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1. introduction: carbohydrates, insulin resistance, and clinical nutrition carbohydrates in the diet provide an essential metabolic fuel, commonly in the form of glucose. while necessary for life, excess or rapidly changing levels of glucose in the blood can lead to several health problems and contribute to the development of obesity, insulin resistance, and type 2 diabetes mellitus (t2d). furthermore, poorly controlled glucose levels in critically ill patients or in those recovering from surgery can lead to glucose variability with hyper- and hypoglycemia, conditions that can impede recovery and can be fatal. in order to summarize recent research findings, share ideas, and discuss how emerging avenues of research may shape clinical nutrition recommendations and guidelines in the future, the au- thors of this manuscript participated in a workshop hosted by the european society for clinical nutrition and metabolism (espen) on november 8th and 9th 2015, in venice, italy. in this manuscript about glucose and glycemic control in clinical nutrition, we report on key concepts from workshop presentations. this report was prepared from a first draft based on summaries provided by each speaker, professionally edited, and further reviewed and revised in multiple rounds by all authors. in this summary paper, we review how major metabolic organs use glucose and regulate its levels within the body, explain conditions that disrupt glycemic control, and discuss dietary and clinical nutrition guidelines for the treat- ment of conditions that feature dysglycemia. common digestible carbohydrates are classified as mono- saccharides (glucose, fructose, and galactose), disaccharides (su- crose, lactose), or polysaccharides (starches, glycogen), based upon chemical structure [1]. alternatively, carbohydrates are grouped based upon their digestibility and nutritional effect: the alpha bonds between glucose molecules in starch are easily broken down in digestion, whereas beta bonds in fibers are resistant to human digestive enzymes. digestible carbohydrates break down and pro- vide the body with monosaccharides for energy, while those that resist digestion are non-glycemic, but instead provide energy through fermentation in the colon by the gut microbiota. carbo- hydrate quality and digestibility can influence post-prandial plasma glucose concentration and the inflammatory response, which is now known to underlie the development of insulin resistance, metabolic syndrome, and t2d [2]. foods with high glycemic index (gi) and glycemic load (gl) are associated with increased risk of such diseases [3e5]. conversely, lowering dietary gi and gl can improve metabolic control [6e11]. furthermore, increasing the protein-to-carbohydrate ratio can reduce glycemia [12], and inflammation can be tempered through dietary modification [13]. 2. glucose metabolism in the organs advances in research have shed light on the ways in which glucose interacts with a number of organ systems. excess exposure of these organs to glucose as a result of hyperglycemia, as well as uncontrolled spiking of glucose levels after meals, can contribute to the deterioration of an individual's condition by causing metabolic derangements such as oxidative stress, tissue and systemic inflammation, and insulin resistance. this section summarizes the impact of glucose on major organs involved in substrate meta- bolism and utilization. 2.1. central nervous system the relationship between glucose and the brain is important for the whole body. glucose is the major physiological source of energy for the brain, and the brain senses glucose and carbohydrate levels
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