335f2e0 · Cited by 25 · see citing works
A minimum blood glucose value less than or equal to 120 mg/dL under glycemic control is associated with increased 14-day mortality in nondiabetic intensive care unit patients with sepsis and stress hyperglycemia
Chan, M.-C., Tseng, J., Hsu, K.-H., Shih, S., Yi, C.-Y., Wu, C., & Kou, Y. R. (2016) · Journal of Critical Care · doi:10.1016/j.jcrc.2016.04.002 · Cited by 23 · see citing works
Dietary Patterns and The Outcomes of Assisted Reproductive Techniques in Women with Primary Infertility: A Prospective Cohort Study.
Jahangirifar, M., Taebi, M., Nasr‐Esfahani, M. H., & Askari, G. (2019) · Europe PMC (PubMed Central) · doi:10.22074/ijfs.2019.5373 · Cited by 22 · see citing works
A modified portfolio diet complements medical management to reduce cardiovascular risk factors in diabetic patients with coronary artery disease
Keith, M. E., Kuliszewski, M. A., Liao, C., Peeva, V., Ahmed, M., Tran, S., Sorokin, K., Jenkins, D. J. A., Errett, L. E., & Leong-Poi, H. M. (2014) · Clinical Nutrition · doi:10.1016/j.clnu.2014.06.010 · Cited by 21 · see citing works
Hyperinsulinemia is associated with the loss of appendicular skeletal muscle mass at 4.6 year follow-up in older men and women
López-Teros, M. T., C, F. A. R., & Alemán-Mateo, H. (2014) · Clinical Nutrition · doi:10.1016/j.clnu.2014.09.022 · Cited by 20 · see citing works
Observation of incretin effects during enteral feed transitions of critically ill patients
Jamaludin, U. K., Docherty, P. D., Chase, J. G., Compte, A. L., Shaw, G. M., Desaive, T., & Preiser, J. (2012) · e-SPEN Journal · doi:10.1016/j.clnme.2012.05.002 · Cited by 8 · see citing works
Self-citation
Effect of increased physical activity on fructose-induced glycemic response in healthy individuals
Bidwell, A. J., Fairchild, T. J., Wang, L., Keslacy, S., & Kanaley, J. A. (2014) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2014.90 · Cited by 7 · see citing works
Significant Published Articles for Pharmacy Nutrition Support Practice in 2017
Dickerson, R. N., Kumpf, V. J., Bingham, A. L., Blackmer, A. B., Canada, T. W., Chan, L. N., Cogle, S. V., & Tucker, A. M. (2018) · Hospital Pharmacy · doi:10.1177/0018578718779006 · Cited by 6 · see citing works
1.3.4 Digestible and Non-Digestible Carbohydrates
Hojsak, I. (2015) · World review of nutrition and dietetics · doi:10.1159/000360316 · Cited by 2 · see citing works

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ESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · see citing works
“A number of physiologic advantages are associated with the use of EN, such as the preservation of gut integrity and intestinal permeability, as well as a down modulation of the inflammatory response and of insulin resistance [190].”
BackgroundSelf-citation
Sarcopenic obesity: time to meet the challenge
Barazzoni, R., Bischoff, S. C., Boirie, Y., Busetto, L., Cederholm, T., Dicker, D., Toplak, H., Van Gossum, A., Yumuk, V., & Vettor, R. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2018.04.018 · Cited by 260 · see citing works
Self-citation
Sarcopenic obesity: time to meet the challenge
Barazzoni, R., Bischoff, S., Boirie, Y., Busetto, L., Cederholm, T., Dicker, D., Toplak, H., Van Gossum, A., Yumuk, V., & Vettor, R. (2018) · Obesity Facts · doi:10.1159/000490361 · Cited by 244 · see citing works
“…abnormalities [17 e 22] as well as weight-reduction therapies per se [23] may however also compromise the ability to preserve muscle function and mass. Skeletal muscle changes are not uniformly observed in obese individuals and heterogeneous phenotypes may contribute to their underestimation.”
Self-citation
Stress-Induced Hyperglycemia: Consequences and Management
Vedantam, D., Poman, D. S., Motwani, L., Asif, N., Patel, A., & Anne, K. K. (2022) · Cureus · doi:10.7759/cureus.26714 · Cited by 167 · see citing works
“An increase in blood glucose variability and the number of hypoglycaemic events are further recognized to lead to poor outcomes [14,15].”
Background
Clinical Nutrition in Critical Care Medicine – Guideline of the German Society for Nutritional Medicine (DGEM)
Elke, G., Hartl, W. H., Kreymann, K. G., Adolph, M., Felbinger, T. W., Graf, T., de Heer, G., Heller, A. R., Kampa, U., Mayer, K., et al. (2019) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2019.05.002 · Cited by 150 · see citing works
Self-citation
Double burden of malnutrition in persons with obesity
Barazzoni, R., & Cappellari, G. G. (2020) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-020-09578-1 · Cited by 125 · see citing works
Self-citation
Nutrition management for head and neck cancer patients improves clinical outcome and survival
Müller-Richter, U. D. A., Betz, C. S., Hartmann, S., & Brands, R. C. (2017) · Nutrition Research · doi:10.1016/j.nutres.2017.08.007 · Cited by 115 · see citing works
The effects of probiotics and synbiotic supplementation on glucose and insulin metabolism in adults with prediabetes: a double-blind randomized clinical trial
Kassaian, N., Feizi, A., Aminorroaya, A., Jafari, P., Ebrahimi, M. T., & Amini, M. (2018) · Acta Diabetologica · doi:10.1007/s00592-018-1175-2 · Cited by 101 · see citing works
The Vicious Cycle of Type 2 Diabetes Mellitus and Skeletal Muscle Atrophy: Clinical, Biochemical, and Nutritional Bases
López-Pedrosa, J. M., Camprubí-Robles, M., Rolo, G. G., Lopez-Gonzalez, A., García‐Almeida, J. M., Sanz‐París, A., & Rueda, R. (2024) · Nutrients · doi:10.3390/nu16010172 · Cited by 98 · see citing works
Personalized Nutrition in the Management of Female Infertility: New Insights on Chronic Low-Grade Inflammation
Fabozzi, G., Verdone, G., Allori, M., Cimadomo, D., Tatone, C., Stuppia, L., Franzago, M., Ubaldi, N., Vaiarelli, A., Ubaldi, F. M., et al. (2022) · Nutrients · doi:10.3390/nu14091918 · Cited by 80 · see citing works
“, whole grain or ancient grains rich in dietary fiber) [423,424].”
Background
Enhanced recovery after surgery (ERAS®) in gynecologic oncology – Practical considerations for program development
Nelson, G. S., Dowdy, S. C., Lasala, J., Mena, G. E., Bakkum-Gamez, J. N., Meyer, L. A., Iniesta, M. D., & Ramirez, P. T. (2017) · Gynecologic Oncology · doi:10.1016/j.ygyno.2017.09.023 · Cited by 77 · see citing works
DGEM-Leitlinie: „Klinische Ernährung in der Intensivmedizin“
Elke, G., Hartl, W. H., Kreymann, K. G., Adolph, M., Felbinger, T. W., Graf, T., de Heer, G., Heller, A. R., Kampa, U., Mayer, K., et al. (2018) · Aktuelle Ernährungsmedizin · doi:10.1055/a-0713-8179 · Cited by 76 · see citing works
Self-citation
Therapy with probiotics and synbiotics for polycystic ovarian syndrome: a systematic review and meta-analysis
Cozzolino, M., Vitagliano, A., Pellegrini, L., Chiurazzi, M., Andriasani, A., Ambrosini, G., & Garrido, N. (2020) · European Journal of Nutrition · doi:10.1007/s00394-020-02233-0 · Cited by 65 · see citing works
Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance
Barazzoni, R., Bischoff, S. C., Busetto, L., Cederholm, T., Chourdakis, M., Cuerda, C., Delzenne, N. M., Genton, L., Schneider, S. M., Singer, P., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.05.006 · Cited by 59 · see citing works
“dietary content of mono- and polyunsaturated fatty acids [102,103].”
Self-citation
The Western diet: a blind spot of eating disorder research?—a narrative review and recommendations for treatment and research
Ayton, A. K., & Ibrahim, A. (2019) · Nutrition Reviews · doi:10.1093/nutrit/nuz089 · Cited by 52 · see citing works
“Recent studies have shown that a highfat, low-carbohydrate (HFLC) diet can be helpful in both type 1 and type 2 diabetes and can improve various metabolic parameters, including normalization of weight without the need to calorie count.(177,183,184) The use of carbohydrate restriction is not new in the”
Background
Diabetes-specific formulas high in monounsaturated fatty acids and metabolic outcomes in patients with diabetes or hyperglycaemia. A systematic review and meta-analysis
Sanz‐París, A., Matía-Martín, P., Martín-Palmero, Á., Gómez‐Candela, C., & Robles, M. C. (2020) · Clinical Nutrition · doi:10.1016/j.clnu.2020.02.036 · Cited by 53 · see citing works
Sarcopenia as a Little-Recognized Comorbidity of Type II Diabetes Mellitus: A Review of the Diagnosis and Treatment
Vendrell, C. S., Tercero, E. G., Hernández, J. B. M., & Cedeño‐Veloz, B. A. (2023) · Nutrients · doi:10.3390/nu15194149 · Cited by 49 · see citing works
“As a more specialized route, post-pyloric feeding may be considered in cases where there is severe gastroparesis [43,44].”
Background
Nutrition and hyperglycemia management in the inpatient setting (meals on demand, parenteral, or enteral nutrition)
Drincic, A. T., Knezevich, J. T., & Akkireddy, P. (2017) · Current Diabetes Reports · doi:10.1007/s11892-017-0882-3 · Cited by 47 · see citing works
Perioperative lipid-enriched enteral nutrition versus standard care in patients undergoing elective colorectal surgery (SANICS II): a multicentre, double-blind, randomised controlled trial
Peters, E. G., Smeets, B. J. J., Nors, J., Back, C. M., Funder, J. A., Sommer, T., Laurberg, S., Løve, U. S., Leclercq, W. K. G., Slooter, G. D., et al. (2018) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(18)30031-1 · Cited by 45 · see citing works
Ghrelin forms in the modulation of energy balance and metabolism
Cappellari, G. G., & Barazzoni, R. (2018) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-018-0599-6 · Cited by 40 · see citing works
“At whole body level, ghrelin has an important impact on glucose homeostasis, as an important player in the pathophysiology of obesity-related metabolic complications [100].”
BackgroundSelf-citation
Pre-Gestational Consumption of Ultra-Processed Foods and Risk of Gestational Diabetes in a Mediterranean Cohort. The SUN Project
Leone, A., Martínez‐González, M. Á., Craig, W. J., Fresán, U., Gómez‐Donoso, C., & Bes‐Rastrollo, M. (2021) · Nutrients · doi:10.3390/nu13072202 · Cited by 39 · see citing works
Early Enteral Nutrition (within 48 h) for Patients with Sepsis or Septic Shock: A Systematic Review and Meta-Analysis
Grillo-Ardila, C. F., Tibavizco-Palacios, D., Triana, L. C., Rugeles, S. J., Vallejo-Ortega, M. T., Calderón-Franco, C. H., & Ramírez-Mosquera, J. J. (2024) · Nutrients · doi:10.3390/nu16111560 · Cited by 35 · see citing works
“Enteric metabolic support preserves gut integrity and intestinal permeability and contributes to inflammatory response and insulin resistance down-modulation [8].”
Background
Obesity and micronutrients deficit, when and how to suplement
Chapela, S. P., Martinuzzi, A. L. N., Llobera, N. D., Ceriani, F., González, V. C., Montalván, M., Verde, L., & Frías-Toral, E. (2024) · Food and Agricultural Immunology · doi:10.1080/09540105.2024.2381725 · Cited by 29 · see citing works
“Magnesium is critical for energy production and muscle function, and its deficiency can lead to insulin resistance and hypertension, both of which are common comorbidities in obesity (Barazzoni et al., 2017).”
Dietary Management of Blood Glucose in Medical Critically Ill Overweight and Obese Patients: An Open‐Label Randomized Trial
Rice, T. W., Files, D. C., Morris, P. E., Bernard, A. C., Ziegler, T. R., Drover, J., Kress, J. P., Ham, K. R., Grathwohl, D., Huhmann, M. B., et al. (2018) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.1447 · Cited by 29 · see citing works
Metabolomics reveals the toxicological effects of polar compounds from frying palm oil
Yuan, L., Jiang, F., Cao, X., Liu, Y., & Xu, Y. (2020) · Food & Function · doi:10.1039/c9fo02728a · Cited by 24 · see citing works
Impacts of Selected Dietary Nutrient Intakes on Skeletal Muscle Insulin Sensitivity and Applications to Early Prevention of Type 2 Diabetes
Zhang, X., Xu, D., Chen, M., Wang, Y., He, L., Wang, L., Wu, J. W., & Yin, J. (2020) · Advances in Nutrition · doi:10.1093/advances/nmaa161 · Cited by 24 · see citing works
“The relation between dietary carbohydrate intake and insulin resistance has also been summarized, and diets with a lower carbohydrate content, higher proportion of insoluble carbohydrate, and higher fiber content were recommended for the prevention and treatment of T2D (41).”
Background
Mitigating the stress response to improve outcomes for older patients undergoing emergency surgery with the addition of beta-adrenergic blockade
Mohseni, S., Joseph, B. A., & Peden, C. J. (2021) · European Journal of Trauma and Emergency Surgery · doi:10.1007/s00068-021-01647-7 · Cited by 24 · see citing works
“Unimposed physiological stress by acute conditions and subsequent surgical interventions may lead to a relative insulin resistance with elevated circulating glucose levels, which can have negative effects on patient outcomes [87].”
Background
Dietary Patterns and The Outcomes of Assisted Reproductive Techniques in Women with Primary Infertility: A Prospective Cohort Study.
Jahangirifar, M., Taebi, M., Nasr‐Esfahani, M. H., & Askari, G. (2019) · Europe PMC (PubMed Central) · doi:10.22074/ijfs.2019.5373 · Cited by 22 · see citing works
“The inclusion criteria were having female infertility (idiopathic or ovarian infertility), not having significant changes in diet during the last 3 months or having a specific diet, not consuming alcohol and not smoking, not having a history of diseases affecting metabolism including diabetes, galactosemia, maple syru…”
Background
Glycemic Management of Hospitalized Patients Receiving Nutrition Support
Polavarapu, P., Pachigolla, S., & Drincic, A. (2022) · Diabetes Spectrum · doi:10.2337/dsi22-0010 · Cited by 24 · see citing works
ABSI is a poor predictor of insulin resistance in Chinese adults and elderly without diabetes
Wu, K., He, S., Zheng, Y., & Chen, X. (2018) · Archives of Endocrinology and Metabolism · doi:10.20945/2359-3997000000072 · Cited by 21 · see citing works
“Diabetes mellitus was defined as one of the following at follow-up assessment: (1) fasting plasma glucose ≥ 7.”
Background
Medical Foods: Science, Regulation, and Practical Aspects. Summary of a Workshop
Holmes, J. L., Biella, A., Morck, T. A., Rostorfer, J., & Schneeman, B. O. (2020) · Current Developments in Nutrition · doi:10.1093/cdn/nzaa172 · Cited by 21 · see citing works
“The American Diabetes Association (46) has stated that diabetes-specific formulas appear to be superior to standard formula in controlling postprandial glucose, glycated hemoglobin, and insulin response, and an ESPEN expert group (47) endorses the use of diabetes-specific formulas for the nutritional support of people…”
Background
Enteral Nutrition Formulas: Current Evidence and Nutritional Composition
Cámara-Martos, F., & Iturbide-Casas, M. (2019) · Nutrients in Beverages · doi:10.1016/b978-0-12-816842-4.00013-7 · Cited by 16 · see citing works
Deep Dive Into the Effects of Food Processing on Limiting Starch Digestibility and Lowering the Glycemic Response
Lavau, G. C., Goux, A., Atkinson, F. S., Meynier, A., & Vinoy, S. (2021) · Nutrients · doi:10.3390/nu13020381 · Cited by 19 · see citing works
“These results confirm the usefulness of using wheat bran, or even whole grain flour, in cereal product recipes, and of selecting specific food processing technologies to lower the acute postprandial glycemic response and potentially benefit long-term health [32,53,54].”
Background
Low‐carbohydrate, high‐fat enteral formulas for managing glycemic control in patients who are critically ill: A review of the evidence
Burslem, R., Radler, D. R., Parker, A., & Zelig, R. S. (2021) · Nutrition in Clinical Practice · doi:10.1002/ncp.10652 · Cited by 18 · see citing works
The Impact of Glucose-Based or Lipid-Based Total Parenteral Nutrition on the Free Fatty Acids Profile in Critically Ill Patients
Skořepa, P., Sobotka, O., Vaněk, J., Tichá, A., Fortunato, J., Maňák, J., Blaha, V., Horáček, J. M., & Sobotka, L. (2020) · Nutrients · doi:10.3390/nu12051373 · Cited by 16 · see citing works
“Despite the efforts of many experts, the exact doses of glucose and lipids (or their ratios) during the provision of nutritional support have not been completely elucidated and are still being rigorously discussed [2,3].”
Background
Sarcopenic diabetes is an under-recognized and unmet clinical priority. A call for action from the European Society for Clinical Nutrition and Metabolism and the Diabetes Nutrition Study Group
Barazzoni, R., Sievenpiper, J. L., Genton, L., Kendall, C. W. C., Ballesteros-Pomar, M. D., Giosuè, A., Boirie‌, Y., Chiavaroli, L., Cederholm, T., Aas, A., et al. (2025) · Clinical Nutrition · doi:10.1016/j.clnu.2025.10.007 · Cited by 16 · see citing works
Self-citation
Simple Carbohydrate Intake and Higher Risk for Physical Frailty Over 15 Years in Community-Dwelling Older Adults
Chuy, V., Gentreau, M., Artéro, S., Berticat, C., Rigalleau, V., Pérès, K., Helmer, C., Samieri, C., & Féart, C. (2021) · The Journals of Gerontology Series A · doi:10.1093/gerona/glab243 · Cited by 15 · see citing works
The effect of krill oil on longevity and locomotion: a pilot study
Shi, J., Wang, Y., Jiang, F., Liu, Y., & Xu, Y. (2021) · Molecular Omics · doi:10.1039/d1mo00373a · Cited by 14 · see citing works
Macronutrient Intake and Risk of Dementia in Community-Dwelling Older Adults: A Nine-Year Follow-Up Cohort Study
Shang, X., Hill, E., Zhu, Z., Liu, J., Ge, Z., Wang, W., & He, M. (2021) · Journal of Alzheimer s Disease · doi:10.3233/jad-215042 · Cited by 11 · see citing works
“Evidence has also shown that high quality of dietary carbohydrate may be beneﬁcial for glucose regulation and insulin resistance [44, 45], thus then protecting against cognitive decline.”
(p-ClPhSe)2 stimulates carbohydrate metabolism and reverses the metabolic alterations induced by high fructose load in rats
Quines, C. B., Rosa, S. G., Chagas, P. M., Velásquez, D., Prado, V. C., & Nogueira, C. W. (2017) · Food and Chemical Toxicology · doi:10.1016/j.fct.2017.06.038 · Cited by 11 · see citing works
Plasma brain-derived neurotrophic factor and dynamic cerebral autoregulation in acute response to glycemic control following breakfast in young men
Tsukamoto, H., Ishibashi, A., Marley, C. J., Shinohara, Y., Ando, S., Bailey, D. M., Hashimoto, T., & Ogoh, S. (2020) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00059.2020 · Cited by 10 · see citing works
Effect of the Consumption of Alcohol-Free Beers with Different Carbohydrate Composition on Postprandial Metabolic Response
Lamíquiz-Moneo, I., Pérez‐Calahorra, S., Gracia‐Rubio, I., Cebollada, A., Bea, A. M., Fumanal, A. J., Ferrer‐Mairal, A., Prieto-Martín, A., Sanz-Fernández, M. L., Cenarro, A., et al. (2022) · Nutrients · doi:10.3390/nu14051046 · Cited by 10 · see citing works
Insulin Resistance and Urolithiasis as a Challenge for a Dietitian
Lubawy, M., & Formanowicz, D. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19127160 · Cited by 10 · see citing works
Diabetes-Specific Complete Smoothie Formulas Improve Postprandial Glycemic Response in Obese Type 2 Diabetic Individuals: A Randomized Crossover Trial
Mongkolsucharitkul, P., Pinsawas, B., Surawit, A., Pongkunakorn, T., Manosan, T., Ophakas, S., Suta, S., Pumeiam, S., & Mayurasakorn, K. (2024) · Nutrients · doi:10.3390/nu16030395 · Cited by 9 · see citing works
“Diabetes-specific nutrition formulas (DSNFs) that offer less total carbohydrate as well as a variation in the type of carbohydrate become essential nutritional support to help minimize the glycemic response, improve outcomes in acute and critical illness, and lower mortality [2,6,10,11].”
Background
Short-Term Consumption of Probiotic Yogurt Improved HDL-C of Type 2 Diabetes Mellitus Patients: A Double-Blind Randomized Controlled Trial
Lestari, L. A., Ratnasari, D., Azizah, E. F., Farida, I. N., Nuriannisa, F., Yuliani, K., Kusuma, R. J., Huriyati, E., & Kertia, N. (2019) · Romanian Journal of Diabetes Nutrition and Metabolic Diseases · doi:10.2478/rjdnmd-2019-0041 · Cited by 9 · see citing works
Optimizing Preanesthesia Care for the Gynecologic Patient
Dowdy, S. C., Kalogera, E., & Scott, M. J. (2019) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000003323 · Cited by 9 · see citing works
Diretriz BRASPEN de Terapia Nutricional no Diabetes Mellitus
Campos, L. F., Borges, V. C., Barreto, P. A., González, M. C., Ceniccola, G. D., de Abreu, H. B., Alves, J. T. M., Segadilha, N. L. A. L., Kumbier, M. C. C., & Castro, M. G. (2020) · Braspen Journal · doi:10.37111/braspenj.diretrizdm2020 · Cited by 7 · see citing works
“Rua Abílio Soares, 233 Conjunto 144 – São Paulo, SP, Brasil – CEP: 04005-000 Telefone: (11) 3889-9909 – E-mail: revista@braspen.org COMITÊ DA CRIANÇA E DO ADOLESCENTE Presidente: Daniela Gomes Vice-Presidente: Fernanda Luisa Ceragioli Oliveira Secretária: Cláudia Bezerra de Almeida COMITÊ DE REABILITAÇÃO INTESTINAL Pr…”
Postprandial glycemic response to a high-protein diabetes-specific nutritional shake compared to isocaloric instant oatmeal in people with type 2 diabetes: a randomized, controlled, crossover trial
Thomas, S., Besecker, B. Y., Choe, Y. S., & Christofides, E. (2024) · Frontiers in Clinical Diabetes and Healthcare · doi:10.3389/fcdhc.2024.1399410 · Cited by 8 · see citing works
Early lean mass sparing effect of high-protein diet with excess leucine during long-term bed rest in women
Vinci, P., Girolamo, F. G. D., Mangogna, A., Mearelli, F., Nunnari, A., Fiotti, N., Giordano, M., Bareille, M., & Biolo, G. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.976818 · Cited by 7 · see citing works
Self-citation
Effects of a novel rice-based diabetes-specific formula on postprandial glucose and gastrointestinal hormones: a double-blinded multi-arm randomized crossover trial
Chaiyakul, S., Ketkham, N., Chaichana, C., Khumkhana, N., Deekum, W., Wongshaya, P., Suwanmalai, T., Hutchinson, C., & Pramyothin, P. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1141497 · Cited by 7 · see citing works
Parenteral Nutrition, Sepsis, Acute Heart Failure and Hepatotoxic Drugs Are Related to Liver Test Disturbances in Critically Ill Patients
Rosseel, Z., Cortoos, P., Jonckheer, J., Cools, W., Vinken, M., Reynaert, H., & Waele, E. D. (2023) · Nutrients · doi:10.3390/nu15112612 · Cited by 7 · see citing works
“If ILEs are reduced or omitted, larger amounts of carbohydrates are needed and will lead to an increase in circulating insulin, contributing to increased lipogenesis and FFA production, which in turn will generate pro-inflammatory signals and can give rise to non-alcoholic fatty liver disease (NAFLD) with increased tr…”
Background
Ernährungsempfehlungen beim metabolisch-vaskulären Syndrom
Lechner, K., Erickson, N. T., Lechner, B., & Horn, F. (2017) · DMW - Deutsche Medizinische Wochenschrift · doi:10.1055/s-0043-118334 · Cited by 7 · see citing works
“[30] Barazzoni R, Deutz NE, Biolo G et al.”
Background
Efficacy of a Novel Therapeutic, Based on Natural Ingredients and Probiotics, in a Murine Model of Multiple Food Intolerance and Maldigestion
Ardizzone, A., Lanza, M., Casili, G., Campolo, M., Paterniti, I., Cuzzocrea, S., & Esposito, E. (2022) · Nutrients · doi:10.3390/nu14112251 · Cited by 7 · see citing works
“A high dietary carbohydrate intake results in elevated circulating glucose levels and hyperinsulinemia [37] as well as pancreatic β cell dysfunction, thus leading to poor management of the glycemic load [38].”
Background
Glycaemic index and glycaemic load of foods and food products in Malaysia: a review
Osman, N. M. H., Yusof, B. N. M., & Ismail, A. (2021) · International Food Research Journal · doi:10.47836/ifrj.28.2.01 · Cited by 7 · see citing works
A Refined Carbohydrate-Rich Diet Reduces Vascular Reactivity Through Endothelial Oxidative Stress and Increased Nitric Oxide: The Involvement of Inducible Nitric Oxide Synthase
Gomes, K. N., Mawandji, N. B. D. S., Schereider, I. R. G., Oliveira, E. P. G., Vieira, J. M., Lopes, A. B., Graceli, J. B., Dantas, J. A., Cardoso, L. S., Vassallo, D. V., et al. (2025) · Nutrients · doi:10.3390/nu17152395 · Cited by 6 · see citing works
“Thus, the results of this study reinforce the strong association between refined carbohydrate intake and the development of insulin resistance [52].”
Diet and exercise among students of a wellreputed dental college in Chennai: A questionnaire-based survey
Uma, P., Ramani, P., Sherlin, H., Gheena, S., Ramasubramanian, A., Don, K. R., Jayaraj, G., & Santhanam, A. (2018) · International Journal of Orofacial Biology · doi:10.4103/ijofb.ijofb_1_19 · Cited by 6 · see citing works
“Studies have shown that dietary treatment consists in lowering the energetic value through reduction of fat consumption and quantity and quality changes with respect to carbohydrates decreased obesity.[16]”
Background
A Descriptive Analysis of Macronutrient, Fatty Acid Profile, and Some Immunomodulatory Nutrients in Standard and Disease-Specific Enteral Formulae in Europe
Ruperto, M., Montero-Bravo, A., Partearroyo, T., Puga, A. M., Varela‐Moreiras, G., & Samaniego-Vaesken, M. D. L. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.877875 · Cited by 6 · see citing works
Significant Published Articles for Pharmacy Nutrition Support Practice in 2017
Dickerson, R. N., Kumpf, V. J., Bingham, A. L., Blackmer, A. B., Canada, T. W., Chan, L. N., Cogle, S. V., & Tucker, A. M. (2018) · Hospital Pharmacy · doi:10.1177/0018578718779006 · Cited by 6 · see citing works
The predominant role of glucose as a building block and precursor of reducing equivalents
Sobotka, L., & Sobotka, O. (2021) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000786 · Cited by 6 · see citing works
Effect of berberine on hyperandrogenemia, ovulation dysfunction and inflammation in a mouse model of polycystic ovary syndrome
Lu, K., & Lin, H. (2020) · Tropical Journal of Pharmaceutical Research · doi:10.4314/tjpr.v19i9.23 · Cited by 5 · see citing works
Parenterale Ernährung – Grundlagen und Durchführung
Aeberhard, C., & Mühlebach, S. (2017) · Aktuelle Ernährungsmedizin · doi:10.1055/s-0042-121786 · Cited by 5 · see citing works
“Verhinderung der Hyperglykämie durch PE bei Intensivpatienten ist aktuell von großer Diskussion [15].”
Background
Anemia: influence of dietary fat, sugar, and salt on hemoglobin and blood health
Downs, B. W., Corbier, J.-R., Speight, N., Kushner, S. W., Aloisio, T., Bagchi, M., & Bagchi, D. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816918-6.00005-6 · Cited by 5 · see citing works
Prevalence, diagnosis and treatment of sarcopenic obesity in older adults: a systematic review and a meta-analysis
Ayçiçek, G. Ş., Baş, A. O., Karabulut, E., & Halil, M. G. (2025) · Acta Clinica Belgica · doi:10.1080/17843286.2025.2583187 · Cited by 4 · see citing works
Analysis of the association between dietary patterns and nonalcoholic fatty liver disease in a county in Guangxi
Xiao, S., Chen, Z., Mai, T., Cai, J., Chen, Y., Tang, X., Gou, R., Luo, T., He, K., Li, T., et al. (2023) · BMC Gastroenterology · doi:10.1186/s12876-023-02864-7 · Cited by 4 · see citing works
“A large number of studies have proved that insulin resistance is an important risk factor for NAFLD [30, 31].”
Background
Glycemic Control in Diabetic Patients Receiving a Diabetes-Specific Nutritional Enteral Formula: A Case Series in Home Care Settings
Pantanetti, P., Cangelosi, G., Sguanci, M. E., Palomares, S. M., Nguyen, C. T. T., Morresi, G., Mancin, S., & Petrelli, F. (2024) · Nutrients · doi:10.3390/nu16162602 · Cited by 5 · see citing works
“The efficacy of diabetes-specific nutritional therapy for GC and complication progression in diabetes patients is supported by the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines [22], which endorse the use of Diabetes-Specific Formulas (DSFs).”
Background
OPTIMIZATION OF RECIPE FOR BAKERY PRODUCTSWITH LOW-MOISTURE CONTENTFOR REDUCING THE GLYCEMIC INDEX
Iorgachova, K., Sokolova, N., & Kotlik, S. (2019) · Food Science and Technology · doi:10.15673/fst.v13i2.1379 · Cited by 4 · see citing works
Hypoglycaemic effects of Salvia officinalis extracts on alloxan-induced diabetic Swiss albino mice
Kanana, F. M., Maina, C. M., Kibet, J. M., & Clement, J. M. (2020) · Journal of Medicinal Plants Research · doi:10.5897/jmpr2019.6822 · Cited by 4 · see citing works
“Consequently, it stimulates protein breakdown in order to provide amino acids necessary for gluconeogenesis to occur (Barazzoni et al., 2017).”
Background
Immunonutrition in major oncologic head and neck surgery: Analysis of complications, plasmatic equilibrium, and costs
Ascoli, A., Missale, F., Giordano, G., Vallin, A., Gradaschi, R., Guiddo, E., Schenone, G., Sukkar, S., Copello, F., Parrinello, G., et al. (2022) · Head and Neck · doi:10.1002/hed.27270 · Cited by 5 · see citing works
Amino acid, fatty acid, and carbohydrate metabolomic profiles with ginsenoside-induced insecticidal efficacy against Ostrinia furnacalis (Guenee)
Liu, S., Wang, X., Zhang, R., Song, M., Zhang, N., Li, W., Wang, Y., Xu, Y., & Zhang, L. (2019) · Journal of Ginseng Research · doi:10.1016/j.jgr.2019.04.006 · Cited by 4 · see citing works
“Digestible carbohydrates provide the body with monosaccharides, the primary source of energy needed for metabolism and activities [20].”
Background
Empfehlungen und Innovationen in der Ernährungsmedizin für kritisch Kranke
Vögelin, C., Koch, J., Marx, G., & Hill, A. (2025) · AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie · doi:10.1055/a-2292-8916 · Cited by 3 · see citing works
CESTA BÁSICA NACIONAL: ANÁLISE NUTRICIONAL E FINANCEIRA
BINKOSKI, A., Pinheiro, D. F., Schmitt, V., & Mazur, C. E. (2020) · Visão Acadêmica · doi:10.5380/acd.v20i4.69039 · Cited by 3 · see citing works
Dietary recommendations for people with diabetes in special situations: a position statement report by Arabic Association for the Study of Diabetes and metabolism (AASD)
Soliman, A. R., Hegazy, M., Ahmed, R. M., Abdelghaffar, S., Gomaa, M. R., Alwakil, S., Soliman, D., Sedky, L., & Shaltout, I. (2024) · Journal of Health Population and Nutrition · doi:10.1186/s41043-024-00619-y · Cited by 3 · see citing works
“It provides a convenient and safe way to meet nutritional needs but lacks phytochemicals and fibers [90–92].”
Background
PTEN expression and its association with glucose control and calorie supplementation in critically ill patients
Molfino, A., Alessandri, F., Mosillo, P., Dell’Utri, D., Farcomeni, A., Amabile, M. I., & Laviano, A. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2017.10.021 · Cited by 3 · see citing works
Mechanisms of muscle atrophy in type 2 diabetes mellitus: factors dysregulating muscle protein synthesis and breakdown
Jeong, M., McColl, T. J., & Clarke, D. C. (2025) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2025-0017 · Cited by 4 · see citing works
Lifestyle medicine and brain health: Insights from the U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) and the promise of personalization
Alfini, A. J., & Dougherty, R. J. (2025) · Alzheimer s & Dementia Translational Research & Clinical Interventions · doi:10.1002/trc2.70180 · Cited by 2 · see citing works
“18 Personalization within a standardized framework requires knowledge of one’s baseline status, allowing for scalability while preserving individual tailoring, which is a more clinically meaningful alternative to a one-size-fits-all prescription in dementia prevention.”
Challenges of nutritional support in patients with diabetes: A position paper of the ESPEN special interest group
Genton, L., Sanz, M. L., Arvanitakis, M., Ballesteros-Pomar, M. D., Bally, L., Barazzoni, R., Betry, C., Burgos, R., Cuerda, C., Hadefi, A., et al. (2025) · Clinical Nutrition · doi:10.1016/j.clnu.2025.106550 · Cited by 3 · see citing works
Self-citation
Ernährungsempfehlungen beim metabolisch-vaskulären Syndrom
Lechner, K., Erickson, N. T., Lechner, B., & Horn, F. (2018) · Aktuelle Ernährungsmedizin · doi:10.1055/s-0043-124599 · Cited by 2 · see citing works
“[30] Barazzoni R, Deutz NE, Biolo G et al.”
Background
Formuladiäten zum Abnehmen bei Typ-2-Diabetes – sinnvolle Strategie oder verzichtbar?
Bojunga, J., & Sircar, I. (2017) · Der Diabetologe · doi:10.1007/s11428-017-0246-2 · Cited by 2 · see citing works
THE CENTRAL ROLE OF GLUCOSE IN METABOLISM AND NUTRITION OF CRITICALLY ILL PATIENTS
Skořepa, P., Sobotka, O., Fortunato, J., Blaha, V., & Horáček, J. M. (2017) · Military Medical Science Letters · doi:10.31482/mmsl.2017.026 · Cited by 2 · see citing works
Nutrition and Weight Management in Midlife
Feller, M. (2021) · Springer eBooks · doi:10.1007/978-3-030-85484-3_12 · Cited by 1 · see citing works
Evidence summary for optimal glycemic variability management during enteral nutrition in adult ICU patients with cerebral infarction
Mei, H., Li, C., Liu, M., Zhang, Z., Cao, C., & Ban, G. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1822666 · Cited by 1 · see citing works
“However, during EN, these patients are prone to elevated GV due to factors such as disease-related stress, reduced insulin sensitivity, fluctuations in nutritional infusion, and glucocorticoid administration (4).”
Physicochemical Characterization of High-Protein Gruels Intended for Malnourished Patients after Visceral Surgery
Gampoula, R. H., Elenga, M., Sompila, A. W. G. T., Nguie, R., Ntsossani, S. P., Souleyman, H. L. M., Ngandzounou, E. J. N., & Oleba, M. V. M. (2026) · Journal of Biosciences and Medicines · doi:10.4236/jbm.2026.147030 · Cited by 1 · see citing works
Physicochemical Characterization, Proximate Composition and Fatty Acid Profile of Fruits from Brazilian Northeast Agrobiodiversity
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Carbohydrate Provision in the Era of Tight Glucose Control
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Authors: Barazzoni, R., Deutz, N. E. P., Biolo, G., Bischoff, S., Boirie, Y., Cederholm, T., Cuerda, C., Delzenne, N., Leon Sanz, M., Ljungqvist, O., Muscaritoli, M., Pichard, C., Preiser, J. C., Sbraccia, P., Singer, P., Tappy, L., Thorens, B., Van Gossum, A., Vettor, R., & Calder, P. C.
Affiliations: University of Trieste (IT)
Texas A&M University (US)
University of Hohenheim (DE)
Uppsala University (SE)
Hospital General Universitario Gregorio Marañón (ES)
UCLouvain (BE)
Örebro University (SE)
Sapienza University of Rome (IT)
University Hospital of Geneva (CH)
Erasmus Hospital (BE)
University of Rome Tor Vergata (IT)
Tel Aviv University (IL)
University of Lausanne (CH)
SIB Swiss Institute of Bioinformatics (CH)
University of Padua (IT)
University Hospital Southampton NHS Foundation Trust (GB)
Corresponding author: Barazzoni, R.
ORCID: Barazzoni, R.
Deutz, N.E.P.
Biolo, G.
Bischoff, S.
Cederholm, T.
Cuerda, C.
Delzenne, N.
Ljungqvist, O.
Pichard, C.
Preiser, J.C.
Sbraccia, P.
Singer, P.
Tappy, L.
Thorens, B.
Vettor, R.
Calder, P.C.
Venue: Clinical Nutrition
Publisher: Elsevier BV
Published: 2017-04
Volume: 36
Issue: 2
Pages: 355-363
ISSN: 0261-5614 (ISSN-L)
DOI: 10.1016/j.clnu.2016.09.010
OpenAlex: W2522546676
Cited by: 112
References: 135
Citations by year: 2026: 9 · 2025: 10 · 2024: 9 · 2023: 14 · 2022: 11 · 2021: 12 · 2020: 14 · 2019: 10 · 2018: 13 · 2017: 10
FWCI: 1.62
Type: journal article
Language: en
Open access: green
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Clinical Nutrition (publishedVersion)
PubMed (publishedVersion)
ePrints Soton (University of Southampton) (acceptedVersion)
HAL (submittedVersion, other-oa)
ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by-nc-nd)
Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
Digital Access to Libraries (submittedVersion, other-oa)
IRIS (submittedVersion)
IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
SERVAL (Université de Lausanne) (submittedVersion)
Padua Research Archive (University of Padova) (submittedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Keywords: carbohydrates, insulin resistance, glycemic control, nutritional support, plasma glucose, glycemic variability, fructose, low glycemic index diet, high-fiber diet, critical illness, diabetes mellitus, obesity, skeletal muscle, adipose tissue, liver
MeSH terms: Blood Glucose, Diet, Dietary Carbohydrates, Humans, Hyperglycemia, Hypoglycemia, Insulin Resistance, Italy, Nutritional Requirements, Risk Factors, Societies, Scientific, Nutritional Support, Nutrition Policy, Evidence-Based Medicine, Glycemic Index, Carbohydrate Metabolism

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

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