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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

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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.
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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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... Dietary fiber content of the vegetable sauces ranged from 2.25 to 3.26g and was higher than 0.47 to 0.91 (ora soup) and 0.54 to 1.25 (egusi soup) as reported by Davidson et al. [26]. The dietary fiber content was lower than Nnadi and Keshiniro's study [28] on meat, okra soup with fermented cassava dough (4.09g). They included other food sources like meat, dried fish, pumpkin leaves, and fermented cassava dough which contributed to the high dietary fiber content compared to the okra sauce (3.26g) in the present study. ...
... The recipe in the present study was designed in a way that fat contribution from palm oil will be small. Energy content of the sauces was quite low compared to other literatures on dish preparation [28,30]. The vegetable sauce will accommodate little of the energy needs of adult diabetic patients. ...
... The study recommends that further studies should be carried out on these sauces with different tuber and cereal foods. Dietary fiber plays a role in controlling postprandial glycemic response because of its effects on gastric emptying and macronutrient absorption from the gut [28]. Dietary fiber helps to stabilize blood sugar by modulating sugar absorption from the intestinal tract [29]. ...
Article
Background: Diet-related chronic disease especially diabetes mellitus, cardiovascular disease (CVDs), obesity, hypertension and cancers is a major public health problem in Nigeria. The use of locally made foods has been advocated for in the management of diabetes mellitus in recent times. Methods: The recipe for the test food was developed and standardized. Proximate and dietary fibre analysis was carried out on the test food (okra, African spinach and lettuce sauces) and reference food (white bread). Thirty-six non-diabetic undergraduate students of Imo State University, Nigeria were selected after diabetes screening using oral glucose tolerance test (OGTT), glycated hemoglobin, anthropometric indices, blood pressure and other exclusion criteria. Subjects consumed a serving portion of vegetable sauce containing 25g of digestible carbohydrate. Postprandial plasma glucose was measured at 0, 15, 30, 45, 60, 90 and 120 minutes. The glycemic index and load was calculated per serving. Results were expressed in means, standard deviation and percentages. ANOVA was used in comparing the means while turkey test was used in separating the means using Statistical product for service solution (SPSS) version 22.0. The decision criteria was set at p<0.05. Results: Moisture content ranged from 64.10±0.57% (okra sauce) to 64.62±0.66% (lettuce sauce) did not differ significantly (p<0.05). Fat, fibre, and ash content higher in lettuce sauce 3.40± 0.24%, 1.69±0.1%2, and 4.40±0.24% respectively, carbohydrate was higher in African spinach (15.07±0.77%) while dietary fibre (3.26±0.01%), protein (15.15±0.09%) and energy (136.62±2.24 kcal) was higher in okra sauce. Sauces were not significantly different. White bread shows that moisture content was 17.62, fat 1.53%, protein 14.86%, ash 6.90%, carbohydrate 58.88%, energy 308.66kcal and dietary fibre 0.33.The anthropometric indices show that BMI of the subjects ranged from 23.12kg/m2 in African spinach sauce subjectsto 23.53kg/m2 (okra sauce subjects). WHR was highest in lettuce sauce subjects (0.84). All the subjects that participated were all females. HbA1C was higher in okra sauce (5.23%) group subjects. Systolic blood pressure was 119.08mmHg (African Spinach sauce subjects) while diastolic blood pressure was highest in lettuce sauce subjects (85.68mmHg). Pulse rate (85.17) was highest in okra sauce subject. The IUAC for the white bread was significantly (p<0.05) higher in all the subjects compared to the vegetable sauces with a high glycemic index and load of 93.25 and 54.91 respectively. African spinach sauce had a lower postprandial plasma glucose peak of 88.00mg/dl at 60 minutes compared to okra and lettuce sauces. All the vegetable sauces had a low glycemic index of 17.02 (okra sauce), 14.05 (African spinach) and 36.76 (lettuce) and low glycemic load was 0.75, 0.38 and 3.80 for okra, African spinach and lettuce sauces respectively. Conclusion: All the vegetable sauces studied should be used while planning meal for the diabetic patients. Keywords: vegetable sauces, glycemic response, healthy
... Dietary fiber content of the vegetable sauces ranged from 2.25 to 3.26g and was higher than 0.47 to 0.91 (ora soup) and 0.54 to 1.25 (egusi soup) as reported by Davidson et al. [26]. The dietary fiber content was lower than Nnadi and Keshiniro's study [28] on meat, okra soup with fermented cassava dough (4.09g). They included other food sources like meat, dried fish, pumpkin leaves, and fermented cassava dough which contributed to the high dietary fiber content compared to the okra sauce (3.26g) in the present study. ...
... The recipe in the present study was designed in a way that fat contribution from palm oil will be small. Energy content of the sauces was quite low compared to other literatures on dish preparation [28,30]. The vegetable sauce will accommodate little of the energy needs of adult diabetic patients. ...
... The study recommends that further studies should be carried out on these sauces with different tuber and cereal foods. Dietary fiber plays a role in controlling postprandial glycemic response because of its effects on gastric emptying and macronutrient absorption from the gut [28]. Dietary fiber helps to stabilize blood sugar by modulating sugar absorption from the intestinal tract [29]. ...
Article
Full-text available
Background: Diet-related chronic disease especially diabetes mellitus, cardiovascular disease (CVDs), obesity, hypertension and cancers is a major public health problem in Nigeria. The use of locally made foods has been advocated for in the management of diabetes mellitus in recent times.Methods: The recipe for the test food was developed and standardized. Proximate and dietary fibre analysis was carried out on the test food (okra, African spinach and lettuce sauces) and reference food (white bread). Thirty-six non-diabetic undergraduate students of Imo State University, Nigeria were selected after diabetes screening using oral glucose tolerance test (OGTT), glycated hemoglobin, anthropometric indices, blood pressure and other exclusion criteria. Subjects consumed a serving portion of vegetable sauce containing 25g of digestible carbohydrate. Postprandial plasma glucose was measured at 0, 15, 30, 45, 60, 90 and 120 minutes. The glycemic index and load was calculated per serving. Results were expressed in means, standard deviation and percentages. ANOVA was used in comparing the means while turkey test was used in separating the means using Statistical product for service solution (SPSS) version 22.0. The decision criteria was set at p<0.05.Results: Moisture content ranged from 64.10±0.57% (okra sauce) to 64.62±0.66% (lettuce sauce) did not differ significantly (p<0.05). Fat, fibre, and ash content higher in lettuce sauce 3.40± 0.24%, 1.69±0.1%2, and 4.40±0.24% respectively, carbohydrate was higher in African spinach (15.07±0.77%) while dietary fibre (3.26±0.01%), protein (15.15±0.09%) and energy (136.62±2.24 kcal) was higher in okra sauce. Sauces were not significantly different. White bread shows that moisture content was 17.62, fat 1.53%, protein 14.86%, ash 6.90%, carbohydrate 58.88%, energy 308.66kcal and dietary fibre 0.33.The anthropometric indices show that BMI of the subjects ranged from 23.12kg/m2 in African spinach sauce subjectsto 23.53kg/m2 (okra sauce subjects). WHR was highest in lettuce sauce subjects (0.84). All the subjects that participated were all females. HbA1C was higher in okra sauce (5.23%) group subjects. Systolic blood pressure was 119.08mmHg (African Spinach sauce subjects) while diastolic blood pressure was highest in lettuce sauce subjects (85.68mmHg). Pulse rate (85.17) was highest in okra sauce subject. The IUAC for the white bread was significantly (p<0.05) higher in all the subjects compared to the vegetable sauces with a high glycemic index and load of 93.25 and 54.91 respectively. African spinach sauce had a lower postprandial plasma glucose peak of 88.00mg/dl at 60 minutes compared to okra and lettuce sauces. All the vegetable sauces had a low glycemic index of 17.02 (okra sauce), 14.05 (African spinach) and 36.76 (lettuce) and low glycemic load was 0.75, 0.38 and 3.80 for okra, African spinach and lettuce sauces respectively.Conclusion: All the vegetable sauces studied should be used while planning meal for the diabetic patients.Keywords: vegetable sauces, glycemic response, healthy adults
... While glycaemic load per serving reflects the total glycaemic response by accounting for the quantity and quality of carbohydrate consumed, glycaemic index ranks carbohydrate diet according to its potentials to increase blood glucose levels. Carbohydrate foods are thus described as low glycaemic index foods (foods digested and absorbed slowly) and high glycaemic index foods (foods digested and absorbed rapidly) [1]. Foods rich in or fortified with micronutrients (magnesium, selenium, chromium) have low glycaemic index [2] as some of the available micronutrients serve as cofactors and coenzymes for enzyme activities which improves their catalytic potentials, increases Insulin secretions and glucose metabolism, and eventually decreases rate of glucose availability in the blood. ...
... Foods rich in or fortified with micronutrients (magnesium, selenium, chromium) have low glycaemic index [2] as some of the available micronutrients serve as cofactors and coenzymes for enzyme activities which improves their catalytic potentials, increases Insulin secretions and glucose metabolism, and eventually decreases rate of glucose availability in the blood. Fatty foods generally reduce the rate of gastric emptying, postprandial flow rates in the upper small intestine, jejunal motility, and postprandial blood glucose level [1]. However, dietary fibres, especially soluble fibres, increases the viscosity of digested food; slow down gastric emptying rates; and slow down digestion and absorption efficiency of the small intestine thereby causing absorption to occur over a longer period of time. ...
Article
Background: The classification of carbohydrate gives information about their digestibility, contribution to blood glucose concentration and effect of cellular metabolism. Objective: This study determined the postprandial glycaemic and insulin responses to some commonly consumed fruits. Methods: This study was conducted on five separate days using 20 healthy subjects. They were subjected to standard pre-test instructions, fasted, served the fruits and their blood samples collected. Postprandial plasma glucose and insulin responses were obtained at 0, 15, 30, 60, 90, and 120 minutes after glucose and fruit ingestion. Inc remental area under curve (IAUC), glycaemic load (GL), peak plasma postprandial glucose (PPPG) and maximum increase in plasma glucose (MIPG) were determined. Glycaemic index was calculated and proximate analysis of the fruits was done. Results: The fruits contain appreciable amount of moisture, ash, protein, fibre, and carbohydrate. The patterns of PPPG, glucose and Insulin responses to glucose and test fruits are similar. There were significant (p < 0.05) differences in the IAUC, GI, GL, MIPG between glucose and the test fruits and a proportionate relationship exists between IAUC and GI values of the test fruits. Conclusion: The quality of carbohydrate present in fruits varies among fruits as determined by variations in their fiber, ash, moisture, and carbohydrate contents and postprandial glucose and insulin responses. INTRODUCTION The traditional classification of carbohydrate present in foods as monosaccharides, disaccharides, oligosaccharides and polysaccharides gives information about their digestibility, obtainable glucose, contribution to postprandial blood glucose concentration and effect on metabolism. The quality of carbohydrate consumed is classified using the glycaemic load (GL) and glycaemic index (GI). While glycaemic load per serving reflects the total glycaemic response by accounting for the quantity and quality of carbohydrate consumed, glycaemic index ranks carbohydrate diet according to its potentials to increase blood glucose levels. Carbohydrate foods are thus described as low glycaemic index foods (foods digested and absorbed slowly) and high glycaemic index foods (foods digested and absorbed rapidly) [1]. Foods rich in or fortified with micronutrients (magnesium, selenium, chromium) have low glycaemic index [2] as some of the available micronutrients serve as cofactors and coenzymes for enzyme activities which improves their catalytic potentials, increases Insulin secretions and glucose metabolism, and eventually decreases rate of glucose availability in the blood. Fatty foods generally reduce the rate of gastric emptying, postprandial flow rates in the upper small intestine, jejunal motility, and postprandial blood glucose level [1]. However, dietary fibres, especially soluble fibres, increases the viscosity of digested food; slow down gastric emptying rates; and slow down digestion and
... While glycaemic load per serving reflects the total glycaemic response by accounting for the quantity and quality of carbohydrate consumed, glycaemic index ranks carbohydrate diet according to its potentials to increase blood glucose levels. Carbohydrate foods are thus described as low glycaemic index foods (foods digested and absorbed slowly) and high glycaemic index foods (foods digested and absorbed rapidly) [1]. Foods rich in or fortified with micronutrients (magnesium, selenium, chromium) have low glycaemic index [2] as some of the available micronutrients serve as cofactors and coenzymes for enzyme activities which improves their catalytic potentials, increases Insulin secretions and glucose metabolism, and eventually decreases rate of glucose availability in the blood. ...
... Foods rich in or fortified with micronutrients (magnesium, selenium, chromium) have low glycaemic index [2] as some of the available micronutrients serve as cofactors and coenzymes for enzyme activities which improves their catalytic potentials, increases Insulin secretions and glucose metabolism, and eventually decreases rate of glucose availability in the blood. Fatty foods generally reduce the rate of gastric emptying, postprandial flow rates in the upper small intestine, jejunal motility, and postprandial blood glucose level [1]. However, dietary fibres, especially soluble fibres, increases the viscosity of digested food; slow down gastric emptying rates; and slow down digestion and absorption efficiency of the small intestine thereby causing absorption to occur over a longer period of time. ...
Article
Full-text available
Rising incidences of life-style disorders like obesity, diabetes and cardiovascular diseases are a matter of concern coupled with escalated consumption of highly refined and high energy foods with low nutrient density. Food choices of consumers have witnessed significant changes globally with rising preference to highly processed palatable foods. Thus, it calls food scientists, researchers and nutritionists’ attention towards developing and promoting pleasant-tasting yet healthy foods with added nutritional benefits. This review highlights selected underutilized and novel ingredients from different food sources and their by-products that are gaining popularity because of their nutrient density, that can be employed to improve the nutritional quality of conventionally available empty-calorie foods. It also emphasizes on the therapeutic benefits of foods developed from these understudied grains, nuts, processing by-products of grains, fruits- and vegetable-byproducts and nutraceutical starches. This review aims to draw attention of food scientists and industrialists towards popularizing the utilization of these unconventional, yet nutrient rich foods sources in improving the nutritional profile of the conventional foods lacking in nutrient density.
Chapter
Carbohydrates are the most common source of energy for humans. Among this class of macronutrients, starch and sugar are the main representatives. Starches of different types can be obtained from tubers and grain-based foods such as cereals, legumes, pasta and noodles. Sugars can be extracted from plants or eaten as part of a wholesome food, typically fruits and milk. Nutritionally, low glycemic index offers the best long term health effects. That means choosing less refined food products (wholegrains vs refined; fruits vs. sugar). Processing can have a positive impact, as in the case of pasta vs. bread. Environmentally, grains require more resources than produce, while attracting consumers for their taste and competitive price. Innovations such as malt flour can provide an interesting alternative to other starches. Sugar wise, Stevia can be a sustainable sweetener, yet not providing energy. Upcycled sweeteners from spent grains are low in both glycemic index and carbon footprint, while fruits, sweet vegetables and fibre-rich syrups can be both energizing and environmentally friendly.KeywordsCarbon footprintFruitsGlycemic indexStarchSugarWholegrains
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Pulses are a major source for plant-based proteins, with over 173 countries producing and exporting over 50 million tons annually. Pulses provide many of the essential nutrients and vitamins for a balanced and healthy diet, hence are health beneficial. Pulses have been known to lower glycemic index (GI), as they elicit lower post prandial glycemic responses, and can prevent insulin resistance, Type 2 diabetes and associated complications. This study reviews the GI values (determined by in vivo methodology) reported in 48 articles during the year 1992–2018 for various pulse type preparations consumed by humans. The GI ranges (glucose and bread as a reference respectively) for each pulse type were: broad bean (40 ± 5 to 94 ± 4, 75 to 93), chickpea (5 ± 1 to 45 ± 1, 14 ± 3 to 96 ± 21), common bean (9 ± 1 to 75 ± 8, 18 ± 2 to 99 ± 11), cowpea (6 ± 1 to 56 ± 0.2, 38 ± 19 to 66 ± 7), lentil (10 ± 3 to 66 ± 6, 37 to 87 ± 6), mung bean (11 ± 2 to 90 ± 9, 28 ± 1 to 44 ± 6), peas (9 ± 2 to 57 ± 2, 45 ± 8 to 93 ± 9), pigeon peas (7 ± 1 to 54 ± 1, 31 ± 4), and mixed pulses (35 ± 5 to 66 ± 23, 69 ± 42 to 98 ± 29). It was found that the method of preparation, processing and heat applications tended to affect the GI of pulses. In addition, removal of the hull, blending, grinding, milling and pureeing, reduced particle size, contributed to an increased surface area and exposure of starch granules to the amylolytic enzymes. This was subsequently associated with rapid digestion and absorption of pulse carbohydrates, resulting in a higher GI. High or increased heat applications to pulses were associated with extensive starch gelatinization, also leading to a higher GI. The type of reference food used (glucose or white bread) and the other nutrients present in the meal also affected the GI.
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Certain types of carbohydrates increase glucose and insulin levels to a greater extent than others. In turn, insulin may raise levels of insulin-like growth factors, which may influence breast cancer risk. We analyzed the effect of type and amount of carbohydrates on breast cancer risk, using the glycemic index and the glycemic load measures in a large case-control study conducted in Italy. Cases were 2,569 women with incident, histologically-confirmed breast cancer interviewed between 1991 and 1994. Controls were 2588 women admitted to the same hospital network for a variety of acute, non-neoplastic conditions. Average daily glycemic index and glycemic load were calculated from a validated 78-item food frequency questionnaire. Direct associations with breast cancer risk emerged for glycemic index (odds ratio, OR for highest vs. lowest quintile = 1.4; P for trend <0.01) and glycemic load (OR = 1.3; P < 0.01). High glycemic index foods, such as white bread, increased the risk of breast cancer (OR = 1.3) while the intake of pasta, a medium glycemic index food, seemed to have no influence (OR = 1.0). Findings were consistent across different strata of menopausal status, alcohol intake, and physical activity level. This study supports the hypothesis of moderate, direct associations between glycemic index or glycemic load and breast cancer risk and, consequently, a possible role of hyperinsulinemia/insulin resistance in breast cancer development.
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Background: Increased intake of whole-grain foods has been related to a reduced risk of developing diabetes and heart disease. One underlying pathway for this relation may be increased insulin sensitivity. Objective: We assessed the relation between dietary intake of whole grain-containing foods and insulin sensitivity (SI). Design: We evaluated data from the Insulin Resistance Atherosclerosis Study (IRAS Exam I, 1992-1994). Usual dietary intakes in 978 middle-aged adults with normal (67%) or impaired (33%) glucose tolerance were ascertained by using an interviewer-administered, validated food-frequency questionnaire. Whole-grain intake (servings per day) was derived from dark breads and high-fiber and cooked cereals. SI was assessed by minimal model analyses of the frequently sampled intravenous-glucose-tolerance test. Fasting insulin was measured by using a radioimmunoassay. We modeled the relation of whole-grain intake to log(SI + 1) and to log(insulin) by using multivariable linear regression. Results: On average, IRAS participants consumed 0.8 servings of whole grains/d. Whole-grain intake was significantly associated with SI (β = 0.082, P = 0.0005) and insulin (β = −0.0646, P = 0.019) after adjustment for demographics, total energy intake and expenditure, smoking, and family history of diabetes. The addition of body mass index and waist circumference attenuated but did not explain the association with SI. The addition of fiber and magnesium resulted in a nonsignificant association that is consistent with the hypothesis that these constituents account for some of the effect of whole grains on SI. Conclusion: Higher intakes of whole grains were associated with increases in insulin sensitivity.
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Introduction Refined carbohydrates have been suggested to deteriorate glucose metabolism; however, whether persons with elevated intakes of white rice, a major staple food for the Japanese, experience increased risk of developing type 2 diabetes remains unclear. We prospectively investigated the association between white rice intake and risk of type 2 diabetes. Methods Participants were 25 666 men and 33 622 women aged 45–75 years who participated in the second survey of the Japan Public Health Center-based Prospective Study and had no prior history of diabetes. We ascertained food intake by using a validated 147-item food frequency questionnaire. ORs of self-reported physician-diagnosed type 2 diabetes over 5 years were estimated by using logistic regressions. Results A total of 1103 new cases of type 2 diabetes were self-reported. Rice intake was significantly associated with an increased risk of type 2 diabetes in women; the multivariate-adjusted OR for the highest compared with lowest quartiles of rice intake was 1.65 (95% CI 1.06 to 2.57; p for trend =0.005). In men, the association was unclear, although there was a suggestion of a positive association among persons who were not engaged in strenuous physical activity (p for trend = 0.08). Conclusions Elevated intake of white rice is associated with an increased risk of type 2 diabetes in Japanese women. The finding suggestive of a positive association of rice intake among physically inactive men deserves further investigation.
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We examined the association of diet quality with diet cost in a sample of youth with type 1 diabetes, for whom diet is an important component of medical management. Differences in food group spending by diet quality were also examined to identify potential budgetary reallocation to improve overall diet quality. Families of 252 youth with type 1 diabetes aged 8 to 18 years completed 3-day youth diet records. Cost of each food reported was calculated based on the average price obtained from two online grocery stores. Diet cost was estimated as average daily cost of foods consumed. The Healthy Eating Index 2005 (HEI2005), Nutrient Rich Foods Index version 9.3, and Whole Plant Food Density scores were evaluated. Differences in mean daily diet cost across tertiles of HEI2005, Nutrient Rich Foods Index version 9.3, and Whole Plant Food Density were modest, with none reaching statistical significance. Those in the upper tertile of HEI2005 spent more on whole fruit, whole grains, lean meat, and low-fat dairy, and less on high-fat meat and high-fat dairy compared with those in the lower tertiles. Higher-quality diets can be obtained at comparable costs to lesser-quality diets, suggesting that cost need not be an insurmountable barrier to more healthful eating. Reallocation of spending may increase overall quality without substantially increasing overall spending. Findings suggest potential strategies for assisting families of youth with type 1 diabetes in identifying cost-effective ways to achieve a more healthful diet.
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Adding large amounts of fat to carbohydrate reduces glycaemic responses, but the effect of varying fat across the normal range of intakes has not been studied. To test the hypothesis that fat would reduce glycaemic responses in a non-linear fashion, 12 overnight-fasted healthy subjects were studied on 5 separate days after consuming 50g available carbohydrate (white bread) plus 0, 5, 10, 20, or 40g fat (non-hydrogenated-fat margarine). Blood glucose peak rise (PR) and incremental area under the curve (iAUC) were reduced after 40g fat by 38 and 30%, respectively (p < 0.05). However, more than half these effects were seen after 5g fat. Grams fat correlated with both PR (r2 = 0.158, n = 60, p = 0.002) and iAUC (r2 = 0.080, p = 0.028), but an exponential model resulted in a better fit for iAUC (r2 = 0.084, p = 0.025) and a significantly better fit for PR (r2 = 0.244, p < 0.001). Thus, the results support the hypothesis that fat reduces glycaemic responses in a dose-dependent, but non-linear fashion. Variation of fat intake across the normal range of intakes (17–44% energy) did not significantly affect glycaemic responses.
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Latinos are the largest minority population in the United States, and are characterized by higher rates of obesity and diabetes compared to Whites. The prevalence of diagnosed diabetes in Latinos is two-fold higher than in Caucasians, and Latinos suffer from higher rates of diabetic complications and mortality. As the diabetes epidemic continues to expand and exert greater socioeconomic strain on national healthcare systems, the success of global and national healthcare initiatives for diabetes prevention and improvement of care will depend upon strategies targeted specifically toward this population. Essential to such strategies is an understanding of success factors unique to the Latino population for diabetes prevention and achievement of optimal treatment outcomes. A PubMed search was conducted for literature describing type 2 diabetes and its complications in Latinos. Specifically, we sought data describing epidemiology, disparities, management considerations, and success factors in this population. The title search yielded more than 2000 articles, 80 of which were deemed directly relevant to this review. The inherent limitations of this subjective selection process are acknowledged. A number of studies have highlighted various ethnic disparities in Latinos with diabetes including higher HbA1c levels, greater rates of obesity and metabolic syndrome, and a larger proportion of individuals with inadequate access to care. While relatively fewer studies describe success factors for redressing cultural disparities in diabetes, the current body of literature supports primary care strategies aimed at effective provider-patient relationships and culturally tailored education and lifestyle modification regimens. Further research demonstrating effective, culturally tailored practices that are suitable to the primary care setting would be of value to providers treating Latinos with diabetes.
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Three Garri samples (A, B, C) from the same cassava specie (Manihot utillsima) produced at different fermentation time (24, 48 and 72 h) were evaluated for Glycemic Indices (G.I). Oral glucose-D was used as standard food. Proximate analysis including the dietary fibre and glycemic carbohydrate were determined using standard methods. Result showed that dietary fibre decreased with length of fermentation giving values as 15.75, 10.85 and 7.60 for 24, 48 and 72 h respectively. Glycemic carbohydrate increased with length of fermentation giving values as 63.57, 69.11 and 73.05 for 24, 48 and 72 h respectively. Fermentation time affected the glycemic indices of the foods. The G.I values increased from 62, 67 and 73 for 24, 48 and 72 h respectively. Results showed that sample A and B were intermediate GI foods while sample C was a high GI food. The mean glycemic responses of the samples showed significant difference (p>0.05). The co-efficient of variation for the standard food was 26%.
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Refined carbohydrates have been suggested to deteriorate glucose metabolism; however, whether persons with elevated intakes of white rice, which is a major staple food for the Japanese, experience increased risk of developing type 2 diabetes remains unclear. We prospectively investigated the association between white rice intake and risk of type 2 diabetes. Participants were 25,666 men and 33,622 women aged 45-75 y who participated in the second survey of the Japan Public Health Center-based Prospective Study and who had no prior history of diabetes. We ascertained food intake by using a validated 147-item food-frequency questionnaire. Odds ratios of self-reported, physician-diagnosed type 2 diabetes over 5 y were estimated by using logistic regressions. A total of 1103 new cases of type 2 diabetes were self-reported. There was a significant association between rice intake and an increased risk of type 2 diabetes in women; the multivariate-adjusted odds ratio for the highest compared with lowest quartiles of rice intake was 1.65 (95% CI: 1.06, 2.57; P for trend = 0.005). In men, the association was unclear, although there was a suggestion of a positive association in persons who were not engaged in strenuous physical activity (P for trend = 0.08). Elevated intake of white rice is associated with an increased risk of type 2 diabetes in Japanese women. The finding that is suggestive of a positive association of rice intake in physically inactive men deserves further investigation.
Article
There is controversy regarding the clinical utility of classifying foods according to their glycemic responses by using the glycemic index (GI). Part of the controversy is due to methodologic variables that can markedly affect the interpretation of glycemic responses and the GI values obtained. Recent studies support the clinical utility of the GI. Within limits determined by the expected GI difference and by the day-to-day variation of glycemic responses, the GI predicts the ranking of the glycemic potential of different meals in individual subjects. In long-term trials, low-GI diets result in modest improvements in overall blood glucose control in patients with insulin-dependent and non-insulin-dependent diabetes. Of perhaps greater therapeutic importance is the ability of low-GI diets to reduce insulin secretion and lower blood lipid concentrations in patients with hypertriglyceridemia.