Cited by 140Regulation of Appetite and ObesityFood composition and propertiesNutritional Studies and Diet

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Effects of dietary glycemic index on brain regions related to reward and craving in men

Open access

Abstract

Background Qualitative aspects of diet influence eating behavior, but the physiologic mechanisms for these calorie-independent effects remain speculative.Objective We examined effects of the glycemic index (GI) on brain activity in the late postprandial period after a typical intermeal interval.Design With the use of a randomized, blinded, crossover design, 12 overweight or obese men aged 18-35 y consumed high- and low-GI meals controlled for calories, macronutrients, and palatability on 2 occasions. The primary outcome was cerebral blood flow as a measure of resting brain activity, which was assessed by using arterial spin-labeling functional magnetic resonance imaging 4 h after test meals. We hypothesized that brain activity would be greater after the high-GI meal in prespecified regions involved in eating behavior, reward, and craving.Results Incremental venous plasma glucose (2-h area under the curve) was 2.4-fold greater after the high- than the low-GI meal (P = 0.0001). Plasma glucose was lower (mean ± SE: 4.7 ± 0.14 compared with 5.3 ± 0.16 mmol/L; P = 0.005) and reported hunger was greater (P = 0.04) 4 h after the high- than the low-GI meal. At this time, the high-GI meal elicited greater brain activity centered in the right nucleus accumbens (a prespecified area; P = 0.0006 with adjustment for multiple comparisons) that spread to other areas of the right striatum and to the olfactory area.Conclusions Compared with an isocaloric low-GI meal, a high-GI meal decreased plasma glucose, increased hunger, and selectively stimulated brain regions associated with reward and craving in the late postprandial period, which is a time with special significance to eating behavior at the next meal. This trial was registered at clinicaltrials.gov as NCT01064778.

Overview

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TL;DR

In a randomized, blinded crossover trial in overweight or obese men, a high-glycemic-index meal compared with an isocaloric low-glycemic-index meal produced lower late postprandial plasma glucose, greater hunger, and greater resting activity in the right nucleus accumbens/striatum 4 h later. These findings suggest high-GI meals may stimulate brain reward and craving circuitry during the late postprandial period.

Key findings

  • The 2-h incremental plasma glucose AUC was 2.4-fold greater after the high-GI than low-GI meal (2.9 ± 0.36 vs. 1.2 ± 0.27 mmol·h/L; P = 0.0001), and the 2-h insulin AUC was also greater (127.1 ± 18.1 vs. 72.8 ± 9.78 mU·h/mL; P = 0.003).
  • At 4 h, plasma glucose was lower after the high-GI meal (4.7 ± 0.14 vs. 5.3 ± 0.16 mmol/L; P = 0.005), and hunger was greater (P = 0.04); the 5-h hunger AUC was also greater after the high-GI meal (P = 0.04).
  • Cerebral blood flow was greater 4 h after the high-GI meal in the right nucleus accumbens (mean difference: 4.4 ± 0.56 mL·100 g⁻¹·min⁻¹; range: 2.1–7.3; 8.2% relative difference), remaining significant after Bonferroni correction for 25 prespecified regions (P = 0.0006) and after correction for all 334 nonredundant brain regions (P = 0.009); activity spread to other right striatal areas and the olfactory area.
  • No differences were observed in the contralateral striatum or other prespecified regions of interest; meal palatability did not differ (5.5 ± 0.67 vs. 5.3 ± 0.65 cm; P = 0.7).

Methods

  • Randomized, blinded, crossover study in 12 overweight or obese men aged 18–35 y (BMI ≥25) who consumed high- and low-GI liquid test meals on 2 occasions separated by 2–8 wk; meals were controlled for calories (25% of estimated daily energy requirements), macronutrients, ingredient sources, and palatability, with predicted GI values of 84% and 37%.
  • The primary outcome was resting cerebral blood flow measured by arterial spin-labeling fMRI 4 h after test meals; secondary outcomes included plasma glucose, serum insulin, and hunger over the 5-h postprandial period.
  • Analyses used prespecified brain regions of interest, paired 2-tailed t tests adjusted for order effect with Bonferroni correction for 25 regions, and voxel-wise general linear model analysis at P ≤ 0.002; imaging data were usable for 11 participants because of a data-storage error.

Limitations

  • The paper states the main limitations: small sample size and exclusive focus on overweight and obese men, with no lean controls, women, or pre- and post-weight-loss participants; hedonic responses and food cravings were not directly assessed; and liquid test meals limit generalizability to solid meals.
  • The paper states that venous rather than arterialized blood sampling could have caused error in measuring arterial blood glucose concentrations above and below fasting, especially for the high-GI meal.
  • The paper notes an unanticipated right-hemisphere-only effect and that lack of differences in other prespecified regions could reflect insufficient power or true absence of effects at 4 h; it also states that the small size increases risk of a false-negative but not false-positive finding.

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Integrity signals

Registry

Crossref · 10.3945/ajcn.113.064113

Cites

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39 of 39
  • The paper relies on this without support.

    The late postprandial period is a time with special significance to eating behavior at the next meal.

    “Compared with an isocaloric low-GI meal, a high-GI meal decreased plasma glucose, increased hunger, and selectively stimulated brain regions associated with reward and craving in the late postprandial period, which is a time with special significance to eating behavior at the next meal.”
  • The paper relies on this without support.

    The US food supply has changed radically, with rapidly increasing consumption of highly processed food products derived primarily from grain commodities.

    “the food supply has changed radically, with the rapidly increasing consumption of highly processed food products derived primarily from grain commodities.”
  • The paper relies on this without support.

    Small studies limit generalizability and increase risk of a false-negative (but not false-positive) finding.

    “Small studies limit generalizability and increase risk of a false-negative (but not falsepositive) finding.”
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Metadata

Authors
Lennerz, B. S., Alsop, D. C., Holsen, L. M., Stern, E., Rojas, R., Ebbeling, C. B., Goldstein, J. M., & Ludwig, D. S.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Ludwig, David S
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2013-09
Volume
98
Issue
3
Pages
641-647
ISSN
0002-9165 (ISSN-L)
OpenAlex
W2164163218
Cited by
140
References
53
Citations by year
2026: 9 · 2025: 8 · 2024: 6 · 2023: 7 · 2022: 8 · 2021: 8 · 2020: 9 · 2019: 9 · 2018: 14 · 2017: 12 · 2016: 12 · 2015: 18 · 2014: 13 · 2013: 6
FWCI
8.83
Type
journal article
Language
en
Open access
Locations
  • American Journal of Clinical Nutrition (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Harvard University
  • Harvard Catalyst (UL1-RR025758, UL1 RR025758-01, RR025758)
  • Pediatric Endocrine Society
  • Endocrine Fellows Foundation
  • National Institutes of Health (UL1RR02575801, RR025758, RR025758-01)
  • National Institute of Mental Health (R01MH080729)
  • National Institute of Diabetes and Digestive and Kidney Diseases (K24DK082730)
  • National Center for Research Resources (UL1RR025758, RR025758, RR 025758-01)
Topics
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
  • Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
glycemic index, cerebral blood flow, nucleus accumbens, striatum, olfactory cortex, reward, craving, hunger, postprandial blood glucose, dietary habits, obesity, overweight men, arterial spin labeling
MeSH terms
Adult, Appetite, Blood Glucose, Brain, Brain Mapping, Female, Humans, Hunger, Male, Obesity, Regional Blood Flow, Reward, Postprandial Period, Area Under Curve, Glycemic Index, Young Adult

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