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Comparative Effect Of Tetrapack Juices And Fresh Fruit Juices On Blood Glucose Level Among Healthy Individuals

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To compare the effect of tetra pack juices and fresh fruit juices on blood glucoselevels among healthy individuals. Objective: 10 participants were selected using an internationalstandard Glycemic Index (GI) test protocol. After getting their fasting blood sample theywereinstructed to consume all the juice served in a period of 5 min. Further blood samples were taken at different intervals of time that is 0, 30, 60, 90, 120 and 150 minutes after consumption. Participants wereremained sedentaryduring each session. Blood was obtained by nger-prick and tested by the glucometer. Methods: The glycemic index of Apple juice Nestle has the glycemic index of 95.87, Orangejuice Nestle has the GI value 93.78, Apple juice fresh has the GI value of 92.17 and Orangejuice fresh has the glycemic index value of 99.07, respectively. Results: Detailed study of glycemic index of tetrapack juices (Nestle Apple and Orangejuice) and fresh fruit juices (Apple and Orange juice) showed similar impact on the blood glucose level of healthy individual. In the study, both types of juices were found to be equally hyperglycemic (GI 70+) causing a fast rise in blood-sugar levels, hence should not be given to diabetic patients.
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PBMJ Vol. 1 Issue 1 Jan - Jun 2018 21
Comparative Effect Of Tetrapack Juices And Fresh Fruit Juices
On Blood Glucose Level Among Healthy Individuals
Original Article
1 1 1 1
Junaid Manzoor , Hafsa Kamran, Sidra Khalid * and Anum Shakeel
1 Dietetics and Nutrition Sciences, University Institute of Diet and Nutritional Sciences, Faculty of Allied
Health Sciences, The University of Lahore, Pakistan
*sidrakhalid.uaf@gmail.com
Uses of tetra pack juices enhances the risk of diabetes and obesity. People were unaware of impact
of fresh fruit juices on health.
Abstract:
To compare the effect of tetra pack juices and fresh fruit juices on blood glucoselevels among
healthy individuals.
Objective:
10 participants were selected using an internationalstandard Glycemic Index (GI) test protocol.
After getting their fasting blood sample theywereinstructed to consume all the juice served in a period of 5
min. Further blood samples were taken at different intervals of time that is 0, 30, 60, 90, 120 and 150
minutes after consumption. Participants wereremained sedentaryduring each session. Blood was
obtained by nger-prick and tested by the glucometer.
Methods:
The glycemic index of Apple juice Nestle has the glycemic index of 95.87, Orangejuice Nestle has the GI
value 93.78, Apple juice fresh has the GI value of 92.17 and Orangejuice fresh has the glycemic index value of
99.07, respectively.
Results:
Detailed study of glycemic index of tetrapack juices (Nestle Apple and Orangejuice) and fresh fruit
juices (Apple and Orange juice) showed similar impact on the blood glucose level of healthy individual. In
the study, both types of juices were found to be equally hyperglycemic (GI 70+) causing a fast rise in blood-
sugar levels, hence should not be given to diabetic patients.
Conclusions:
Glycemic Index, Glycemic Load,Diabetes, Tetra Pack Juices, Fresh Fruit Juices.
Key Words:
Introduction:
The glycemic index (GI), was discovered by David
Jenkins and Thomas Wolver of the University of
Toronto in 1981, It is a systematic process for
classifying carbohydrate-containing foods on the
basis of how fast they elevate blood-glucose
levels. Glycemic index is a rating system that how
much carbohydrates containing food raise blood
glucose levels. Standardized range of glycemic
effect is from 0 to 100. Glycemic load range from
55 and lower is considered as a low glycemic index
food. 56 to 69 is consider as middle and 70 to 100 is
high glycemic load of the food. The Glycemic
Response (GR) is a term use in measuring the
effect of food on blood glucose levels [1].
Glycemic index (GI) and Glycemic load (GL) are two
different terms used for Glycemic Response [2].
PBMJ Vol. 1 Issue 1 Jan - Jun 2018 22
Raised postprandi al blo od glucos e levels
establish a global epidemic and a high risk factor
for pre-diabetes and type II diabetes [3]. Diabetes
is classied into three categories. Type1, Type 2
diabetes and Gestational diabetes mellitus [4, 5].
Carbohydrate with low-GI values is related with a
lower risk whereas carbohydrate with high-GI
values i s associated with a higher risk of
myocardial infarction[6].
The GI and GL are valuable variable in the
nutritional classication of carbohydrate foods.
Diets Identied by a low GI as well as low GL have
been repeatedly and independently connected
with reduce risk of diabetes and other chronic
diseases[7]. Foods having carbohydrates with a
less GI are more slowly digested and absorbed, but
diets with a low GI are benecial in controlling
post pr andia l plasm a g lu cose ex curs io ns
[8].Lowering the GI of the diet also improve
glycemic control and decrease the risk factors for
coronary heart disease (CHD)[9]. A low GI diet is
helpful for people with diabetes and has been
appeared to improve pregnancy results when
used from the rst trimester. A low GI diet is
commonly prompted as treatment for women
with gestational diabetes mellitus (GDM)[10].
Su gar-sweetened drinks and Tetra packed
including entire variety of fruit drinks, soft drinks,
vitamin water drinks, are composed of naturally
extract caloric sweeteners that are sucrose, high
fructose corn syrup, or fruit juice concentrates.
Overall they are the biggest contributor in US to
added sugar consumption diet. Over the past
years different long term observational studies
have found positive relation between tetra packed
juices utilization and long-term weight gain and
development of type2 diabetes and related
metabolic diseases[11].
Tetra pa cked or sug ar sweetened jui ces
consumption has been appeared to induce fastest
rise in blood glucose and insulin levels from high
levels of sugars which in related with the high
volumes consumed contribute to a high dietary GL
[12, 13]. High GL foods assist in weight gain and
may also increase the risk of CVD through
postprandial hyper-insulinemia and insulin
resistance promoting dyslipidemia and
inammation and t h rough p o s t prandial
hyperglycemia by inducing oxidative stress, which
advers ely effect (BP) blood pressure, clot
formation, and endothelium-dependent blood
ow [14].
Pure organic (100 %) fruit juices can be nutrient-
dense foods containing Ca, Mg, K, folate, vitamins
C and A, and soluble ber as well as a variety of
bioactive compounds containing carotenoids and
avonoids. Although, utilization of fruit as part of
a healthy and balanced diet is often encouraged
by nutritionists, yet balanced consumption of fruit
as juices is recommended due to the lack of
bers. Also, the capability of high energy intake
Juices having moderately high GI ratings shows
relatively instant and high post-prandial glucose
response as compared with foods with a low GI,
and foods lower in these types of simple carbs
may be rele va nt fo r the prev ention and
management of some chronic diseases including
Type 2 Diabetes [15].
Consumption of high-GI foods for a long time has
been prefer to increase insulin demand, increase
insulin resistance, damage pancreatic -cell
function, and ultimately lead to type 2
diabetes[16]. Carbonated beverages (called soft
drinks) and tetra packed juices, which have a high
glycemic load comparative to other foods and 100
% fruit juices, have been hypothesized as
pancreatic cancer risk factors[17].
Fruit juice is also criticized for not having a ber
content However, Schulze et al, discover that fruit
ber was not essentially identied to the lower
risk of diabetes based on the data of past
prospective studies [18]. Furthermore, it has been
exhibited that in spite of the fact that natural fruit
juice is inadequate in ber, other important
preventive nutritional components, such as
antioxidants and phytochemicals are present in
fruit juice[19].
This study was designed to determine the
difference between the health benets of fresh
fruit juices and tetra pack juices and to carefully
Comparative Effect of Juices on Blood Glucose Level
Manzoor J et al.
PBMJ Vol. 1 Issue 1 Jan - Jun 2018 23
analyze their effect on blood glucose levels. This
study will guide people to choose a healthy option
and risk of diabetes and other metabolic disorders
associated with consumption of juices could be
reduced.
Methods:
To carry out the research an experimental study
was designed and experiments were performed in
Nutrition lab 101, University Institute of Dietetics
and Nutritional Sciences, Faculty of Allied Health
Sciences, The University of Lahore. Total of 10
healthy individuals with no previous medical
diagnosis (aged between 18 to 45 years) were
selected for the study period of 4 months.
Diabetic, Obese or individuals with any other
medical diagnosis, or people below or above the
age limit were excluded.
Study Protocol:
Participants were examined physically and
anthropometric ally. A day before the test
participants were appro ach to limit th eir
participation in extreme physical activity. The
entire products sample prepared contained 50gm
carbohydrates in 500ml solution. After a 12 hr.
night fasting blood sample were taken and then
pre p a re d s a mple were p r ovi d ed to t he
participants that they had to consume in 5
minutes. Further blood samples were taken at 0,
30, 60, 90, 120, 150 minutes. New lancet was used
at every nger prick. Alcohol swab were used for
cleaning nger. New packed sugar sticks were
use d at every blo od sa mple. Acc u-check
glucometer were used to nd out the sugar levels.
Resu lt s of sam ples wer e note d on tim e.
Participants remained sedentary during each
session of experiment.
Determination of Glycemic Index:
The Glycemic Index (G.I) was indicate as a ratio
comparing the blood sugar increase caused by a
test food to that of a reference food for 2 hours
following ingestion [20].
For every individual subject, the GI value of the
test food is calculated as, GI value of test food =
[IAUC * of the test food/individual subject's
average IAUC of the reference food] × 100
The overall GI was calculated as, the mean (±SEM)
GI value for 10 or more participants.
The Trapezoidal Rule
Trapezoidal sums were applied. In this, area under
a cu rve is c omm only approx ima ted usi ng
rectangles (e.g. left, right, and midpoint Riemann
sums), but it can also be approximated by
trapezoids. Trapezoidal sums actually give a
better a pp roximation; in g eneral, than
rectangular sums that use the same number of
subdivisions [21]. Following procedure was
followed;
Step 1: time was taken as variable on X-axis and
glucose level on Y-axis.
Step 2: joint points of variable (Time) with Glucose
level were plotted.
Step 3: line from the point was drawn and a
perpendicular line on X-axis was drawn making
trapezoids.
Step 4: area of trapezoids was calculated using
the formula.
Where t is the time unit taking as t = 1,2,3, ... , n.
Step 5: sum of area of all the trapezoids was
calculated and area und er the cur ve wa s
measured.
Results:
Study included 3 participants aged between 22 to
25 years and 7 participants were aged between 26
to 32 years and the mean age of these participants
was 27.50+-3.21. Among 10 participants 6 were
males and 4 were females and out of 10 only 2
participants were smokers while 8 were non-
smokers. When inquired about sleeping habits 4
participants were taking 8-9-hour sleep and 6
were sleeping 9-10 hour, but al l of the 10
participants were having normal BMI. When
inquired about eating habits, 6 participants
p r e fe rred w hole w heat c hap a t ti a n d 4
participants preferred white oor chapatti, while
Comparative Effect of Juices on Blood Glucose Level
Manzoor J et al.
GI is estimated in the human participants in vivo.
PBMJ Vol. 1 Issue 1 Jan - Jun 2018 24
only 4 preferred whole wheat bread and when it
came to rice all preferred white rice over brown
rice. Among fruits, 7 preferred whole fruit while
only 3 preferred fruit juices. Moreover, it was also
observed that all the participants preferred white
sugar over brown sugar and none of them was
using articial sweetener.
1No. of participants 10
2Gender
3Age limit 18-40 years
4 BMI All normal
5Smoking habits 2 smokers
8 non smokers
6Eating preferences
Chapatti
6 preferred whole wheat
chapatti
4 preferred white oor
chapatti
Bread 4 preferred whole wheat
bread
6 preferred white bread
Rice All preferred white rice
over brown rice
7Sugar preference All preferred white sugar
8Fruit and juice preference 7 preferred whole fruit
3 preferred fruit juice
Sr. No. ATTRIBUTES FREQUENCY
6 males
4 females
Table 1: Frequency distribution of subjects
according to attributes:
According to the results the Apple juice Nestle
glycemic response mean values in blood were
87. 40 at 0 minute and 1 14.30,115.0 0,9 6.
60,85.50,83.70 were at 30, 60, 90, 120 and 150
minutes respectively, as shown in Figure 1.
Whereas, for Apple juice fresh GR values in blood
were 91.90 at 0 minute and 121.00, 103.90,
88.10, 80.60, 77.30 were at 30, 60, 90, 120 and 150
minutes respectively, as shown in Figure 1.
Figure 1: Distribution of participants according to
Apple juice Nestle and Apple juice fresh glycemic
response mean values.
According to the results the Orange juice Nestle
GR mean values in blood were 87.20 at 0 minute
and 116.30,106.40,93.70,89.10,86.40 were at 30,
60, 90, 120 and 150 minutes respectively, as shown
in Figure 2. Whereas, for Orange juice fresh GR
mean values in blood were 91.20 at 0 minute and
132.10, 112.30, 94.30, 88.10, 83.20 were at 30, 60,
90, 120 and 150 minutes respectively, as shown in
Figure 2.
Figure 2: Distribution of participants according to
Orange juice Nestle and Orange juice fresh
glycemic response mean values.
Glycemic Index for The Products:
According to the results Apple juice Nestle has the
glycemic index of 95.87, Orange juice Nestle has
the GI value of 93.78, Apple juice fresh has the GI
Comparative Effect of Juices on Blood Glucose Level
Manzoor J et al.
PBMJ Vol. 1 Issue 1 Jan - Jun 2018 25
Discussion:
value of 92.17 and Orange juice fresh has the
glycemic index value of 99.07, as shown in the
Table 1.
Apple Juice Nestle 95.87
Orange juice Nestle 93.78
Apple juice fresh 92.17
Orange juice fresh 99.07
Test Food G.I
Table 2: Mean Difference of Tetra pack and Fresh
Juices
Apple juice
Nestle
582.50+23.30594
1.708 0.122
Apple juice
fresh
10
562.80+36.28835
Orange juice
Nestle
10
579.10+39.90670
-2.396 0.040*
Orange juice
fresh
10
601.20+43.18384
Variables NMean + SD tP-value
10
Table 3: Mean Difference of Tetra pack and Fresh
Juices
Paired Sample t-test
P-value <0.05*
The mean value of Apple Juice nestle was
5 8 2.50+23 . 30594 a nd Fre s h Jui c e was
562.80+3 6.28835. There was insigni cant
difference was observed between Effect of Tetra
pack and Fresh Apple Juices in GI. The mean value
of Orange juice Nestle was 579.10+39.90670 and
Orange juice fresh was 601.20+43.18384. There
was signicant difference was observed between
Effect of Tetra pack and Fresh Orange Juices in GI.
Present study was carried out on 10 healthy
participants, aged between 18 to 40 years.
Analysis of glycemic values revealed that tetra
pack juices i.e. Apple juice Nestle has GI of 95.87
and Orange juice Nestle has GI of 93.78. On the
other hand, almost similar values of fresh Apple
juice and Orange juice were observed i.e. 92.17 and
99.07 respectively. The result signied that both
types of juices (tetra pack and fresh fruit juices)
have GI values above 70, hence were categorized
as high GI food/ hyperglycemic food. Therefore,
the study concluded that consumption of both
types of juices (tetra pack juices and fresh fruit
juices) has almost similar impact on blood glucose
level among healthy individuals. Moreover, no
signicant difference in glycemic index of Apple
juice and Orange juice was observed (i.e. both
juices were equally glycemic). Recently, a similar
study on ten healthy individuals was conducted by
KouassiAK et al., in 2017 where they adopted the
same strategy to observe the GI and GL of fresh
fruit juices of Baobab, Tomi and Néré. Unlike the
results of our study which showed both the fresh
fruit juices equally hyperglycemic, the results of
t he i r s tu d y h ig hl i gh t ed N é r é j ui ce a s
hyperglycemic (GI 89.54 ±1.63) whereas Baobab
and Tomi juices were found to have intermediate
glycemic index[22].
Like current research, many other researchers
also studied the association of natural food
sources and articial drinks with reference to
glucose level. In 2013, Eshak ES et al., conducted a
study on 27,585 Japanese men and women (aged
40-9 years) having no past history of diabetes and
effect of vegetable, fruit juices and soft drink
intake was observed[23]. Results contradictory
to our research was observed. Current study
suggest that fresh juices are hyperglycemic,
whereas their study concluded that pure juices
intake is not linked to risk of diabetes in Japanese
population, specically women but soft drinks
could lead to diabetes. Basu S et al., also studied
the association between intake of soft drinks and
obesity and diabetes within 7 countries. His
ndings backed up the results of previously
discussed study that soft drinks have a signicant
associ ation with obesity an d dia bet es in
developing and developed countries [24]. His
work contradicts from our work as he concluded
that soft drinks but not juices raise the glucose
levels in blood.
Comparative Effect of Juices on Blood Glucose Level
Manzoor J et al.
PBMJ Vol. 1 Issue 1 Jan - Jun 2018 26
Conclusions:
Detailed study of GI of tetra pack juices (Nestle
Apple and Orange juice) and fresh fruit juices
(Apple and Orange juice) showed similar impact on
the blood glucose level of healthy individual. In
conclusion, both types of juices were found to be
equally hyperglycemic (GI 70+) causing a rapid rise
in blood-glucose levels, hence should not be given
to diabetic patients.
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Article
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Studies on the effects of consuming 100 % fruit juice on measures of glycaemic control are conflicting. The purpose of the present study was to systematically review and quantitatively summarise results from randomised controlled trials (RCT) examining effects of 100 % fruit juice on glucose–insulin homeostasis. Eligible studies were identified from a systematic review of PubMed and EMBASE and hand searches of reference lists from reviews and relevant papers. Using data from eighteen RCT, meta-analyses evaluated the mean difference in fasting blood glucose (sixteen studies), fasting blood insulin (eleven studies), the homeostatic model assessment of insulin resistance (HOMA-IR; seven studies) and glycosylated Hb (HbA1c; three studies) between the 100 % fruit juice intervention and control groups using a random-effects model. Compared with the control group, 100 % fruit juice had no significant effect on fasting blood glucose (−0·13 (95 % CI −0·28, 0·01) mmol/l; P = 0·07), fasting blood insulin (−0·24 (95 % CI −3·54, 3·05) pmol/l; P = 0·89), HOMA-IR (−0·22 (95 % CI −0·50, 0·06); P = 0·13) or HbA1c (−0·001 (95 % CI −0·38, 0·38) %; P = 0·28). Results from stratified analyses and univariate meta-regressions also largely showed no significant associations between 100 % fruit juice and the measures of glucose control. Overall, findings from this meta-analysis of RCT suggest a neutral effect of 100 % fruit juice on glycaemic control. These findings are consistent with findings from some observational studies suggesting that consumption of 100 % fruit juice is not associated with increased risk of diabetes.
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