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Effect of Whole wheat bread and white bread consumption on pre-diabetes patient

Authors:

Abstract

Background and Objective: Soluble dietary fibers reduce postprandial glucose, total and LDL cholesterol level. Finding about the efficacy of whole grain on chronic disease such as diabetes and ischemic heart disease (IHD) and mortality is controversial. Bread is the most important source of carbohydrate diet and investigation the effect of bread on glycemic response is important. The aim of this study was to compare the effect of whole wheat bread and white wheat bread on risk factors of pre-diabetes patients. Methodology : Nine hundred forty six (946) men and women 35 to 55 year of age were included in the study. Dietary intake was assessed with 3 days record. Whole breads involve sangak and barbary (are a kind of Iranian breads) that were considered 270 and 250 grams for each one, respectively. White breads involve bagets, lavash and taftoon (are a kind of Iranian breads) that were considered 90, 88 and 120 grams for each one, respectively. Biochemical assessments and anthropometric indices were determined according to the standard protocol. Results: About 23% of participant was men and 77% were women. Significant positive correlation between white bread consumption and WC, BS 120, HbA1C, TG and SBP were found. We didn't find any significant correlation between white bread and other variables. After controlling some confounding factors such as age, sex and total energy intake, we found a positive association between white bread consumption and BS120, HbA1C and TG. Conclusions: According to our finding white breads have an inverse effect of healthy status and whole wheat bread didn't have any significant effect of risk factors of diabetes.
Pak J Med Sci 2013 Vol. 29 No. 1 Special Supplement IUMS www.pjms.com.pk 275
Open Access
INTRODUCTION
Diabetes patients are increasing by population
growth, aging, urbanization, increasing prevalence
of obesity and physical inactivity.1 Lipid prole
abnormality, increasing blood glucose and glaciated
hemoglobin (HbA1c) and obesity are the most risk
factors for diabetes and lead to complications of this
disease.2
Important factor to control and manage diabetes
is dietary habits and nutrition. A novel approach in
dietary habits is glysemic index (GI) and glycemic
load (GL). Different interventions were made to
lower the glycemic response. Studies showed
soluble and non-soluble ber and low GL diet can
control glycemic response. Rened carbohydrate
1. Gholamreza Askari,
Assistant Professor of Clinical Nutrition,
Food Security Research Center,
2. Motahar Heidari-Beni,
Food Security Research Center,
3. Maryam Bakhtiari Broujeni,
Isfahan Endocrine and Metabolism Research Center,
4. Alireza Ebneshahidi,
Isfahan Endocrine and Metabolism Research Center,
5. Massoud Amini,
Professor of Internal Medicine and Endocrinology,
Isfahan Endocrine and Metabolism Research Center,
6. Reza Ghisvand,
Assistant Professor of Clinical Nutrition,
Food Security Research Center,
7. Bijan Iraj,
Assistant Professor of Internal Medicine and Endocrinology,
Isfahan Endocrine and Metabolism Research Center,
1-7: Isfahan University of Medical Sciences, Isfahan, Iran.
Correspondence:
Bijan Iraj,
E mail: bijaniraj@gmail.com
Original Article
Effect of whole wheat bread and white bread
consumption on pre-diabetes patient
Gholamreza Askari1, Motahar Heidari-Beni2, Maryam Bakhtiari Broujeni3,
Alireza Ebneshahidi4, Massoud Amini5, Reza Ghisvand6, Bijan Iraj7
ABSTRACT
Background and Objective: Soluble dietary bers reduce postprandial glucose, total and LDL cholesterol
level. Finding about the efcacy of whole grain on chronic disease such as diabetes and ischemic heart
disease (IHD) and mortality is controversial. Bread is the most important source of carbohydrate diet and
investigation the effect of bread on glycemic response is important. The aim of this study was to compare
the effect of whole wheat bread and white wheat bread on risk factors of pre-diabetes patients.
Methodology :Nine hundred forty six (946) men and women 35 to 55 year of age were included in the
study. Dietary intake was assessed with 3 days record. Whole breads involve sangak and barbary (are a kind
of Iranian breads) that were considered 270 and 250 grams for each one, respectively. White breads involve
bagets, lavash and taftoon (are a kind of Iranian breads) that were considered 90, 88 and 120 grams for
each one, respectively. Biochemical assessments and anthropometric indices were determined according
to the standard protocol.
Results: About 23% of participant was men and 77% were women. Signicant positive correlation between
white bread consumption and WC, BS 120, HbA1C, TG and SBP were found. We didn’t nd any signicant
correlation between white bread and other variables. After controlling some confounding factors such as
age, sex and total energy intake, we found a positive association between white bread consumption and
BS120, HbA1C and TG.
Conclusions: According to our nding white breads have an inverse effect of healthy status and whole
wheat bread didn’t have any signicant effect of risk factors of diabetes.
KEY WORDS: Whole bread, White bread, Pre-diabetes.
doi: http://dx.doi.org/10.12669/pjms.291(Suppl).3516
How to cite this:
Gholamreza A, Heidari-Beni M, Broujeni MB, Alireza E, Amini M, Reza G, et al. Effect of whole wheat bread and white bread
consumption on pre-diabetes patient. Pak J Med Sci 2013;29(1)Suppl:275-279. doi: http://dx.doi.org/10.12669/pjms.291(Suppl).3516
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
276 Pak J Med Sci 2013 Vol. 29 No. 1 Special Supplement IUMS www.pjms.com.pk
and grains without bran have higher GL and GI than
whole grains and have adverse effect on health.3
According to ndings soluble dietary bers reduce
postprandial glucose, total and LDL cholesterol
levels.4 Finding about the efcacy of whole grain
on chronic disease such as diabetes and ischemic
heart disease (IHD) and mortality is controversial.5
Studies showed high intake of carbohydrates
increase TG levels by enhancing hepatic synthesis of
very low-density lipoprotein (VLDL) and decrease
activity of lipoprotein lipase.6 Large portion of
energy be obtained from carbohydrates.7
Bread is the most important source of
carbohydrate diet. Since bread is low cost and is the
most part of Iranian diet and approximately more
people consume it in all days of week, investigation
about the effect of bread on glycemic response is
important. Findings about whole and rened grains
in recent studies are inconsistent so the aim of this
study was to compare the effect of whole wheat
bread and white wheat bread on risk factors of pre-
diabetes patients.
METHODOLOGY
Participant: This cross sectional research was per-
formed in Isfahan Endocrine and Metabolism Re-
search Center (IEMRC). We choose participants
from a cohort study that was conducted from 2003
until now with 3454 member in this center. Aims
of this cohort study were prevention of type 2 dia-
betes by changing in life style or by medical inter-
vention among high risk people. Inclusion criteria
were men and female 35 to 55 years who were rst
relative history of type 2 diabetes. Exclusion crite-
ria were those who used medication that has ef-
fect on glucose tolerance test and lipid proles. One
thousand three hundred fteen subjects were pre-
diabetes and 1050 of them had food record. Nine
hundred forty six participants reported that they
consume white or whole bread. According to ADA
criteria8 three hundred sixty eight subjects were
impaired fasting glucose (IFG), those with 100-125
mg/dl of fasting blood glucose. In IFG group, 117
subjects consumed whole bread and 251 subjects
consumed white bread. Three hundred three sub-
jects were Impaired Glucose Tolerance (IGT), those
with 140-199 mg/dl of blood glucose 120 minute
after intake 75gr oral glucose. In IGT group, 133
subjects consumed whole bread and 170 subjects
consumed white bread. Two hundred seventy ve
subjects were combined pre-diabetes (IFG +IGT)
that 87 subjects consumed whole bread and 188
subjects consumed white bread. The Isfahan En-
docrine and Metabolism Research Center (IEMRC)
Medical Ethics Committee approved this study and
each participant gave written informed consent.
Assessment of anthropometric indices: Weight
was measured by Seca scales (Germany) to the
nearest 100g with minimal clothing and without
shoes. Height was measured in a standing position,
without shoes while the shoulders were in a normal
position to the nearest 0.5 cm. Waist circumference
(WC) was measured using un-stretchable tape in a
standing position without applying any pressure to
the body’s surface, and was recorded to the nearest
0.1 cm. WC was measured in the middle of the
lowest gear and the top of the iliac crest (the most
narrow waist circumference) Body mass index was
estimated as weight (kg) divided by height (m)
squared. WC was considered as abdominal obesity
index and BMI was considered as general obesity
index.
Biochemical assessment: Blood samples were taken
from 7:30 to 9:30 AM, after 12 hours overnight fasting
to determine serum lipids and whole blood glucose
levels. Blood glucose, serum triglyceride (TG), total
cholesterol and high density lipoprotein cholesterol
(HDL-C) levels were determined by using an
enzymatic method. Oral Glucose Tolerance Test
(OGTT) was done after 10-12 hours of overnight
fasting, a 75gr oral glucose was administered and
plasma glucose concentrations were measured at
fasting and 120 minutes after glucose taking (BS120).
The analysis of sample was performed with an auto
analyzer (BT 3000, Rome, Italy) using commercial
kits (Chem Enzyme, Tehran Iran). Serum total
cholesterol and triglycerides levels were measured
by enzymatic reagents (Chem. Enzyme, Tehran
Iran) adapted to Selecta auto analyzer.
HDL-C levels were measured by using available
commercial kits (Pars Azmun, Tehran Iran). Low
density lipoprotein cholesterol levels (LDL-C) were
calculated from the values of serum triglyceride
(TG), total cholesterol and HDL cholesterol
according to the Fried Wald formula in triglyceride
<400 mg/dl9: LDL-C=Total cholesterol –HDL-C-
TG/5.
HbA1c were assessed with DS5 analyzer uses
low pressure cat ion exchange chromatography
in conjunction with gradient elution to separate
human hemoglobin subtypes and variants from
hemolyse whole blood.10,11
Inter assay coefcients of variations were 1.25
for triglycerides, 1.2 for cholesterol and 1.25 for
glucose. The corresponding intra-assay coefcients
of variations were 1.97, 1.6 and 2.2, respectively.
Gholamreza Askari et al.
Pak J Med Sci 2013 Vol. 29 No. 1 Special Supplement IUMS www.pjms.com.pk 277
Assessment of dietary intake: Dietary intake was
assessed by three days record and trained dietitian
adjusted it. These records had eleven columns that
included cereals group, legumes, dairy, meat, fat,
nuts, fruit, vegetable, sweet and sugar free and
drinks. Dietitians educated the groups in classes
how to prepare records. Then dietitians changed
record’s contents to gram.12 According to the kind
of breads consumption in their record we divided
subjects in two groups (white bread consumer and
whole bread consumer). Whole breads involve
sangak and barbary (are a kind of Iranian breads)
that were considered 270 and 250 grams for each
one, respectively. White breads involve bagets,
lavash and taftoon (are a kind of Iranian breads)
that were considered 90, 88 and 120 grams for each
one, respectively.
Statistic Analysis: SPSS (version 13) was used for
statistical analysis. Continuous variables presented
as mean ± standard deviation. Correlation between
dependent variables (glucose and lipid parameters,
anthropometric indices and blood pressure) and
independent variables (whole and white bread)
was evaluated by Pearson correlation. The
relationships between dependent variable with
bread consumption were examined using multiple
linear regression analysis, after controlling for
potential confounders (adjusted with age, sex,
energy intake). P<0.05 was considered statistically
signicant.
RESULTS
About 23% of participant were men and 77%
were women. Clinical and characteristics of the
study participant are shown in Table-I.
Signicant positive correlation between white
bread consumption and WC, BS 120, HbA1C, TG
and SBP were found. We didn’t nd any signicant
correlation between white bread and other variables.
Any signicant correlation between whole bread
and variables was not observed.
After controlling some confounding factors
such as age, sex and total energy intake, we
found a positive association between white
bread consumption and BS120, HbA1C and TG.
Increasing the amount of white bread consumption
lead to enhance BS120, HbA1C and TG levels. Any
signicant association was not observed between
whole bread consumption and variables.
DISCUSSION
In this study we observed a positive association
between white bread consumption and BS120,
HbA1C and TG levels with and without adjusting of
confounding factor. There were positive correlation
between white bread consumption and WC and
SBP without adjusting. High intake of whole grains
is related to a reduced risk of type 2 diabetes and
consumed regularly, may reduce body weight,
improving insulin sensitivity, blood pressure and
lipid metabolism;13,14 however we didn’t observe
any signicant association between whole wheat
bread and risk factors of pre-diabetes. Similarly
our ndings; studies showed whole grains have no
signicant effect on metabolic syndrome variables
such as TG, LDL-C, HDL-C, SBP, DBP, FBS and
BMI.15 A cross sectional study did not show any
association between whole grain consumption and
HDL-C, HbA1c and TG.16 An interventional study
Table-I: Clinical and biochemical
variables of participants.
Variables mean±SD*
Age 44.25±6.82
Waist circumference 90.78±9.42
Hip circumference 108.4±9.26
BMI 29.59±4.25
FBS 105.7±10.84
Bs120 143.51±38.39
HbA1C 5.22±0.82
TG 174.95±107.57
TC 202.35±40.45
HDL-C 45.63±12.33
LDL-C 109.03±24.73
SBP 11.7±1.67
DBP 7.6±1.22
*Mean ± Standard Deviation
BMI=body mass index, FBS=fasting blood sugar, BS
120=blood sugar 120, HbA1C= glycosylated hemoglobin,
TG=triglycerides, TC=total cholesterol, HDL-C= high-density
lipoprotein cholesterol, LDL-C= low-density lipoprotein
cholesterol, SBP= systolic blood pressure, DBP= diastolic
blood pressure.
Table-II: Correlation coefcient of risk factors of pre-diabetes and type of bread consumption.
Waist BMI FBS BS120 HbA1C TG TC HDL LDL SBP DBP
circumference
White bread 0.14*(0.001) 0.04(0.32) 0.03(0.52) 0.16(0.001) 0.01(0.04) 0.1(0.01) -0.01(0.92) -0.02(0.54) 0.13(0.48) 0.11(0.007) 0.05(0.2)
Whole bread 0.07(0.18) 0.02(0.62) -0.04(0.48) -0.03(0.63) 0.67(0.23) 0.06(0.21) -0.01(0.86) -0.02(0.7) 0.23(0.41) -0.02(0.61) 0.024(0.65)
* Correlation coefcient (p-value), Abbreviations as in Table-I
278 Pak J Med Sci 2013 Vol. 29 No. 1 Special Supplement IUMS www.pjms.com.pk
showed three month consumption of wheat bran
didn’t change FBS and HbA1c in diabetes patients.17
However some ndings indicated that whole grain
may have benecial affect on glucose and lipid
metabolism. Epidemiological studies showed
an inverse effect of whole grain on risk factors of
diabetes and benecial effect to prevention of type
2 diabetes but ndings are inconsistent.2 Exact
biological mechanisms related to the benecial
effects of whole grains are unknown.15
Whole grains are a rich source of ber, minerals,
vitamins, phenolic compounds, phytoestrogens
and antioxidants and these components are related
to benecial effects of whole grains on healthy and
improve insulin sensitivity. High ber of whole
grains leads to slower absorption of macronutrient,
decrease blood glucose and insulin secretion. Soluble
ber can decrease cholesterol concentrations.
However whole wheat (whole bread) contain little
soluble ber and cannot be responsible for reduce
cholesterol levels.5 Lack of association between
whole wheat bread and risk factors of diabetes in
our study and other studies may be due to little
amount of soluble ber in whole wheat bread. In
addition to whole breads that subjects consumed
may not have enough bran to effect of glucose and
lipid parameters.
In contrast to our nding, some studies showed
whole grains were associated with less weight
gain.18 Results of cohort prospective studies have
reported whole grain foods decrease BMI and
improve the metabolic abnormalities that related
to diabetes progression.19 Whole grains effect on
satiety and decrease energy intake.4 However, other
studies reported no signicant effects.20,21
Our study showed white bread may increase BS120,
HbA1C and TG levels. White bread and rened
carbohydrates have high GI and rapidly absorb
from intestine and lead to increase blood glucose
and insulin secretion. The Nurses’ Health Study
showed high dietary GL and low grain ber and
bran intake was associated with higher risk of type
2 diabetes mellitus.22 High intake of carbohydrates
induces hypertriglyceridemia.23,24 Among healthy
people, high rened-carbohydrate consumption
reduces levels of HDL.25 Many metabolic studies
have shown that high carbohydrate diets increase
levels of fasting triglycerides and increase in plasma
remnant lipoprotein cholesterol and remnant
lipoprotein triglycerides.26 Studies have also
showed rened grains increase dietary glycemic
load, insulin demand and glysemic responce
that may enhance the risk of type 2 diabetes and
coronary heart disease.6 Despite the contradictory
ndings, whole grains because of high content of
ber and many enzymatic inhibitors are digested
and absorbed more slowly than rened grains
and associated with small postprandial glucose
responses and little insulin demand.27
CONCLUSION
According to our nding white breads have an
inverse effect of health status and whole wheat
bread didn’t have any signicant effect of risk
factors of diabetes. Efcacy of whole wheat breads
because of low content of soluble ber must be
further investigated to assess benecial effect of
them on healthy status.
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Table-III: Multiple regression analysis on the association
between type of bread consumption and risk factors
of pre-diabetes.
White bread Whole bread
B±SE P B±SE P
Model 1: Bs0 0.002±0.001 0.14 0.002±0.002 0.32
Model 2: Bs120 0.011±0.003 0.001 0.004±0.004 0.24
Model 3: HbA1c 0.01±0.001 0.04 0.01±0.001 0.26
Model 4: TG 0.12±0.013 0.035 0.005±0.14 0.73
Model 5: TC 0.05±0.005 0.99 0.001±0.006 0.95
Model 6: HDL 0.01±0.002 0.69 0.01±0.003 0.82
Model 7: LDL 0.013±0.43 0.51 0.001±0.43 0.97
Model 8:WC 0.01±0.001 0.38 0.001±0.001 0.57
Model 9:BMI 0.01±0.001 0.73 0.01±0.001 0.32
*Data are B-coefcient ± Standard Error. Values are
corrected for various confounders such as total energy,
sex and age. Independent variable is type of bread
consumption. Abbreviations as in Table-I
Gholamreza Askari et al.
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Pak J Med Sci 2013 Vol. 29 No. 1 Special Supplement IUMS www.pjms.com.pk 279
... Eaten in the recommended amounts, whole grains have been associated with a significant reduction in the risk of chronic diseases such as cancer [16], metabolic syndrome [17] and hypertension [18,19], more favorable long-term weight management [20], and an increase in satiety [21]. Each of these points will be considered herein. ...
... For whole grains, the results are conflicting. While some studies have not found significant differences between white and whole bread on the glycemic profile [19,29], others have suggested that the consumption of whole wheat products leads to lower levels of fasting glucose [28,30,31] and insulin [32]. ...
... The consumption of products made with Kamut ® khorasan and the ancient varieties "Verna", "Gentil Rosso", and "Autonomia B" has led to a significant improvement in total and LDL-cholesterol [6,[26][27][28]. In contrast, the consumption of white bread has been correlated with an increase in triglyceride levels [19]. ...
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... Bread is a simple food of regular human nutrition and wheat flour is the main ingredient in bread making ( Kourkouta et al., 2017 ). Bread contains complex carbohydrates, mainly starch which provide about 90% of the total carbohydrate content of bread ( Askari et al., 2013 ;Hiller et al., 2011 ). White bread is made from white flour which is produced from the cereal (wheat) that has its bran removed ( Askari et al., 2013 ;Miller and Stanner 2016 ). ...
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... White bread has high GI and quickly absorbs in small intestine to shoot up the blood glucose level. This is in accordance with the work of Askari et al., 2013 . There was a glaring correlation between progression of diabetes mellitus and high GI carbohydrate such as white bread ( Askari et al., 2013 ). ...
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High glycaemic index diet and α-glucosidase activity have been implicated in postprandial hyperglycaemia. Regulation of α-glucosidase activity and high glycaemic index diet has promising consequence on curbing the prevalence of type-2 diabetes mellitus. The present study investigated inhibitory effect of aqueous extract of Camellia sinensis (green tea) on α-glucosidase activity and glycaemic index of white bread. In vitro inhibition of α-glucosidase activity using p-nitrophenyl glucopyranoside as substrate and Camellia sinensis aqueous extract as inhibitor was investigated. Likewise, in vivo study on effect of the tea on glycaemic index of white bread using 30 healthy participants was carried out. The outcomes of the investigation revealed that Camellia sinensis aqueous extract reduced the activity of α-glucosidase to 17.50% with IC50 of 202.12 µg/mL. The mode of inhibition was mixed competitive. It also lowered the glycaemic index (GI) of white bread by 39.71% when bread consumption was delayed for 5 minutes after the extract consumption. In conclusion, report has shown that agent that reduces postprandial hyperglycaemia has an important role to play in the handling type-2 diabetes mellitus. This agent does this by lowering the GI of carbohydrate-rich food and/or inhibiting the activities of α-glucosidase enzyme. This study shows that aqueous extract of Camellia sinensis has a great potential to reduce the undue postprandial hyperglycaemia.
... Eaten in the recommended amounts, whole grains have been associated with a significant reduction in the risk of chronic diseases such as cancer [16], metabolic syndrome [17] and hypertension [18,19], more favorable long-term weight management [20], and an increase in satiety [21]. Each of these points will be considered herein. ...
... For whole grains, the results are conflicting. While some studies have not found significant differences between white and whole bread on the glycemic profile [19,29], others have suggested that the consumption of whole wheat products leads to lower levels of fasting glucose [28,30,31] and insulin [32]. ...
... The consumption of products made with Kamut ® khorasan and the ancient varieties "Verna", "Gentil Rosso", and "Autonomia B" has led to a significant improvement in total and LDL-cholesterol [6,[26][27][28]. In contrast, the consumption of white bread has been correlated with an increase in triglyceride levels [19]. ...
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Recently, a large and growing body of literature has investigated the health potential of different wheat species. In particular, a considerable number of studies dealing with nutritional aspects has grown up around the theme of the recovery of ancient wheat varieties (species that have remained unchanged over the last hundred years). According to several studies, indeed, ancient varieties present a healthier nutritional profile than modern ones. In the framework of the European project "CERERE, CEreal REnaissance in Rural Europe: embedding diversity in organic and low-input food systems", this paper aimed to review recent research on the issue of health and nutritional cereal systems by adopting an innovative and participatory multi-actor approach which involved practitioners along with researchers. The participatory approach is the main innovation and peculiarity of this literature review. Nevertheless, the review highlights the many positive effects derived from eating whole and ancient grains such as a significant reduction in the risk of chronic diseases such as cancer, cardiovascular disease, and also a more favorable long-term weight management and increase in satiety. This review may be considered as a fruitful starting point that integrates research results to foster current and future healthier and sustainable practices in cereal systems.
... So, based on this perception, wheat followed by pea was labeled to be the most non-preferential input; in that, all food preparations containing it or prepared from it are prohibited. However, maybe due to the vitamin richness of whole wheat grain, a quantitative study showed, despite a significant positive correlation between white bread consumption and blood sugar, a high intake of whole grains is related to a reduced risk of T2DM (Askari et al., 2013). ...
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Background: Compliance of patients with self-care practices is the mainstay of measures to manage diabetes. This study explored self-care practices of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia. Methods: The study employed an interpretive phenomenological approach using purposive sampling. The data were collected from 24 (11 males and 13 females) participants (July 2019 to January 2020) using in-depth interviews till theoretical saturation. The data were analyzed thematically and organized using QDA Miner Lite v2.0.8. Results: The findings were categorized into: labeling diabetes, self-care maintenance experiences, recognition of symptoms, and mitigating mechanisms of symptoms. The self-care maintenance practice of patients was linked with diet input preferences and the effectiveness level of insulin. What guides the self-care behavior was the patients’ preferentiality of strictly adhering to their preferred dietary inputs. Barley and wheat were the most common preferential and non-preferential inputs, respectively. The patients strictly adhered to insulin treatment because they found it effective. The most common hyperglycemia symptoms to be managed by taking an additional dose of insulin, were frequent urination, increased thirst, and their consequences (dehydration). Excessive sweating (initial), shivering (middle), and falling (final), respectively in severity, were the most common symptoms of hypoglycemia which were perceived to be treated with sweet snacks. Originality: To our knowledge, this is the first research in Ethiopia to investigate the self-care experiences of type 2 diabetes patients receiving insulin using an interpretive phenomenological approach.
... However, nuggets are usually manufactured with a wheat flour coating (Sahin et al. 2005;Teruel et al. 2015), which is poor in protein and rich in carbohydrates (Baljeet et al. 2010;Sui et al. 2016), mainly highly digestible starch with a high glycemic index (GI) (Sui et al. 2016). A high GI has been associated with increased risk of certain diseases such as diabetes (Askari et al. 2013) and biliary tract cancer (Larsson et al. 2016). The coating flour is, however, a good vehicle for the application of dry ingredients presenting highnutrient quality (Nasiri et al. 2012). ...
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The aim of the present study was to evaluate the physicochemical and sensory qualities of pre-fried and fried fish nuggets manufactured with partial replacement of coating flour by fish (Priacanthus arenatus) waste flour. Four formulations of pre-fried and fried nuggets were prepared as follows: control (coating with 100% wheat flour), C10 (coating with 90% wheat flour and 10% fish waste flour), C25 (coating with 75% wheat flour and 25% fish waste flour), and C40 (coating with 60% wheat flour and 40% fish waste flour). All samples were analyzed regarding proximate composition, instrumental color parameters, instrumental texture profile, and sensory attributes (overall liking, purchase intention, consumer interest, and check-all-that-apply). The addition of 40% fish waste flour in place of coating flour increased (P < .05) protein, lipid, and ash contents in both pre-fried and fried fish nuggets, while (P < .05) carbohydrate levels decreased compared to fish nuggets without the inclusion of fish waste flour. Overall, the replacement of coating flour by 25% and 40% fish waste flour increased (P < .05) h° angle and a* and b* values in both pre-fried and fried fish nuggets. In addition, the same replacement levels decreased (P < .05) hardness and chewiness in pre-fried nuggets, while increasing (P < .05) these parameters in fried nuggets. Regarding sensory attributes, fish waste flour increased (P < .05) the perception of a dark golden color, fish flavor, and crunchiness, leading to a higher (P < .05) overall liking and preference for nuggets containing 25% and 40% fish waste flour in replacement of coating flour. Therefore, the replacement of fish nugget coating flour with 40% fish (Priacanthus arenatus, Cuvier, 1829) waste flour is a potential strategy for waste management and health market encouragement.
... Bread is the most staple cereal-based food consumed worldwide (Bagdi et al., 2016). However, bread is constituted of flour, water, and yeast, poor in protein and rich in carbohydrates, with a high glycemic index, which can lead to obesity and susceptibility to diabetes and biliary-tract cancer (Askari et al., 2013;Larsson, Giovannucci, & Wolk, 2016). On the other hand, fish and fish by-products are highly nutritional foods, due to their high protein and essential fatty acid amounts (FAO, 2016;Monteiro et al., 2016). ...
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The physicochemical stability of six bread formulations with different tilapia flour (BTF) levels (0%, 2.5%, 5%, 10%, 15%, and 20%) in substitution to wheat flour was investigated regarding moisture content, water activity (aw), pH, instrumental color parameters, texture profile, lipid and protein oxidation on days 0, 2, 4, 6 and 8 at 25°C. BTF10%, BTF15%, and BTF20% displayed lower (P < 0.05) moisture, aw, lightness index, cohesiveness, springiness and resilience, and higher (P < 0.05) pH, redness index, yellowness index, hardness, chewiness, lipid and protein oxidation compared to BTF0%, BTF2.5%, and BTF5%. Nevertheless, pH drops, lipid and protein oxidation were less pronounced (P < 0.05) for BTF10%, BTF15%, and BTF20% during storage. Although quality loss has been observed in breads containing ≥ 10% TF, bread at 5% TF did not display altered traditional wheat bread physicochemical characteristics and may be an attractive alternative for the health food market.
... The increasing awareness of consumers and interest in different types of bread in recent years has led to increased consumption of high fiber bread types 9 . There are many positive health effects of dietary fiber such as decreased postprandial glucose level, total and LDL cholesterol levels and prevention of colon cancer 10 . For this reason, nutrition and nutrient guidelines published in official institutions in many countries focus on whole grains as the most basic food item of a healthy and balanced diet 11 . ...
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Background and Objective: Bread is a most basic food item consumed commonly all over the world. Bread consumption habits mostly reflects lifestyle and the type and amount of the consumed bread varies with the changes in socioeconomic, cultural and educational conditions of societies. Previously, the bread consumption habits of the Turkish people were evaluated with different local and national studies. This study aimed to determine the bread consumption habits of well-educated individuals and the amount of nutrients provided from bread consumption. Materials and Methods: All academic staff members and civil servants, working in Karamanoğlu Mehmetbey University, included for the study. Within the scope of the study, a questionnaire including bread consumption habits was applied. Bread consumption and bread types in 24 h dietary recall were recorded and, energy and nutrient intake from bread consumption were analysed by a food analysis software. Results: The percentage of white bread consumers was 50.0%. This rate was 58.0% for men and 36.1% for women. The mean amount of bread consumption was 147.3±83.98 g for men and 86.5±47.92 g for women respectively. In addition, daily dietary intake of energy, carbohydrate, fiber, thiamine, vitamin B6, folate and sodium from bread consumption in men significantly higher than those in women. Carbohydrate intake from bread consumption provides averagely 54.7% of adequate intake of carbohydrate for men. This averagely rate was 31.6% in women. Moreover, bread consumption provided adequate micronutrient intake (AI) in men significantly higher than in women. Conclusion: The amounts of bread consumption of the present study are lower than that of the local and national studies. So, it is clear that education level is important for bread consumption awareness. Government-sponsored educational activities are thought to be able to change people's bread consumption habits significantly.
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Bread is highly nutritious and consumed in many ways by most. This study was carried out to determine the effect of daily bread consumption on serum insulin, glycated hemoglobin, and plasma glucose level among male daily bread consumers. Thirty male students were randomly selected and fed with bread for 21 days. Their pre and post-blood samples were analyzed using the Enzyme-Linked Immunosorbent Assay (ELISA) method for insulin and glycated hemoglobin whereas glucose estimation was done using the glucose oxidase method. Pre and post Body Mass Index (BMI) were also determined. Results showed that there was a signicant decrease in the BMI of the participants in daily post bread eaters (21.80±2.21) compared to baseline (20.04±2.36) (p<0.05) while there were no signicant differences in the mean levels of fasting plasma glucose, glycated hemoglobin, and insulin in daily post bread eaters (4.94±0.24, 5.88±0.63, and 6.43±3.22 respectively) (p>0.05). Likewise, no signicant association existed between the parameters studied. Therefore no signicant alteration was observed in the parameters studied except for the decreased BMI observed after bread consumption among the participants which could be attributed to the increase in academic stress activities experienced by participants as the studied participants were students at examination during the post sample collection.
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Background: Compliance of patients with self-care practices is the mainstay of measures to manage diabetes. This study explored self-care practices of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia. Methods: The study employed an interpretive phenomenological approach using purposive sampling. The data were collected from 24 (11 males and 13 females) participants (July 2019 to January 2020) using in-depth interviews till theoretical saturation. The data were analyzed thematically and organized using QDA Miner Lite v2.0.8. Results: The findings were categorized into: labeling diabetes, self-care maintenance experiences, recognition of symptoms, and mitigating mechanisms. The self-care maintenance practice of patients was linked with diet input preferences and the effectiveness level of insulin. What guides the self-care behavior was the patients’ preferentiality of strictly adhering to their preferred dietary inputs. Barley and wheat were the most common preferential and non-preferential inputs, respectively. The patients strictly adhered to insulin treatment because they found it effective. The most common hyperglycemia symptoms to be managed by taking an additional dose of insulin, were frequent urination, increased thirst, and their consequence (dehydration). Excessive sweating (initial), shivering (middle), and falling (final), respectively in severity, were the most common symptoms of hypoglycemia which were perceived to be treated with sweet snacks. Originality: To our knowledge, this is the first research in Ethiopia to investigate the self-care experiences of type 2 diabetes patients receiving insulin using an interpretive phenomenological approach.
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Full-text available
Background: Compliance of patients with self-care practices is the mainstay of measures to manage diabetes. This study explored self-care practices of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia. Methods: The study employed an interpretive phenomenological approach using purposive sampling. The data were collected from 24 (11 males and 13 females) participants (July 2019 to January 2020) using in-depth interviews till theoretical saturation. The data were analyzed thematically and organized using QDA Miner Lite v2.0.8. Results: The findings were categorized into: labeling diabetes, self-care maintenance experiences, recognition of symptoms, and mitigating mechanisms of symptoms. The self-care maintenance practice of patients was linked with diet input preferences and the effectiveness level of insulin. What guides the self-care behavior was the patients’ preferentiality of strictly adhering to their preferred dietary inputs. Barley and wheat were the most common preferential and non-preferential inputs, respectively. The patients strictly adhered to insulin treatment because they found it effective. The most common hyperglycemia symptoms to be managed by taking an additional dose of insulin, were frequent urination, increased thirst, and their consequences (dehydration). Excessive sweating (initial), shivering (middle), and falling (final), respectively in severity, were the most common symptoms of hypoglycemia which were perceived to be treated with sweet snacks. Originality: To our knowledge, this is the first research in Ethiopia to investigate the self-care experiences of type 2 diabetes patients receiving insulin using an interpretive phenomenological approach.
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Objective: To examine prospectively the relationship between glycemic diets, low fiber intake, and risk of non-insulin-dependent diabetes mellitus. Design: Cohort study. Setting: In 1986, a total of 65173 US women 40 to 65 years of age and free from diagnosed cardiovascular disease, cancer, and diabetes completed a detailed dietary questionnaire from which we calculated usual intake of total and specific sources of dietary fiber, dietary glycemic index, and glycemic load. Main outcome measure: Non-insulin-dependent diabetes mellitus. Results: During 6 years of follow-up, 915 incident cases of diabetes were documented. The dietary glycemic index was positively associated with risk of diabetes after adjustment for age, body mass index, smoking, physical activity, family history of diabetes, alcohol and cereal fiber intake, and total energy intake. Comparing the highest with the lowest quintile, the relative risk (RR) of diabetes was 1.37 (95% confidence interval [CI], 1.09-1.71, P trend=.005). The glycemic load (an indicator of a global dietary insulin demand) was also positively associated with diabetes (RR= 1.47; 95% CI, 1.16-1.86, P trend=.003). Cereal fiber intake was inversely associated with risk of diabetes when comparing the extreme quintiles (RR=0.72, 95% CI, 0.58-0.90, P trend=.001). The combination of a high glycemic load and a low cereal fiber intake further increased the risk of diabetes (RR=2.50, 95% CI, 1.14-5.51) when compared with a low glycemic load and high cereal fiber intake. Conclusions: Our results support the hypothesis that diets with a high glycemic load and a low cereal fiber content increase risk of diabetes in women. Further, they suggest that grains should be consumed in a minimally refined form to reduce the incidence of diabetes.
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Different carbohydrate diets have been administrated to diabetic patients to evaluate the glycemic response, while Poor-controlled diabetes is increasing world wide. To investigate the role of an alternative carbohydrate diet on glycemic control, we explored the effect of a low glycemic load (Low GL)-high fat diet on glycemic response and also glycated hemoglobin (HbA1c) of poor-controlled diabetes patients. Hundred poorly-controlled diabetes patients, HbA1c > 8, age 52.8 ± 4.5 y, were administrated a low GL diet , GL = 67 (Energy 1800 kcal; total fat 36%; fat derived from olive oil and nuts 15%; carbohydrate 42%; protein 22%) for 10 weeks. Patients did their routine life style program during intervention. Fasting blood glucose and HbA1c before and after intervention with significant reduction were: 169 ± 17, 141 ± 12; 8.85% (73 mmol/mol) ± 0.22%, and 7.81% (62 mmol/mol) ± 0.27%; respectively (P < 0.001). Mean fasting blood glucose reduced by 28.1 ± 12.5 and HbA1c by 1.1% (11 mmol/mol) ± 0.3% (P=0.001). There was positive moderate correlation between HbA1c concentration before intervention and FBS reduction after intervention (P < 0.001, at 0.01 level, R =0.52), and strong positive correlation between FBS before intervention and FBS reduction (P < 0.001, at 0.01 level, R = 0.70). This study demonstrated that our alternative low glycemic load diet can be effective in glycemic control.
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Purpose To examine the association of red meat and whole-grain bread consumption with plasma levels of biomarkers related to glucose metabolism, oxidative stress, inflammation and obesity. Methods Our cross-sectional study was based on 2,198 men and women who were selected as a sub-cohort for an investigation of biological predictors of diabetes and cardiovascular diseases from the European Prospective Investigation into Cancer and Nutrition-Potsdam study. Circulating levels of glycated hemoglobin, adiponectin, hs-CRP, gamma-glutamyltransferase, alanine-aminotransferase, fetuin-A, HDL-cholesterol and triglycerides were measured from random blood samples. Diet and lifestyle data were assessed by questionnaires, and anthropometric data were measured. Results After multivariable adjustment, higher consumption of whole-grain bread was significantly (P trend <0.05) associated with lower levels of GGT, ALT and hs-CRP, whereas higher consumption of red meat was significantly associated with higher levels of GGT and hs-CRP when adjusted for potential confounding factors related to lifestyle and diet. Further adjustment for body mass index and waist circumference attenuated the association between red meat and hs-CRP (P = 0.19). Conclusions The results of this study suggest that high consumption of whole-grain bread is related to lower levels of GGT, ALT and hs-CRP, whereas high consumption of red meat is associated with higher circulating levels of GGT and hs-CRP.
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A high dietary fiber (DF) intake is emphasized in the recommendations of most diabetes and nutritional associations. It is accepted that viscous and gel-forming properties of soluble DF inhibit macronutrient absorption, reduce postprandial glucose response, and beneficially influence certain blood lipids. Colonic fermentation of naturally available high fiber foods can also be mainly attributed to soluble DF, whereas no difference between soluble and insoluble DF consumption on the regulation of body weight has been observed. However, in prospective cohort studies, it is primarily insoluble cereal DF and whole grains, and not soluble DF, that is consistently associated with reduced diabetes risk, suggesting that further, unknown mechanisms are likely to be involved. Recent research indicates that DF consumption contributes to a number of unexpected metabolic effects independent from changes in body weight, which include improvement of insulin sensitivity, modulation of the secretion of certain gut hormones, and effects on various metabolic and inflammatory markers that are associated with the metabolic syndrome. In this review, we briefly summarize novel findings from recent interventions and prospective cohort studies. We discuss concepts and potential mechanisms that might contribute to the further understanding of the involved processes.
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Factors reported to influence the plasma triglyceride concentration include the amounts and type of carbohydrate and fat and the caloric intake. The effects must be exerted through changes in triglyceride formation, removal or both, which in turn may be influenced by changes in free fatty acid (FFA) turnover, insulin secretion or body weight. These factors have been studied under the following circumstances: (1) comparison of diets rich in either sucrose, starch, glucose or fructose; (2) comparison of diets rich in either saturated or polyunsaturated fatty acids; and (3) comparison of eucaloric, hypercaloric and hypocaloric diets. The triglyceride concentration, the insulin responsiveness to glucose, and the total, though not the fractional rate of appearance of radioactive FFA in triglyceride fatty acids (TGFA) were always greater with sucrose than with starch; the formation of TGFA therefore appeared to be greater with sucrose though the higher triglyceride levels showed that removal was also less efficient. Glucose and fructose raised triglycerides to a similar extent but the rate of appearance of FFA in TGFA seemed to be greater with glucose. Saturated fats invariably led to higher triglyceride levels although the rate of incorporation of FFA into TGFA was one the average less than with polyunsaturated fats, suggesting that saturated fats gave rise to a relative diminution in the removal of triglycerides. Studies carried out sequentially during carbohydrate-rich diets showed that the rise in triglyceride levels was associated at first with an increase and later with a decrease in the incorporation of plasma FFA into TGFA. With starvation there was a fall in the triglyceride concentration which was however associated with an increase in the total rate of appearance of FFA in TGFA. Plasma FFA turnover was also raised but insulin responsiveness to glucose fell. Overeating led to a marked rise in triglyceride concentration and the insulin response; the total rate of appearance of FFA in TGFA increased only modestly whereas the fractional rate of equilibration of FFA with TGFA fell strikingly, suggesting that inadequate removal was a major cause of hypertriglyceridemia. Among the subjects studied on eucaloric carbohydrate-rich diets the plasma triglyceride concentration was significantly related to the rate of appearance of FFA in TGFA, to FFA turnover, to the insulin response and to the ponderal index. The insulin response and the ponderal index were also significantly correlated.
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In this study we compared the effects of variations in dietary fat and carbohydrate (CHO) content on concentrations of triglyceride-rich lipoproteins in 8, healthy, nondiabetic volunteers. The diets contained, as a percentage of total calories, either 60% CHO, 25% fat, and 15% protein, or 40% CHO, 45% fat, and 15% protein. They were consumed in random order for 2 weeks, with a 2-week washout period in between. Measurements were obtained at the end of each dietary period of plasma triglyceride, cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, remnant lipoprotein (RLP) cholesterol, and RLP triglyceride concentrations, both after an overnight fast and throughout an 8-hour period (8 a.m. to 4 p.m.) in response to breakfast and lunch. The 60% CHO diet resulted in higher (mean ± SEM) fasting plasma triglycerides (206 ± 50 vs 113 ± 19 mg/dl, p = 0.03), RLP cholesterol (15 ± 6 vs 6 ± 1 mg/dl, p = 0.005), RLP triglyceride (56 ± 25 vs 16 ± 3 mg/dl, p = 0.003), and lower HDL cholesterol (39 ± 3 vs 44 ± 3 mg/dl, p = 0.003) concentrations, without any change in LDL cholesterol concentration. Furthermore, the changes in plasma triglyceride, RLP cholesterol, and RLP triglyceride persisted throughout the day in response to breakfast and lunch. These results indicate that the effects of low-fat diets on lipoprotein metabolism are not limited to higher fasting plasma triglyceride and lower HDL cholesterol concentrations, but also include a persistent elevation in RLPs. Given the atherogenic potential of these changes in lipoprotein metabolism, it seems appropriate to question the wisdom of recommending that all Americans should replace dietary saturated fat with CHO.
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This viewpoint aims to 1) review the available scientific literature on the relationship between whole grain consumption and body weight regulation; 2) evaluate the potential mechanisms whereby whole grain intake may help reduce overweight and 3) try to understand why epidemiological studies and clinical trials provide diverging results on this topic. All the prospective epidemiological studies demonstrate that a higher intake of whole grains is associated with lower BMI and body weight gain. However, these results do not clarify whether whole grain consumption is simply a marker of a healthier lifestyle or a factor favoring "per se" lower body weight. Habitual whole grain consumption seems to cause lower body weight by multiple mechanisms such as lower energy density of whole grain based products, lower glycemic index, fermentation of non digestible carbohydrates (satiety signals) and finally by modulating intestinal microflora. In contrast with epidemiological evidence, the results of few clinical trials do not confirm that a whole grain low-calorie diet is more effective in reducing body weight than a refined cereal diet, but their results may have been affected by small sample size or short duration of the intervention. Therefore, further intervention studies with adequate methodology are needed to clarify this question. For the time being, whole grain consumption can be recommended as one of the features of the diet that may help control body weight but also because is associated with a lower risk to develop type 2 diabetes, cardiovascular diseases and cancer.