Information Desk J Korean Diabetes 2015;16: Vol.16, No.2, 2015 ISSN Glycemic Index 실생활에서활

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1 J Korean Diabetes 2015;16: Vol.16, No.2, 2015 ISSN 이정화경희대학교병원영양팀 Utility of the Glycemic Index in Practical Diabetes Management Jung Hwa Lee Nutrition Team, Kyung Hee University Medical Center, Seoul, Korea Abstract The glycemic index (GI) is the measure of how much and how quickly a particular food elevates blood glucose levels. The glycemic load (GL) is a related measurement that is used to reflect how an average serving of a particular food will affect blood glucose. Using the GI in meal planning can improve diabetes control and other health parameters. Many factors affect a food s glycemic effect, including its soluble fiber content, the type of starch it contains, its fat and protein content, its acid content, its physiologic state, the cooking method used, and the glycemic condition of the person eating it. GI focuses on only one parameter of how quickly blood glucose rises in response to a particular food and provides no guidance in terms of serving size or nutrient balance. It is not necessary to teach patients to calculate the GI/GL of complex meals made up of many different ingredients. Instead, advice to patients should focus on broad general principles that can be easily followed. The most helpful message is to not focus on the numerical GI or GL values of each meal, but rather to think about the overall glycemic impact of that particular meal. Such practical methods to use GI may be helpful in improving glycemic control. Keywords: Glycemic index, Glycemic load, Practical, Utilization Corresponding author: Jung Hwa Lee Nutrition Team, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul , Korea, cathars@hanmail.net Received: Apr. 27, 2015; Accepted: May. 5, 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright c 2015 Korean Diabetes Association The Journal of Korean Diabetes 135

2 서론 혈당지수 (glycemic index) 는탄수화물의질적섭취를평가하기위해사용되는지표로써특정식품의식후혈당반응정도를기준식품 ( 포도당또는흰빵 ) 과비교하여수치화한것이며표준식품을 100으로한다 [1]. 같은양의탄수화물식품을섭취하더라도서로다른속도로소화 흡수되기때문에인체내에서의혈당반응은식품에따라다르게나타나며일반적으로혈당지수가 55 이하일때저혈당지수, 56~69 이면중혈당지수, 70 이상이면고혈당지수식품으로분류한다. 혈당부하 (glycemic load) 는당질의흡수속도에양적개념을더한것으로식품의 1회섭취량에함유되어있는탄수화물의양을고려하여혈당반응을계산한값이다 [2]. 저혈당지수식품은천천히소화 흡수되어, 혈당반응이낮아지고인슐린민감성이향상되고 [3], 고혈당지수식사에비해당화혈색소 (HbA1c) 를평균 0.5% 낮추고저혈당도개선되어당뇨병에서혈당조절에효과적이다 [4]. 뿐만아니라저혈당지수식품은저밀도지단백콜레스테롤을낮추고, 고밀도지단백콜레스테롤은증가시키며 [5,6], 중성지방을낮춰서혈중지질을개선시킨다고보고되고있다 [7]. 또한저혈당지수식품은고혈당지수식품에비해심혈관질환의발생을감소시키고 [8], 포만감을증가시켜섭취열량이감소하여체중조절에효과가있다고알려졌으며 [9], 여러가지암과관련한연구들도활발하게이루어지고있다 [10-14]. 이러한연구결과들을근거로캐나다 [15] 와유럽 [16] 등의당뇨병관리지침에서는혈당지수가높은식품대신혈당지수가낮은식품을섭취하는것이당뇨병환자의혈당조절에유의적으로효과가있다고권고하고있으며, 2015년미국당뇨병학회 (American Diabetes Association) 의진료지침에서도당부하지수가높은식품을당부하지수가낮은식품으로대체하는것이혈당조절을향상시키는데에도움이된다고제시하고있다 [17]. 우리나라는밥을주식으로하여탄수화물섭취가총섭취에너지의약 65% 를차지할정도로높고 [18], 선호되는당질식품과조리방법등이서구와는차이가있으나국내상용 식품에대한혈당지수자료는미비한실정이다. 본고에서는당질의총섭취량과더불어혈당지수의개념을당뇨병환자의실제식사에서어떻게적용할수있는지에대해알아보고자한다. 본론 식품의혈당지수는섭취하는수용성섬유소의함량, 전분의형태, 단백질과지방의함량, 산의함량, 물리적인상태 ( 액체 vs. 고체 ), 식품의가공및조리방법, 섭취하는사람의혈당상태등에의해많은영향을받는다 [19]. 다음은실생활에서혈당지수를낮출수있는방법이다. 1. 쌀밥대신잡곡밥으로섭취한다. 우리나라는밥을주식으로섭취하고있으며밥에있어서도특히쌀밥의선호도가가장높아서섭취에너지와식사혈당지수 (dietary glycemic index), 식사혈당부하 (dietary glycemic load) 에기여도가가장높은식품이쌀로보고되고있다. 이는초등학생 [20], 남자 [21]/ 여자고등학생 [22], 여대생 [23], 성인 [24] 등을대상으로한여러연구결과연령및성별에상관이없는것으로나타났다. 따라서주식으로섭취하는밥을잡곡밥으로대체했을때혈당지수를낮추는효과가가장클것으로생각된다. 도정이많이된백미의경우소화효소에대한물리적방벽역할을하는곡류외층배아층의손실로소화 흡수속도가촉진되어높은혈당지수를나타내게된다. Jung 등 [25] 의연구에서실제섭취열량에있어잡곡밥을제공했을때백미밥보다더적게섭취했음에도불구하고다음식사까지의공복감을최소화하고포만감을증가시켜과식을예방하고전체섭취열량을낮출수있다고보고하였다. 2. 가능하면혈당지수가낮은식품을선택한다. 전분의성분중아밀로오스 (amylose) 와아밀로펙틴 136

3 이정화 (amylopectin) 의비율도중요하다. 아밀로오스는직선형이고아밀로펙틴은분지 (branching point) 를많이가지는형태로아밀로오스에비해쉽게젤라틴화되므로더빠르게소화된다. 그러므로아밀로오스의함량이높을수록더천천히소화되고혈당지수도더낮다 [26]. 찹쌀은아밀로펙틴의비율이높고메밀, 보리, 수수등의잡곡은백미에비해아밀로오스의비율이높다. 과일의혈당지수는재배지역과수확시기, 성숙정도등에따라영향을받는다. 당도가높은과일이혈당지수가높은것이아니며당의유형, 특히포도당과과당의비율, 솔비톨의함량에따라달라진다. 과일에서과당의함량이높을수록혈당지수는낮아지고서당의함량이많을수록혈당지수가높아지는경향을나타낸다 [27]. 전형적인저혈당지수식품으로는콩, 완두콩, 파스타, 통호밀, 보리, 귀리등과최근에관심을받고있는렌틸콩과퀴노아, 그리고온대성과일 ( 사과, 배, 오렌지, 복숭아, 자두, 살구, 체리류, 베리류 ) 등이대표적이다. 혈당지수가높은식품으로는흰밀가루나감자, 고도로압출한시리얼, 그리고열대과일 ( 파인애플, 망고, 파파야, 멜론, 수박 ) 등이있다 [15]. 3. 다양한식품을선택하여골고루섭취한다. 혈당지수는함께섭취한식품의종류에의해서도변한다. 육류및가금류, 어패류, 채소류, 난류등은탄수화물을거의포함하지않아많은양을섭취해도혈당에큰영향을미치지않는다는연구결과에따라 2002년 Foster-Powell 등 [28] 이발표한 international table에서도혈당지수를제시하지않았다. 따라서통곡물, 콩, 생선, 해산물, 살코기와저지방유제품, 올리브유나카놀라유, 오메가 3 지방산등의불포화지방, 과일과채소등의다양한식품을함께먹으면혈당지수를낮추면서균형된영양섭취가가능하다. 특히식품속에함유된단백질과지방은인슐린반응을증가시키고, 위배출을지연시킴으로써혈당반응을늦추는것으로알려져있다 [29,30]. Kim 등의연구 [31] 에서조리방법별로비교했을때감자튀김, 감자전의혈당지수가찐감자, 구운 감자의혈당지수보다낮은것으로나타났다. 이는감자를튀기는동안감자의저항전분 (resistant starch) 량을증가시키고전분구조의가수분해속도를늦추기때문이라고보고하였다. 그러나튀김류의간식은혈당지수는낮지만고열량식품으로대사성질환의위험률이높으므로자주섭취하는것을피해야한다. 4. 섬유소를충분히섭취한다. 점성이있거나수용성섬유소가많은식품은소장내용물의점도를증가시켜전분과효소사이의상호작용이천천히일어나도록하고식후혈당을감소시킴으로써혈당지수를낮춘다 [32]. 따라서섬유소가풍부한다양한색깔의채소와해조류를충분히섭취한다. 5. 혈당지수를낮추는조리방법을이용한다. 압출성형조리, 팽화, 즉석식품과같은방법들은전분을더쉽게소화되게만든다. 식품의가공과정에서높은온도와압력으로입자의가수분해 ( 젤라틴화 ), 화학구조의변화, 입자구조의분쇄를만들기때문에전분의소화율을높여혈당지수가더올라간다 [33]. 가공중에소화성효소가전분내부로접근하는것을지연시키는곡물의섬유질외피도제거될수있다. 섬세하게제분한밀가루는일반적으로혈당지수가높고맷돌로간거친밀가루는입자가크고혈당지수도낮으므로가급적덜가공된식품을선택한다. 음식을조리할때는조리시간을줄이고가급적식품의크기를크게하여조리한다. 식품의가열처리정도에따라호화도가달라져소화흡수속도에차이가나고입자크기가감소하면표면적이증가하여소화효소가더욱쉽게작용하여빨리흡수되고식품의혈당지수를증가시킨다. Kim 등 [31] 의연구결과, 찜보다죽처럼분쇄하여끓인조리방법에서혈당지수가더높은경향을보였다

4 6. 식초등산을첨가한다. 식초를고혈당지수식사에추가했을때제2형당뇨병환자의식후고혈당이감소되며, 위배출지연이식초의혈당강하효과와관련이있다고보고되었다 [34]. 과일의산도는위장관배출을지연시키고소장으로음식을천천히전달되게하여소화를천천히이루어지게함으로써혈당수준을낮추는것으로알려져있다 [35]. 식초, 유제품, 콩과탄수화물을조합한혼합식사에서흰쌀의혈당지수가 20~40% 유의적으로감소되었다 [36]. 피클로된식품이나식초, 레몬주스등산이포함된식품은혈당지수가더낮다. 예를들어효모의발효과정으로락토바실러스 ( 젖산균 ) 나젖산배양을사용한샤워도우빵 ( 발효시켜시큼한맛이나는빵 ) 은흰빵보다혈당지수가더낮다 [32]. 따라서레몬이나식초를드레싱으로섭취하거나채소, 생선위에직접뿌려서먹으면혈당지수를낮출수있다. 현재까지발표된대부분식품들의혈당지수는외국자료를이용하여우리나라에서재배되고우리나라사람들이많이섭취하는식품들에대한자료는미비한실정이며, 최근에서야한국인상용식품 653개의혈당지수값을구축하고식사혈당지수와식사혈당부하를계산하여섭취실태를파악한연구 [24] 와탄수화물간식류 [31], 다빈도섭취과일 [27] 등에대한연구가이루어졌다. 앞으로우리나라상용식품의혈당지수에대한정확하고많은정보가필요하며혈당지수를낮추는조리방법에대한연구도필요하다고생각된다. 혈당지수가낮은식사를실생활에서적용하는것은어렵지않다. 식품을선택하는방법이나조리과정등여러요인들이혈당지수에영향을줄수있다. 따라서혈당지수가낮은식품위주로선택하고, 혈당지수가낮더라도지방이많거나가공이많이된식품은주의하여당질의양과질을함께고려한다양한식품을섭취하는것이중요하다. 결론 REFERENCES 2,400개이상의식품에대한혈당지수목록을포함하고있는 international table은과학적으로정확한혈당지수에대한정보를제공하고있지만 [28], 우리나라에서실제로적용하기에는많은문제점을가지고있다. 같은식품이라도조리방법, 형태, 숙성도, 전분의노화정도에따라혈당지수가달라서쌀에대한혈당지수목록만해도 104개나되고, 대부분서양식식단에이용되는식품을중심으로혈당지수 / 혈당부하가규명되어있어우리가자주섭취하는식품은대부분목록에없다 [32]. 또한혈당지수는식품에반응하여혈당이얼마나빨리증가하는가에대한한가지변수에만초점을맞추므로 1회섭취량이나영양의균형에대한가이드를제공하지못한다. 식사를계획할때개별적인식품의혈당지수나혈당부하가중요한것이아니라기본적인식사원칙에대사적조절을향상시킬수있는식사패턴을좀더세밀하게조정하기위해혈당지수를이용하는것이도움이될수있을것이다 [19]. 1. Jenkins DJ, Kendall CW, Augustin LS, Franceschi S, Hamidi M, Marchie A, Jenkins AL, Axelsen M. Glycemic index: overview of implications in health and disease. Am J Clin Nutr 2002;76:266S-273S. 2. Willett W, Manson J, Liu S. Glycemic index, glycemic load, and risk of type 2 diabetes. Am J Clin Nutr 2002;76:274S-280S. 3. Thomas DE, Elliott EJ. The use of low-glycemic index diets in diabetes control. Br J Nutr 2010;104: Thomas D, Elliott EJ. Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database Syst Rev.2009;(1):CD Ford ES, Liu S. Glycemic index and serum high-density lipoprotein cholesterol concentration among us adults. Arch Intern Med 2001;161: Slyper A, Jurva J, Pleuss J, Hoffmann R, Gutterman D. 138

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Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ

Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee University College of Medicine & Hospital E mail : ycell2@yahoo.co.kr Abstract