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INTRODUCTION
Different carbohydrate-foods produce
different blood glucose responses (Otto
and Niklas, 1980). Considerable interest
has been raised in the effects of various
carbohydrate-containing foods on post-
prandial blood glucose response. Results
obtained have been a basis for dietary rec-
ommendations for diabetic patients
(Crapo, Reaven & Olesky, 1976; Bantle et
al., 1983). These findings led to a method
of classification of carbohydrate-contain-
ing food based on their acute blood
Mal J Nutr 11(1): 47-57, 2005
A Study of Blood Glucose Response Following Temperate
and Tropical Fruit Ingestion in Healthy Adults
Barakatun Nisak Mohd Yusof, Ruzita Abd. Talib & Norimah A. Karim
Department of Nutrition & Dietetics, Faculty of Allied Health Sciences, Universiti Kebangsaan
Malaysia, Jalan Raja Muda Abd. Aziz, Kuala Lumpur 50300.
ABSTRACT
Fruits are well known to have high nutritional values. However, the
response in blood glucose level varies with different fruits. To date, data
has not been compiled to rank local fruits according to their blood glu-
cose response. Therefore, this randomised experimental study was car-
ried out to determine the blood glucose response after consuming ten
types of tropical fruits (mango, rambutan,longan,sapodilla, jackfruit,
watermelon,papaya and banana of three varieties, brangan,rastali and
mas)and four types of temperate fruits (red apple, orange, grape and
green pear). A total of 72 healthy subjects randomly divided into groups
of 12 to 20 subjects (mean age: 21.5+0.6 years, mean BMI: 21.13+1.49
kgm-2)were requested to consume test fruits or reference food (glucose)
after an overnight fasting on separate occasions. Each test fruit and the
glucose contained 50g of carbohydrates. Finger-prick blood samples
were obtained at 0 (fasting), 15, 30 60, 90 and 120 min after consuming
each fruit. The blood glucose response was obtained by calculating area
under the curve (AUC). The AUC ranged between 57.59+10 mmol.min/L
and 313.2 mmol.min/L, with glucose showing the highest AUC (p<0.05)
compared to all fruits tested. Banana gives the highest blood glucose
response while green pear showed the lowest. The fruits ranked in
descending order based on the AUC values were longan,followed by
rambutan,grapes, watermelon, orange, papaya, jackfruit, sapodilla,
mango and red apple. Tropical fruits had significantly higher AUC than
temperate fruits (p<0.05). Overall, bananas demonstrated the largest rise
in postprandial blood glucose response (62%) when compared to glucose
while green pear showed the lowest response (18%). This preliminary
data could be used as a recommendation to diabetic patients for optimum
blood glucose control.
____________________
Correspondence author: Barakatun Nisak Mohd Yusof, email: bnisakmy@yahoo.com
glucose response known as glycaemic
index (Jenkins et al., 1981). Foods that con-
tain carbohydrate are digested and
absorbed at a slower rate, resulting in
lower blood glucose. Hence, these foods
may have metabolic benefits in relation to
diabetic control (Ludwig, 2000). However,
little attention has been given to fruits
(Guevarra & Panlasigui, 2000).
Fruits consist mainly of carbohydrates
and are known to have high nutritional
values specifically in terms of micronutri-
ents (Fatema et al., 2003). Nevertheless, the
compositions vary greatly (Hoover-Plow,
Savesky & Dailey, 1987). Studies have
shown that high intake of fruits and veg-
etables may have a protective effect
against cardiovascular disease (CVD) (Liu
et al., 2000) and decrease the risk of devel-
oping diabetes (Ford & Mokdad, 2001).
The type and amount of fruits to be
included in daily diets of diabetics has
always been a concern (Guevarra &
Panlasigui, 2000). Fatema et al.(2003) has
reported that it is important to know the
composition of fruits and their biological
responses in order to rationalise the advice
of including fruits in the diet of diabetic
patients. In addition, Brand-Miller,
Olagiuri & Foster-Powell (1997) have doc-
umented that tropical fruits may produce
higher responses of postprandial blood
glucose than temperate fruits.
Therefore, the objectives of this study
are to determine the blood glucose
response for some tropical and temperate
fruits in healthy adults compared to glu-
cose itself. This novel data could be used
by dietitians and nutritionists in recom-
mending the most suitable fruits for
patients, especially individuals with dia-
betes.
Methods
Subjects
Four groups (A, B, C, D) consisting of
12 to 20 healthy volunteers were derived
from a total of 72 subjects to participate in
this study (Table 1). There were 32 males
and 40 females with mean age and body
mass index (BMI) of 21.5+0.6 years and
21.1+1.5 kgm-2 respectively. Subjects were
non-smokers and not on any medication.
Subjects were requested to maintain their
usual daily food intake and activity
throughout the study period. The purpose
and protocol of the study were explained
to the subjects and written consent was
obtained.
Test Fruits
Subjects were grouped accordingly. 14
fruits consisting of 10 tropical fruits
[mango (Mangifera Indica), rambutan
(Nephelium lappaceum), longan (Nephelium
malaiense), sapodilla (Manilkara achras),
jackfruits (Artocarpus heterophullus),
papaya (Carica papaya), watermelon
(Citrullus vulgaris) and three varieties of
banana (Musa paradisiacal)i.e. Brangan,
Rastali and Mas]and four temperate fruits
[red apple (Pyrus malus), orange (Citrus
reticula), grape (Vitis vinifera) and green
pear (Pyrus communis)] were tested in this
study. Glucose (Glucolin™) dissolved in
500 ml of water was given as a reference
food to compare with the test fruits. Both
test fruits and glucose consisted of 50g car-
bohydrates. The amount of carbohydrate
and the crude fibre content for each fruit
was calculated using the Food
Composition Table (Tee et al., 1997). Table
2shows the amount of the tested fruits
which had to be consumed to provide 50g
carbohydrates. All subjects managed to
consume the test fruits given despite the
more than average portion size.
Experimental procedures
Subjects were requested to consume
test fruits or reference food (glucose) on
separate occasions in the morning (0800)
after 10-12 hours overnight fast. Fasting
blood sample was taken by finger-pricking
48 Barakatun Nisak MY, Ruzita AT & Norimah AK
at time 0 and the subjects were requested
to consume the test fruits with 250 ml
plain water or glucose in 500ml water
within 15 minutes. Further blood samples
were taken at 15, 30, 60, 90 and 120 min-
utes after initial intake. The blood samples
were obtained and analysed using glucose
oxidase method (Accutrend™ - Roche
Diagnostics GmbH, D-68298 Mannheim,
Germany).
Data Analysis
The blood glucose values for every
point of time over two hours were used to
calculate the area under the curve (AUC)
for each subject and each test individually
by encoding in Lotus software (123; CA
USA). The AUC calculation used was as
described by the Food and Agriculture
Organization of the United Nations (FAO,
1998). The blood glucose responses of test
fruits were then calculated as follows:
Blood Glucose Response
=AUC of test fruits x100
AUC of glucose
Results were expressed as mean +
SEM. Blood glucose value at each time,
AUC and blood glucose response were
subjected to repeated measure ANOVA
followed by Tukey’s multiple range test.
RESULTS
There was no significant difference in
terms of BMI and age between each subject
in the group (Table 1). Table 3 shows the
mean blood glucose at different time
points, the AUC values and blood glucose
response observed after consuming the
fruits. There was a significant increase in
fasting blood glucose after ingestion of all
fruits and glucose (p<0.01). The three tem-
perate fruits (grapes, orange and red
apple) and the two tropical fruits (papaya
and watermelon) reached peak blood glu-
cose values at 15 min while the rest of the
fruits including glucose peaked at 30 min.
The AUC ranged between 57.59mmol.
min/L and 313.2mmol.min/L, and was
significantly highest for glucose (p<0.05)
compared to all fruits tested. Among the
test fruits, the mean AUC was highest for
banana while the lowest was green pear.
The AUC value for banana was signifi-
cantly higher than green pear, red apple,
mango and sapodilla (p<0.05) while not
significantly different compared to the rest
of the fruits tested (Figure 1).
When comparing different varieties of
banana, Brangan has the highest AUC, fol-
lowed by Mas and Rastali (Figure 2).
However, the differences in AUC and
blood glucose response was insignificant
between the three types of bananas
(p>0.05). Nevertheless, banana showed
the largest rise of blood glucose response,
which was 62% when compared to glucose
(100%), while green pear showed the low-
est increment of only 18%. The blood glu-
cose response of other fruits tested was
longan,60% followed by rambutan and
grapes; (59%), watermelon (54%), orange
(47%), papaya (45%), jackfruit (41%),
sapodilla and mango (35%) and red apple
(27%) respectively (Figure 3).
Tropical fruits had significantly higher
AUC values and blood glucose responses
than temperate fruits (p<0.05) and both
were significantly lower than glucose
(p<0.05) (Figure 4). The crude fibre content
of the test fruits was not correlated with
the AUC value (r=-0.126, p>0.05) or blood
glucose response (r=-0.035, p>0.05) respec-
tively.
DISCUSSION
This study showed that the blood glu-
cose response produced after consuming
the test fruits was significantly lower
when compared with glucose (p<0.05).
Several researchers have reported similar
results and their results were attributed to
Blood glucose response following temperate and tropical fruit ingestion 49
the type of carbohydrate content of the
fruits which mainly consisted of fructose
(Wolever et al., 1993; Lunetta et al., 1995;
Guevarra & Panlasigui, 2000). Fructose is
slowly absorbed and is less likely to
increase blood glucose levels when com-
pared to other monosaccharides such as
glucose and lactose (Uusitupa, 1994).
Fructose is rapidly cleared and
metabolised by the liver in both normal
and type 2 diabetic patients (Wolever &
Brand-Miller, 1995). Moreover, the gly-
caemic index (GI) of fructose is significant-
ly lower than that of glucose and is found
to elicit lower blood glucose response (Lee
&Wolever, 1998).
Our results also demonstrated that the
tested fruits gave varying effects on blood
glucose responses. Wolever and Brand-
Miller (1995) noted that the glycaemic
index of fresh fruits vary over a threefold
range from 22 for cherries to 72 for water-
melon. There are several factors that may
affect the digestion and absorption of
fruits and thus the blood glucose response.
Factors such as the degree of ripeness, the
type of sugars present, the presence of
fibre and antinutrients and the physical
state of the fruits have contributed to the
response of glucose level (Guevarra &
Panlasigui, 2000).
In this study, banana has the largest
rise of blood glucose response while green
pear showed the lowest. A possible reason
for this is due to the carbohydrate content
of banana which is approximately twice
the amount of carbohydrate in apple, pear
or orange (Hermansen et al., 1992). The
degree of ripeness of banana may also
influence the postprandial blood glucose
response (Lintas et al., 1995). Over-ripe
banana has been found to be digested by a-
amylase at the highest rate, converting car-
bohydrate to free sugar (Englyst &
Cumming, 1986). However, no difference
was found in blood glucose response for
50 Barakatun Nisak MY, Ruzita AT & Norimah AK
Table 1. Characteristics of human subjects according to groups given each test fruit
Group Test Fruits n Age (years) BMI (kgm-2)
A Mango
Rambutan 20 21.2 + 0.5 20.8 + 1.4
Longan
B Sapodilla
Jackfruits 20 21.8 + 0.8 20.5 + 1.5
Green pear
C Banana
-Brangan
- Rastali 20 21.5 + 1.2 21.3 + 1.2
-Mas
D Watermelon
Papaya
Red apple 12 21.4 + 1.5 21.0 + 0.8
Orange
Grape
Total / Mean + SD (Range) 72 21.5 + 1.0 20.9 + 1.2
(21- 23) (19- 22)
p> 0.05 no significant difference of age and BMI between the groups
Blood glucose response following temperate and tropical fruit ingestion 51
Table 2. Amount of test fruits to be consumed
Test fruits Amount (g) Crude fibre (g)
containing 50 g CHO per 50 g CHO Origin
Mango (Mangifera Indica) 354 1.4 Local
(2 whole fruits)
Rambutan (Nephelium 361 1.3 Local
lappaceum) (12 whole fruits)
Longan (Nephelium malaiense) 313 1.2 Thailand
(24 whole fruits)
Sapodilla (Manilkara achras) 271 2.5 Local
(5 whole fruits without
skin/seeds)
Jackfruits (Artocarpus heterophullus) 686
(18 fruits 38.4 Local
without seeds)
Watermelon (Citrullus vulgaris) 835
(6 slices without skin;
LxWxT, 23.3x10x3 cm) 1.9 Local
Papaya (Carica papaya)703
(4½ slices;
LxWxT, 28x3x2.8 cm) 3.5 Local
Banana (Musa paradisiacal)
-Brangan 207 (3½ fruits) 1.0 Local
- Rastali 230 (7 fruits) 2.3
-Mas 219 (5 fruits) 3.7
Red apple (Pyrus malus)382 1.0 Fuji (Shandong,
(3½ whole fruits) Ltd China)
Orange (Citrus reticula) 552 3.2 Navel
(3½ whole fruits) (Australian
3107)
Grape (Vitis vinifera) 323 3.1 Top Brand
(27 whole fruits) (California)
Green pear (Pyrus communis) 310 5.6 China
(1½ whole fruits)
different types of bananas, indicating that
all varieties of bananas have the same
impact on blood glucose response.
Apple and green pear have been
reported to contain more fructose and less
glucose, thus demonstrating the lowest
blood glucose response (Lunetta et al.,
1995). In this study, sapodilla and mango
showed low glucose response and these
results are in agreement with those shown
by Guevarra & Panlasigui (2000). The
presence of antinutrients such as phytic
acid, tannins, lectins and saponin have
been known to delay the rate of digestion
and absorption (Brand-Miller et al., 1997).
Sapodilla contains saponin that has the
properties of foaming in water while
mango contains tannin and phytic acids
that are found to inhibit intestinal
enzymes lowering the rate of absorption
thus, producing low glucose response
(Guevarra & Panlasigui, 2000).
In addition, Bolton, Heaton &
Burroughs (1981) and Oettle, Emmett &
Heaton (1987) hypothesised that the rate
of the sugar entering the bloodstream
52 Barakatun Nisak MY, Ruzita AT & Norimah AK
Table 3. The mean blood glucose, AUC and blood glucose response (%) of fruits
under study
Test fruits 0 15 30 60 90 120 AUC BGR
(min) (min) (min) (min) (min) (min) (mmol.min/L) (%)
Tropical Fruits
Mango 3.7+0.2 4.6+0.3* 5.8+0.4 4.9+0.3 4.2+0.3 3.7+0.2 110.40+14** 35
Rambutan 4.2+0.2 5.8+0.2* 7.6+0.4 6.0+0.4 5.0+0.3 4.3+0.2 184.56+18** 59
Longan 3.8+0.2 5.6+0.2* 7.5+0.5 5.5+0.4 4.5+0.2 3.9+0.2 189.66+24** 60
Sapodilla 3.8+0.1 4.6+0.2* 5.8+0.2 5.2+0.3 3.6+0.2 3.8+0.2 110.92+15** 35
Jackfruits 3.6+0.1 4.6+0.2* 5.7+0.1 5.3+0.3 3.8+0.2 3.7+0.2 127.94+15** 41
Papaya 4.9+0.2 7.9+0.3* 7.7+0.3 5.7+0.2 5.0+0.2 4.8+0.2 140.32+24** 45
Watermelon 5.0+0.2 8.4+0.3* 7.8+0.2 6.1+0.2 5.5+0.2 5.0+0.1 170.46+23** 54
Various type of Bananas
-Brangan 4.6+0.1 7.6+0.1* 8.1+0.1 6.6+0.1 5.7+0.1 4.9+0.1 214.45+12** 68
-Rastali 4.9+0.1 6.5+0.1* 8.5+0.2 6.6+0.1 5.3+0.2 5.1+0.2 183.34+15** 59
-Mas 4.8+0.1 6.8+0.3* 7.5+0.4 6.6+0.4 6.0+0.3 5.1+0.2 189.45+32** 60
Mean 4.8+0.1 7.1+0.2 8.1+0.2 6.6+0.2 5.6+0.2 5.0+0.2 195.42+18** 62
Temperate Fruits
Grapes 5.2+0.6 9.4+1.1* 8.8+1.5 6.3+1.0 5.0+0.6 4.7+0.4 183.60+21** 59
Orange 4.7+0.4 8.4+1.7* 7.6+1.5 5.5+1.0 4.8+0.7 4.5+0.5 148.17+21** 47
Red apple 4.6+0.3 6.8+0.8* 6.4+0.6 4.8+0.5 4.7+0.3 4.5+0.2 84.27+8** 27
Green pear 3.3+0.2 3.7+0.2* 4.5+0.2 3.6+0.1 3.2+0.1 3.0+0.1 57.59+10** 18
Reference Food
Glucose 4.4+0.1 6.9+0.1* 8.9+0.1 8.0+0.1 6.1+0.1 5.6+0.1 313.20+10 100
(Glucolin®
* p<0.01
**p<0.05 significantly less than glucose
Values in bold determined the peaked blood glucose response. BGR= blood glucose response
Blood glucose response following temperate and tropical fruit ingestion 53
Mean Area Under the Curve
(
AUC
)
for Blood Glucose Response
over 2hr
84.27
110.4
110.92
127.94
140.32
148.17
183.63
184.56
189.66
195.42
313.2
57.59
170.46
0
50
100
150
200
250
300
350
Green pear
Red apple
Mango
Sapodilla
Jack fruits
Papaya
Orange
Watermelon
Grape
Rambutan
Longan
*Banana
Glucose
AUC value (mmol.min/L)
ap<0.05; significantly different from glucose
bp<0.05; significantly different from banana
* Mean AUC of three types of Banana
Figure 1. Mean area under the curve (AUC) for blood glucose response over 2 hours for
test fruits and glucose
Mean AUC and blood glucose responseafter consuming different
varieties of bananas
189.45 183.34
313.2
68 60 59
100
214.45
0
50
100
150
200
250
300
350
Brangan Mas Rastali Glucose
Type of banana
AUC (mmol.min/L)
AUC
Blood Glucose Re sponse
Figure 2. Comparison of AUC and blood glucose response between different varieties of
bananas
54 Barakatun Nisak MY, Ruzita AT & Norimah AK
18
27
35
35
41
45
47
54
59
59
60
62
100
0 20 40 60 80 100
Blood Glucose Response (%)
green pear
red appl e
mango
sapodilla
jackfruits
papaya
orange
wat ermelon
grapes
rambut an
longan
banana
glucose
Tes t Fruits
TheBloodGlucoseResponse (BGR)of TestFruits w hen Compare
with Glucose
Figure 3. Mean blood glucose response (BGR) of test fruits when compared with glucose
(reference food)
Mean of Blood Glucose Area Under the Curve (AUC) betw een
Tropical, Temperate & Glucose
149.8
81.52
313.2
0
50
100
150
200
250
300
350
AUC (mmo l .mi n/L)
Tropical fruits
Temperate fruits
Gl u co s e
a
a,
b
Figure 4. Mean of blood glucose area under the curve (AUC) between tropical, temperate
&glucose
ap<0.05; significantly different from from glucose
bp<0.05; significantly different from tropical fruits
varies with the physical state of the fruit.
Grapes, rambutan,longan,papaya and
watermelon are easily chewed and thus
elicit a high glucose response. Sapodilla,
mango, red apple and green pear, howev-
er, require some effort in chewing due to
their grainy texture. This might also con-
tribute to its low glucose response
(Guevarra & Panlasigui, 2000).
The tropical fruits demonstrated the
largest rise in mean AUC value when com-
pared to temperate fruits (Brand-Miller et
al., 1997). Differences among the fruits
may arise because of variations, particu-
larly in monosaccharide composition and
the nature of fibre (Wolever & Brand-
Miller, 1995).
No significant relationship was seen
between the crude fibre content of the
AUC values and blood glucose response in
this study despite the fact that fibre has
been repeatedly shown to decrease the
postprandial blood glucose (Stevens et al.,
2002). However, our findings were in
agreement with the study by Jenkins et al.,
(1981) and Lunetta et al., (1995). This was
probably due to the types of fibre that dif-
fer within fruits. The total dietary fibres in
fruits consist of soluble and insoluble
fibre. The insoluble fibres such as cellulose
and hemi-cellulose are rigid materials, and
give the structure to plants (Anderson &
Akanji, 1991). Soluble fibre like pectin,
present abundantly in fruits, may form a
viscous solution which has the capacity to
bind to carbohydrate. This could limit the
accessibility to a-amylase and reduce the
blood glucose response (Goni, Valdivieso
&Garcia-Alonso, 2000). Soluble fibre has
been shown to be active on plasma glucose
metabolism and consequently, demon-
strate the lowering effect of blood glucose
response (Riccardi & Rivellese, 1991).
CONCLUSION
Our results showed that there is a dif-
ference in blood glucose response among
tropical and temperate fruits tested. Based
on these results, the most suitable temper-
ate fruits to be recommended for diabetic
patients without significantly increasing
the blood glucose response are green pear
and red apple, while the most suitable
tropical fruits are sapodilla and mango.
Banana can only be eaten in moderate
amounts provided that fruits are within
the carbohydrate allowance. Dose-
response study with various amounts of
fruits for example 15 g of carbohydrate
should be carried out to determine the
most appropriate portion size of the fruits.
Acknowledgments
The authors would like to thank all the
young-committed researchers; Khairil
Shazmin Kamarudin, Noor ul-Aziha
Muhammad, Nubairi Adha Yusof and Tan
Poi Szie from the Department of Nutrition
&Dietetics, UKM, KL who coordinated
the research project and provided the orig-
inal data to allow calculation the area
under the curve (AUC) for each blood glu-
cose value.
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