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South African Journal of Clinical Nutrition
ISSN: 1607-0658 (Print) 2221-1268 (Online) Journal homepage: https://www.tandfonline.com/loi/ojcn20
The effect of the glycaemic response of three
commonly consumed meals on postprandial
plasma glucose in type 2 diabetics at the
University of Nigeria Teaching Hospital, Enugu
IM Nnadi Doctoral Student & OO Keshinro Professor
To cite this article: IM Nnadi Doctoral Student & OO Keshinro Professor (2016) The effect of the
glycaemic response of three commonly consumed meals on postprandial plasma glucose in type
2 diabetics at the University of Nigeria Teaching Hospital, Enugu, South African Journal of Clinical
Nutrition, 29:2, 90-94, DOI: 10.1080/16070658.2016.1216512
To link to this article: https://doi.org/10.1080/16070658.2016.1216512
© 2016 SA JCN Published online: 28 Jul 2016.
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90
Original Research: The effect of the glycaemic response of three commonly consumed meals
2016;29(2)S Afr J Clin Nutr
Nnadi IM, Doctoral Student; Keshinro OO, Professor
Department of Human Nutrition, University of Ibadan, Enugu, Nigeria
Correspondence author, e-mail: remkesh2000@yahoo.com
Keywords: glycaemic, postprandial plasma glucose, diabetics, Nigeria
The effect of the glycaemic response of three commonly consumed
meals on postprandial plasma glucose in type 2 diabetics at the
University of Nigeria Teaching Hospital, Enugu
Introduction
Glycaemic index (GI) and glycaemic load (GL) are two means of
classifying glycaemic response to carbohydrate-containing foods.
The GI is defined as the incremental area under the blood glucose
response curve (IAUC) after the consumption of the carbohydrate
portion of a test food, expressed as a percentage of the average
IAUC response to the same amount of carbohydrate from a reference
food, taken by the same subject on a separate occasion.1 The GI of
food is a scale used to classify the quality of carbohydrate consumed
and ranks carbohydrate according to its potential to increase blood
glucose levels; low GI foods are digested and absorbed slowly,
and high GI foods are digested and absorbed rapidly.2 Oral fat
administration reduces the rate of gastric emptying, jejunal motility
and postprandial flow rates in the upper small intestine, thereby
decreasing the rate of increase in postprandial glucose.3 Dietary
fibre, especially soluble fibre, increases the viscosity of food, slowing
gastric emptying rates, digestion and the absorption efficiency of the
small intestine, causing absorption to occur over a longer time.4 The
GL per serving reflects the total glycaemic response by accounting
for the quantity and quality of carbohydrate consumed.5
A lower GI diet decreases postprandial glucose and insulin response,
improves serum lipid concentrations, decreases total fat mass and
reduces the risk of colon cancer in adults.6 Consuming a high GI meal
can lead to an exaggerated postprandial peak in the blood glucose,7
which can result in diabetes-related complications, including
heart disease, strokes, obesity, kidney disease, blindness, erectile
dysfunction, amputations, mortality8 and cancer.9 Knowledge of the
GI value of locally available food helps diabetic patients to choose
from less expensive healthy foods, and to improve diet quality
without undue financial burden.10 One half to two thirds of people
Abstract
Objectives: This study evaluated the glycaemic response of three commonly consumed meals, and the resultant effect on postprandial
plasma glucose response in type 2 diabetes mellitus patients at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria.
Design: This was an experimental study on 100 consenting type 2 diabetes mellitus patients who were on medical nutrition therapy only,
attending the University of Nigeria Teaching Hospital medical outpatient clinic between May 2012 and March 2013.
Subjects and setting: One hundred non-diabetic healthy University of Nigeria Teaching Hospital workers served as the control. Participants
consumed served portions of each meal containing 50 g of glycaemic carbohydrate. Only the control consumed 50 g glucose to establish
glycaemic response. The three test meals comprised pap and bambara nut pudding; meat and okro soup with fermented cassava dough; and
meat, beans and corn pottage with spinach.
Outcome measures: Plasma glucose was measured quarter hourly, for two hours, from which glycaemic index (GI) and glycaemic load (GL)
values were calculated per serving.
Results: Two meals, namely meat, beans and corn pottage with spinach; and pap and bambara nut pudding; provided a lower glycaemic
response and reduced postprandial plasma glucose peak compared to meat and okro soup with fermented cassava dough at 30, 45, 60,
90 and 120 minutes in non-diabetic and type 2 diabetes mellitus patients (p-value < 0.050). The lowest GI and GL values per serving were
attributed to the meat, beans and corn pottage with spinach (33.00 ± 1.25 and 4.76 ± 0.67), while the highest respective values were found
for the meat and okro soup with fermented cassava dough (74.50 ± 4.91 and 21.59 ± 1.06).
Conclusion: Compared to the other two meals, the meal of meat, beans and corn pottage with spinach resulted in a lower glycaemic response,
reduced postprandial plasma glucose in non-diabetic and type 2 diabetes mellitus patients, and constituted a healthy alternative to the
other two.
Peer reviewed. (Submitted: 2015-06-30. Accepted: 2015-10-17.) © SAJCN S Afr J Clin Nutr 2016;29(2):90-94
91
Original Research: The effect of the glycaemic response of three commonly consumed meals
2016;29(2)S Afr J Clin Nutr
Original Research: The effect of the glycaemic response of three commonly consumed meals
in the south-eastern states of Nigeria consume pap and bambara
nut pudding; meat and okro soup with fermented cassava dough;
and meat, beans and corn pottage with spinach “almost every day”
(food frequency questionnaire in 2013, unpublished). The purpose
of conducting this study was to evaluate the glycaemic response
of some commonly consumed meals and the resultant effect on
postprandial plasma glucose response in type 2 diabetes mellitus
patients at the University of Nigeria Teaching Hospital, Ituku-Ozalla,
Enugu State, Nigeria.
Method
Ethics approval
The joint University of Ibadan/University College Hospital Ibadan
Institutional Review Board and the University of Nigeria Teaching
Hospital (Ituku-Ozalla) Institutional Review Board approved the
study protocol (UI/EC/12/0275, IRB00002323). All of the procedures
were conducted with an adequate understanding by, and the written
consent of, the participants.
Participants
One hundred outpatients (45 men and 55 women), diagnosed with
type 2 diabetes mellitus and recruited randomly from the diabetes
clinic at the University of Nigeria Teaching Hospital, Ituku-Ozalla,
participated in the study. Patients with type 2 diabetes mellitus
were treated with medical nutrition therapy alone, and were aged
40-70 years [mean ± standard deviation (SD) of 55.64 ± 7.84
years], with a body mass index (BMI) of < 30 kg/m2 (mean ± SD
of 27.8 ± 4.52). The duration of diabetes mellitus was ≤ 5 years,
with fasting plasma glucose < 11.2 mmol/l. The participants had not
experienced dyslipidaemia, hypertension, acute illness, fever, undue
stress, gastrointestinal disease, autonomical dysfunction or severe
hypoglycaemic episodes during the past year, nor taken oral or
inhaled prednisone or cortisone medication in the previous 30 days.
One hundred apparently healthy non-diabetic University of Nigeria
Teaching Hospital workers who were matched in age and sex with
the type 2 diabetes mellitus patients formed the control group. They
had a BMI < 30 kg/m2 (mean ± SD of 23.14 ± 4.13), fasting plasma
glucose < 5.8 and > 3.3 mmol/l and > 7.7 mmol/l (why three
values here?) 120 minutes after the ingestion of 75 g oral glucose.
Individuals with coronary heart disease, a history of renal and liver
disease, surgery in the six months preceding the study, or who were
currently on any medication were ineligible to participate. Eligible
participants attended a screening visit.
Test meals
Three different meals were used for testing:
• Pap and bambara nut pudding.
• Meat and okro soup, with fermented cassava dough.
• Meat, beans and corn pottage with spinach.
Test meal 1: Pap and bambara nut pudding
Yellow maize was fermented, grinded, sieved and squeezed to create
a wet slurry. The slurry was further dissolved in water to result in an
even thinner slurry. Boiling water was poured into it to produce a
gelatinised pap. Bambara nut pudding was prepared by reconstituting
the sieved flour of bambara nut seeds with hot water, in which fresh
pepper, palm oil and salt were added for palatability. An acceptable
quantity was poured into banana leaves (Thaumatococcus daniellii)
wrapped and steamed for one hour. The product was bambara nut
pudding (okpa) and was consumed, together with maize pap.
Test meal 2: Meat and okro soup, with fermented cassava dough
The soup ingredients included okro (Abelmoschus esculentus),
fluted pumpkin leaves, beef meat, onions, fresh pepper, salt, palm
oil, a stock cube, dry hake, dry fish and ground crayfish. The
sieved fermented cassava paste was moulded and boiled in hot
water twice and pounded twice. Okro soup was cooked with the
above ingredients. Cooked fermented cassava dough (foofoo) was
consumed with a bowl of soup.
Test meal 3: Meat, beans and corn pottage with spinach
Beans were soaked overnight and cooked with fresh whole corn.
Fresh pepper, onions, salt, a stock cube, crayfish and palm oil were
added to the cooking mixture. The beans and corn pottage was
consumed with spinach leaves and boiled beef meat.
The macronutrient composition of the meals in cooked weight
basis was determined according to the Association of Analytic
Communities method (Table I).
The meals were provided in portions equivalent to 50 g glycaemic
carbohydrate, which is defined as total sugars plus starch, according
to the recommendation of the Joint Food and Agricultural Organization
Table I: Macronutrient composition of each test meal per 100 g edible portion
Macronutrient composition Pap and bambara nut pudding Meat and okro soup with fermented
cassava dough
Meat, beans and corn pottage with
spinach
Total sugar (g) 4.74 ± 0.0 7.91 ± 0.0 3.75 ± 0.0
Starch (g) 6.24 ± 0.0 10.20 ± 0.0 5.86 ± 0.0
Glycaemic carbohydrate (g)*10.98 ± 0.0 18.11 ± 0.1 9.61 ± 0.0
Dietary fibre (g) 2.36 ± 0.0 4.90 ± 0.0 6.10 ± 0.0
Moisture (g) 71.06 ± 0.1 64.77 ± 0.0 63.20 ± 0.0
Protein (g) 5.41 ± 0.1 5.73 ± 0.9 12.62 ± 0.1
Fat (g) 7.53 ± 0.0 3.27 ± 0.0 3.53 ± 0.0
Ash (g) 0.75 ± 0.0 1.23 ± 0.0 2.60 ± 0.0
Energy (kJ) 619.27 ± 0.1 658.02 ± 0.3 673.00 ± 0.1
*Glycaemic carbohydrate (g) = total sugars (g) + starch (g)
Values are mean ± standard deviation
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Original Research: The effect of the glycaemic response of three commonly consumed meals
2016;29(2)S Afr J Clin Nutr
of the United Nations/World Health Organization expert consultation.
11
The test meals portion weights are presented in Table II.
The required portion of each test meal was measured and prepared
by the same dietician on each test day. Fifty grams of glucose
dissolved in 240 ml of water served as the reference food for the
non-diabetics (control group).
Protocol
Subjects were tested on three separate occasions. A washout
period of one week was allowed, which preceded the next test. The
non-diabetics (control group) presented at the hospital for a fourth
and fifth weekly visit for the 50 g glucose administration. Each
participant arrived at 7h00 after a 12-hour overnight fast. Fasting
plasma glucose readings were taken twice, and the average of the
two values was recorded. Subjects were randomly given one of the
three meals to consume with 240 ml of water within 15 minutes.
The non-diabetics also consumed 50 g glucose within this time.
The subjects remained sedentary, with the exception of trips to the
bathroom, during the two-hour study period. All of the participants
completed the study.
Blood samples were drawn through an intravenous catheter placed
in the upper arm in the antecubital vein before the consumption
of the test meal 15, 30, 45, 60, 90 and 120 minutes after starting
to eat. Venous blood glucose (plasma with potassium oxalate and
sodium fluoride anticoagulant) was measured in the University
of Nigeria Teaching Hospital chemical pathology laboratory by a
medical laboratory scientist using the glucose oxidation method
(Roche/Hitachi 902® auto analyzer, Roche Diagnostics, Japan).
Participants received compensation for travel, time and effort upon
study completion.
Statistical analysis
The GI and the IAUC, excluding the area below the fasting baseline,
were calculated using the trapezoid rule. The GI for each non-
diabetic subject (control) was calculated by determining the average
IAUC of the reference food, and then dividing the IAUC of the test
meal by the average IAUC of the reference food, multiplied by 100.12
The GL per serving was calculated by taking the product of the GI
and the grams of carbohydrate per serving and dividing the product
by 100.13 The mean GI and GL per serving were determined only in
non-diabetic subjects (control).
Data were expressed as mean ± SD. One-way analysis of variance
was used to determine the meal and timing effects on glucose.
Student’s t-test was used to compare the IAUC between the groups.
A p-value < 0.050 was considered to be significant in all of the
statistical tests. Statistical analysis was performed with Statistical
Package for Social Sciences® version 20.
Results
Fasting plasma glucose was significantly higher in type 2 diabetes
mellitus patients than in the control group (p-value < 0.050).
However, the values were not significantly different within the two
groups (p-value > 0.050) (Figures 1 and 2). The IAUC for glucose was
significantly lower for all the meals in the non-diabetics than type 2
diabetes mellitus patients (p-value < 0.050) (Figure 3). There were
significant differences in the mean plasma postprandial glucose levels
at 30 and 60 minutes in the non-diabetic participants (Figure 1).
The ingestion of 50 g glucose resulted in a significant increase
(p-value < 0.050) in the IAUC at 153.62 ± 18.77 for 50 g glycaemic
carbohydrate in the meals of meat and okro soup with fermented
cassava dough (114.45 ± 18.58), pap and bambara nut pudding
(61.65 ± 14.24) and meat, beans and corn pottage with spinach
PBP
MOCD
MBCPS
Glucose
9
8
7
6
5
4
3
2
1
0
Plasma glucose (mmol/l)
0
Time (minutes)
15 30 45 60 90 120
MBCPS: Meat, beans and corn pottage with spinach, MOCD: Meat and okro soup, with fermented
cassava dough, PBP: Pap and bambara nut pudding
*Values were obtained in non-diabetic subjects
Figure 1: Mean plasma glucose concentrations at 0, 15, 30, 45, 60, 90 and
120 minutes after the consumption of glucose or the test meals by the non-
diabetic subjects (control group)*
Table II: Macronutrient composition of each test meal and glucose used in a cohort of 100 type 2 diabetes mellitus patients and 100 non-diabetic subjects
Macronutrient
composition
Per test portion Per serving size (one milk tin)
Pap and bambara
nut pudding
Meat and okro soup
with fermented
cassava dough
Meat, beans and
corn pottage with
spinach
Pap and bambara
nut pudding
Meat and okro soup
with fermented
cassava dough
Meat, beans and
corn pottage with
spinach
Portion weight (50 g) 455.37 276.09 520.29 160.00 160.00 150.00
Fat (0 g) 34.29 9.03 18.37 12.05 5.23 5.30
Protein (0 g) 21.90 15.82 65.71 7.70 9.17 18.94
Total sugar (50 g) 21.59 22.08 19.51 7.59 12.80 5.63
Starch (0 g) 28.42 28.16 30.49 9.99 16.32 8.79
Glycaemic carbohy-
drate (50 g)*
50.00 50.00 50.00 17.57 28.98 14.42
Dietary fibre (0 g) 10.75 13.53 31.74 3.78 7.84 9.15
Energy (200 kJ) 2 819.97 1 816.74 3 501.55 990.86 1 052.82 1 009.52
*Glycaemic carbohydrate (g) = total sugars (g) + starch (g)
93
Original Research: The effect of the glycaemic response of three commonly consumed meals
2016;29(2)S Afr J Clin Nutr
(50.70 ± 10.34) (Figure 3). This resulted in a GI value for meat
and okro soup with fermented cassava dough of 74.50 ± 4.91,
pap and bambara nut pudding of 40.13 ± 2.86, and meat, beans
and corn pottage with spinach of 33.00 ± 1.25. The GI values of
pap and bambara nut pudding; and meat, beans and corn pottage
with spinach, were considered to be low GI, while a high GI was
recorded for the meat and okro soup with fermented cassava dough.
The GL values for a serving (one milk tin) of meat, beans and corn
pottage with spinach at 4.76 ± 0.67, and pap and bambara nut
pudding at 7.05 ± 0.61, were significantly lower (p-value < 0.050)
than that for meat and okro soup with fermented cassava dough at
21.59 ± 1.06. The IAUC for blood glucose in the meal of meat, beans
and corn pottage with spinach was significantly lower at 120.90
± 17.59, than that in the pap and bambara nut pudding at 270.30
± 19.54, and meat and okro soup with fermented cassava dough at
448.10 ± 21.52 (p-value < 0.050) in patients with type 2 diabetes
mellitus (Figure 3). The consumption of meat, beans and corn pottage
with spinach significantly decreased the plasma glucose concentration,
reaching a maximum value of 8.85 ± 1.06 mmol/l (159.30 mg/
dl) at 60 minutes. The consumption of meat and okro soup with
fermented cassava dough gradually increased the postprandial peak
glucose at 60 minutes, reaching a maximum value of 12.97 mmol/l
(233.46 mg/dl), while the pap and bambara nut pudding reached a
maximum value of 10.18 mmol/l (183.24 mg/dl) (p-value < 0.050).
The meals of meat, beans and corn pottage with spinach; and pap
and bambara nut pudding, produced a smaller postprandial plasma
glucose peak compared to the meal of meat and okro soup with
fermented cassava dough at 30, 45, 60, 90 and 120 minutes (p-value
< 0.050) (Figure 2). Therefore, these two were more effective in
reducing the postprandial glucose peak.
Discussion
Excessive and prolonged postprandial blood glucose peaks are a
serious health problem for individuals with diabetes mellitus owing to
the risk of micro- and macrovascular damage. As a result, changes in
lifestyle have been suggested as the main strategy for controlling the
biochemical abnormalities associated with type 2 diabetes mellitus.14
The results of this study showed that a low glycaemic response was
achieved with meat, beans and corn pottage with spinach, and that
this meal also resulted in the postprandial blood glucose peak being
minimised. Thus, this meal should be recommended to patients with
type 2 diabetes mellitus.
Many characteristics of a meal affect the glycaemic response,
including the quantity and quality of carbohydrate, meal preparation
method, rate of gastric emptying and the presence of other nutrients
in the meal, such as fibre, fat and protein.15 A significantly higher
GI, GL per serving, peak plasma postprandial glucose, greater
IAUC, higher sugar and starch content, and thus more glycaemic
carbohydrate, was realised with the meal of meat and okro soup
with fermented cassava dough, compared to that in the other two
meals for the same serving size of one milk tin. As the GI was also
higher, the GL per serving was also more than double that of the
other meals. This is because cassava root is a storage organ, cannot
be used for vegetative propagation, and is a concentrated source of
carbohydrate, especially when it is fermented.
Glycaemic response increased with the length of fermentation.
During fermentation, the action of microbes on the starches in
the tuber root favours the amount of monosaccharide which can
be formed from the starch in the food, thus speeding up digestion
in the body.16 Cassava root which is cooked as a starch has a low
GI value of 46, just like sweet potato with purple skin and white
flesh. However, when the cassava root is ground and dried to a
powder or processed into pearls (also called tapioca), the GI almost
doubles to 80 for tapioca flour, and 81 for tapioca pudding, owing
to the processing. Most flour made by the milling of low-GI, intact
wholegrains, e.g. barley, wheat and corn, are high GI, owing to
the processing.17 A positive association between the carbohydrate
amount (especially when the GI is high, yielding a high-GL diet) and
the incidence of diabetes mellitus has been reported in Chinese18 and
Japanese19 women. A diet high in carbohydrate and with a high GI
(implying a high-GL diet) was associated with a higher risk of type 2
diabetes mellitus.18
Lowest glycaemic response was recorded with the meal of meat,
beans and corn pottage with spinach because the cooked corn and
beans were intact and whole, resulting in a slower rate of digestion.
The slowly digestible behaviour may relate to restricted enzymatic
availability and enzyme inhibition because of the compact food
structure. The meal of meat, beans and corn pottage with spinach
may contain soluble fibre, which is associated with delayed gastric
emptying. Delayed absorption may be linked to a delayed gastric
emptying rate and the slow release of starch in the small intestine.20
PBP
MOCD
MBCPS
14
12
10
8
6
4
2
0
Plasma glucose (mmol/l)
0
Time (minutes)
15 30 45 60 90 120
MBCPS: Meat, beans and corn pottage with spinach, MOCD: Meat and okro soup, with fermented
cassava dough, PBP: Pap and bambara nut pudding
* Values were obtained in subjects with type 2 diabetes mellitus
Figure 2: Mean fasting and postprandial plasma glucose concentrations
after the consumption of the test meals by the subjects with type 2 diabetes
mellitus*
600
500
400
300
200
100
0
Plasma glucose IAUC mmol/l
Non-Diabetic Type 2 Diabetes
PBP MBCPSMOCD
IAUC: incremental area under the blood glucose response curve, MBCPS: Meat, beans and corn
pottage with spinach, MOCD: Meat and okro soup, with fermented cassava dough, PBP: Pap and
bambara nut pudding
*Values were obtained in healthy adults without diabetes (control), and in those with type 2 diabetes
mellitus
Figure 3: Mean incremental area under the blood glucose response curve
for plasma glucose after the consumption of the test meals by non-diabetic
and type 2 diabetes mellitus subjects*
94
Original Research: The effect of the glycaemic response of three commonly consumed meals
2016;29(2)S Afr J Clin Nutr
In one study, soluble fibre was significantly inversely associated with
metabolic syndrome.21 The meal of meat, beans and corn pottage
with spinach was also not very dense in carbohydrates, contained
moderate fat, and should be recommended for optimal glycaemic
control in type 2 diabetes mellitus patients.
The meal of pap and bambara nut pudding was high in fat
composition, and should be recommended with caution during
menu planning for type 2 diabetes mellitus patients, despite its low
glycaemic response. The fat content of this meal could be reduced
by using less palm oil than the amount used in the traditional recipe.
Dietary fat, especially saturated fat and trans-fat, is associated with
an increased risk for several chronic diseases, including type 2
diabetes mellitus, hypertension, cardiovascular disease and cancer.22
The meal of pap and bambara nut pudding probably had a low GI as
it contained bambara nut seeds, and a low GI is usually reported for
seeds. Its high fat content may also delay gastrointestinal transit,
leading to a lesser glycaemic response.23 More vegetables could be
added to this meal to help increase its fibre content and volume, and
to lower the GL per serving.
The meals differed in their GL values per serving, even when they
were approximately the same in terms of energy content with
respect to a serving size (one starch exchange). In this context, the
same glycaemic effect (GL value per serving of approximately 10)
could be achieved with three evaporated milk tins of meat, beans
and corn pottage with spinach, one and a half milk tins of pap and
bambara nut pudding, and half a milk tin of meat and okro soup
with fermented cassava dough. Kitchen scales are inaccessible in
most Nigerian homes. Thus, households measures, e.g. a milk tin,
serve as an alternative device to estimate the size of meals. Type
2 diabetes mellitus patients should consume two milk tins of meat,
beans and corn pottage with spinach as a single meal portion for
optimal glycaemic control, as this meal is high in fibre and contains
more slowly digestible (low GI) sugar and starch, is less dense in
carbohydrates, and thus has a low GL per serving. It also contains
moderate fat content.
Target goals for postprandial blood glucose levels have been
established. The International Diabetes Federation recommends a
two-hour postprandial glucose of < 140 mg/dl (< 7.8 mmol/l),24 and
the American Diabetes Association a peak postprandial glucose of
< 180 mg/dl (< 10.0 mmol/l) generally 1-2 hours after commencement
of a meal.25 The meal of meat and beans and corn pottage with
spinach caused blood glucose peaks below that recommended by
the ADA. The European Diabetes Working Group set the maximum
postprandial glucose peak to not exceed 160 mg/dl (9.0 mmol/l) to
reduce microvascular risk.26 The consumption of a meal of meat and
beans and corn pottage with spinach could reduce the incidence
of kidney disease, blindness, erectile dysfunction, amputation and
mortality in patients with type 2 diabetes mellitus.
Conclusion
It was revealed in the present study that compared to the other two
meals, the meal of meat, beans and corn pottage with spinach was
less dense in carbohydrates, while being high in fibre and slowly
digestible carbohydrates, contained cooked, intact grain, and had
a moderate fat content and a significantly lower GI and GL value
per serving, as well as peak plasma postprandial blood glucose
and IAUC. The meal of meat, beans and corn pottage with spinach
is a healthy alternative to the other two. Hence, its consumption is
recommended in patients with type 2 diabetes mellitus for optimal
glycaemic control. As a result of this study, it is recommended that
a meal comprising two milk tins of meat, beans and corn pottage
with spinach should be consumed as a single meal portion as this
will serve to help improve glycaemic control in patients with type 2
diabetes mellitus.
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