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March 9, 2005

Low–Glycemic Load Diet and Resting Energy Expenditure—Reply

JAMA. 2005;293(10):1189-1190. doi:10.1001/jama.293.10.1189-b

In Reply: We agree with Drs Esposito and Giugliano that the generalizability of our findings requires further study, as stated in our article. We would note that this concern is common to many mechanistic and efficacy studies. However, we disagree that the absence of the metabolic syndrome in our participants is necessarily a limitation. According to data from the US National Health and Nutrition Examination Survey III study,1 more than 80% of young adults, aged 20 to 39 years, do not meet diagnostic criteria for the metabolic syndrome. Furthermore, the burden of the metabolic syndrome in the US population is not shouldered exclusively by those with high BMI.2 Moreover, our findings are consistent with observational data indicating strong associations between glycemic load and risk for both diabetes mellitus3 and heart disease4 among overweight adults. We hope that our work will stimulate intervention studies aimed at assessing the effects of a low–glycemic load diet among high-risk populations, including individuals with the metabolic syndrome on a Mediterranean diet as studied by Esposito et al.5

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