Carbohydrate profiling & glycaemic indices of selected traditional Indian foods

Background & objectives: Consumption of high glycaemic index (GI) food is associated with a high risk for diabetes. There is a felt need to understand the GI of common Indian traditional foods using standard GI protocols. The present study was aimed to analyse the carbohydrate profile of common traditional Indian food preparation and to determine their GI using standardized protocols. Methods: Twelve food preparations made of millets, wheat, maize and pulses were evaluated for nutrient composition including detailed carbohydrate profiling and tested for GI in healthy volunteers using standard methodology. Capillary blood glucose responses for the test foods containing 50 g available carbohydrates were recorded and compared to the reference food (50 g glucose). GI was calculated from the incremental area under the curve (IUAC) for the test and reference foods. Results: Available carbohydrate content of the food preparations ranged between 13.6 and 49.4 g per cent. Maize roti showed the highest total dietary fibre (7.5 g%). White chick pea ‘sundal’ showed highest resistant starch content (3.95 g%). Amongst the 12 test foods, five fell in the high GI category (finger millet balls, sorghum, pearl millet and maize roti), four in the medium GI category (sorghum idli, wheat dosa, methi roti and adai) and three in the low GI category (broken wheat upma, white peas sundal and white chick peas sundal). Interpretation & conclusions: Merely being a whole grain-based food does not qualify for a lower GI. The method of processing, food structural integrity and preparation could influence the GI. The type and quality of fibre are important than the quantity of fibre alone. Judicious planning of accompaniments using low GI legumes may favourably modify the glycaemic response to high GI foods in a meal.

The in vivo glycaemic response of different rice varieties in Sri Lanka

@#Introduction: Diabetes poses a heavy economic burden in Sri Lanka. High glycaemic index (GI) diets are known to promote a higher risk of diabetes. This study was aimed to determine the GI values of nine improved and three traditional rice varieties of Sri Lanka including Bg406, H.H.Z.36, Ld368, Bw367, Bg94-1, At405, At362, Bg300, Bg352, Sudu heenati, Madathawalu, and Pachchaperumal. Furthermore, comparisons of GI values between improved and traditional varieties, as well as the effect of subject gender and colour of pericarp on GI were described. Methods: Fourteen healthy subjects consisting of seven males and seven females were fed with a reference food and cooked rice varieties containing 50 g available carbohydrate; GI were calculated. Results: The GI of 12 rice varieties varied from 40-69. All traditional varieties including Sudu heenati, Madathawalu and Pachchaperumal were in the low GI category presenting GI values of 51, 54, and 41, respectively. Rice with red pericarp obtained significantly lower GI compared to those with white pericarp. Yet, GI values obtained in males were significantly higher than females. Conclusion: The result of this study suggested that all traditional varieties and improved rice H.H.Z 36, Ld368, and Bg406 could have beneficial effects on lowering the glycaemic response in healthy subjects. Glycaemic index can be predicted from the colour of the rice grain. Gender should be considered in the determination of GI.

Microwave cooking enhances glycaemic potential of rice: An in vitro study

@#Introduction: Rice is the principle staple and energy source for nearly half the world’s population and has significant nutrition and health implications. Most rice varieties are considered high glycaemic index (GI) foods. With rice being a major contributor to the glycaemic load in Asian populations, there is increasing concern of its impact on the development of type 2 diabetes. Devising ways to reduce the glycaemic impact of rice is therefore imperative. Rice is cooked in a variety of ways, such as over an open fire, electric cooker or microwave. We evaluated the impact of the electric cooker and microwave cooking methods on starch digestibility in a variety of rice commonly consumed in Asia. Methods: Nine rice varieties of varying GIs were cooked in an electric cooker and microwave oven, and the starch digestibility of cooked rice measured using an in vitro digestion method. Results: High GI white rice (WR) had reduced starch digestibility after microwave cooking compared to electric cooker (p<0.05). There was a significant reduction in incremental area under the curves (iAUC) and rapidly digestible starch of WR cooked using microwave rather than electric cooker (p<0.05). Interestingly, even for low GI rice varieties such as iddly rice and extra long basmati rice, microwaving increased slowly digestible starch. Conclusion: The results provide indicative data that the glycaemic impact of rice can be reduced when cooked using a microwave oven. These observations have nutritional implications that need to be substantiated using in vivo studies. Microwaving may provide a simple method of reducing the postprandial glycaemia of high GI rice.

Determination of glycaemic response of a novel cane sugar product incorporated with Phyllanthus emblica and Zingiber officinale extracts

@#Introduction: The use of natural plant extracts to reduce blood glucose response has been practised from ancient times, although their industrial applications are rare. For the convenience of typical cane sugar consumers, selected tropical plant extracts were incorporated with cane sugar to make a low glycaemic sugar product. Methods: This study compared the glycaemic responses of a commercially available product (Product 1) containing seven herbal extracts; fenugreek (Trigonella foenumgraecum), turmeric (Curcuma longa), black pepper (Piper nigrum), ginger (Zingiber officinale), cinnamon (Cinnamomum verum), gooseberry (Phyllanthus emblica) and pomegranate (Punica granatum) against a novel product (Product 2) that was made by incorporating only two plant extracts that were cheaper and readily available in the local market - gooseberry (Phyllanthus emblica) and ginger (Zingiber officinale). Extracts were incorporated with cane sugar to make a series of crystallised solid sugar products and the formulae with the best sensory attributes was selected (Product 2). The glycaemic indices of both products were determined by standardised methodology using 12 healthy volunteers in a randomised crossover study. Results: The mean glycaemic index (GI) value for sugar in Product 1 was 49±9 and in Product 2 was 38±9. Both results elicited significantly (p<0.05) lower GI values than normal cane sugar (GI=65). The novel cane sugar product (Product 2) was far more superior compared to the commercially available product (Product 1) in reducing blood glucose response. Conclusion: Incorporation of suitable herbal extracts to cane sugar and foods like rice and wheat flour may be a suitable option to reduce their glycaemic impact.

El índice leucoglucémico es un predictor de mortalidad por todas las causas al año en pacientes cubanos con infarto agudo de miocardio con elevación del segmento ST / The leucoglycaemic index is a predictor of one-year all-cause mortality in Cuban patients with ST-segment elevation acute myocardial infarction

RESUMEN Introducción: El índice leucoglucémico (ILG) ha sido propuesto como marcador pronóstico de muerte en pacientes con infarto agudo de miocardio; sin embargo, no existe evidencia sobre su valor pronóstico al año. Objetivos: El objetivo del estudio fue determinar el valor pronóstico del ILG en la mortalidad al año de pacientes cubanos con infarto agudo de miocardio con elevación del segmento ST. Método: Los datos fueron obtenidos de las historias clínicas y el objetivo primario fue la muerte por todas las causas al año. El ILG se calculó con los valores al ingreso. Para el análisis se dividieron los pacientes en terciles de ILG, se construyeron curvas de características operativas del receptor y de supervivencia de Kaplan-Meier. Para el análisis multivariable se utilizó la regresión de Cox. Resultados: Se analizaron 344 pacientes (mediana de edad, 68 años; el 65,7% masculino; un 25,6% diabéticos). La mortalidad fue de 25,6% y fue significativamente mayor en el tercil superior (55,7%; p<0,0001). Los pacientes fallecidos presentaron una mediana de ILG significativamente mayor que los sobrevivientes (2,18 y 1,34, respectivamente; p<0,0001). El área bajo la curva del ILG fue de 0,715 y el punto de corte: 2,2. Un valor de ILG mayor de 2,2 se asoció a una supervivencia significativamente menor (177 vs. 309 días; p<0,0001) y fue un predictor independiente de mortalidad (HR=3,56; IC 95%, 2,09-6,07; p<0,0001). Conclusiones: El índice leucoglucémico es buen predictor de mortalidad al año, por todas las causas, en pacientes con infarto agudo de miocardio con elevación del segmento ST.

ABSTRACT Introduction: The leuko-glycaemic index has been proposed as a prognostic marker of death in patients with acute myocardial infarction, but there is uncertainty surrounding its prognostic value to predict one-year mortality. Objectives: The aim of this study was to determine the prognostic value of leuko-glycaemic index for one-year mortality in Cuban patients with ST-segment elevation myocardial infarction. Methods: The data were obtained from the medical records and all cause one-year deaths was the primary endpoint. The leuko-glycaemic index was calculated from measurements at admission. The patients were divided into leuko-glycaemic index tertiles to be evaluated. Receiver operating characteristics and Kaplan-Meier survival curves were performed. Cox regression model was used for all multivariable analysis. Results: Three hundred and forty-four patients were assessed (median age, 68 years; 65.7% males; 25.6% diabetic). The mortality rate was 25.6%, being significantly higher in the upper tertile (55.7%, p<0.0001). The deceased patients presented a median of leuko-glycaemic index significantly higher than the survivors (2.18 and 1.34 respectively, p<0.0001). The area under the curve for leuko-glycaemic index was 0.715 and its cut-off value was 2.2. Any leuko-glycaemic index value higher than 2.2 was associated with significantly lower survival (177 vs. 309 days, p<0.0001) and it was an independent predictor of mortality (HR=3.56, CI 95%, 2.09-6.07, p<0.0001). Conclusions: The leuko-glycaemic index is a good predictor for all cause one-year mortality in patients with ST-segment elevation myocardial infarction.

Are excess carbohydrates the main link to diabetes & its complications in Asians?

Dietary carbohydrates form the major source of energy in Asian diets. The carbohydrate quantity and quality play a vital function in the prevention and management of diabetes. High glycaemic index foods elicit higher glycaemic and insulinaemic responses and promote insulin resistance and type 2 diabetes (T2D) through beta-cell exhaustion. This article reviews the evidence associating dietary carbohydrates to the prevalence and incidence of T2D and metabolic syndrome (MS) in control of diabetes and their role in the complications of diabetes. Cross-sectional and longitudinal studies show that higher carbohydrate diets are linked to higher prevalence and incidence of T2D. However, the association seems to be stronger in Asian-Indians consuming diets high in carbohydrates and more marked on a background of obesity. There is also evidence for high carbohydrate diets and risk for MS and cardiovascular disease (CVD). However, the quality of carbohydrates is also equally important. Complex carbohydrates such as brown rice, whole wheat bread, legumes, pulses and green leafy vegetables are good carbs. Conversely, highly polished rice or refined wheat, sugar, glucose, highly processed foods such as cookies and pastries, fruit juice and sweetened beverages and fried potatoes or French fries are obviously 'bad' carbs. Ultimately, it is all a matter of balance and moderation in diet. For Indians who currently consume about 65-75 per cent of calories from carbohydrates, reducing this to 50-55 per cent and adding enough protein (20-25%) especially from vegetable sources and the rest from fat (20-30%) by including monounsaturated fats (e.g. groundnut or mustard oil, nuts and seeds) along with a plenty of green leafy vegetables, would be the best diet prescription for the prevention and management of non-communicable diseases such as T2D and CVD.

Índice leuco-glucémico como predictor de mortalidad en la insuficiencia cardiaca / Leuko-glycaemic index as mortality predictor in heart failure

RESUMEN Introducción: actualmente en la medicina de emergencia se buscan marcadores de riesgo para predecir resultados. Los índices pronósticos han sido ampliamente aplicados en la insuficiencia cardiaca con resultados variables. Objetivo: probar al índice leuco-glucémico como marcador de mortalidad en la insuficiencia cardiaca, así como calcular el valor de corte. Materiales y métodos: se realizó un estudio analítico longitudinal retrospectivo, con todos los pacientes ingresados en la Unidad de Cuidados Intensivos Emergentes por Insuficiencia Cardiaca descompensada del Hospital Militar Dr. Carlos J. Finlay, de enero de 2017 hasta junio de 2017 que cumplieron con los criterios de inclusión y exclusión. Resultados: la media de la edad fue de 79 ±12 años. La mortalidad global estuvo en el orden de 29 %. En la muestra existieron 17 mujeres y 14 hombres. El índice de error en la predicción de la mortalidad por el ILG es de solo el 5,6 %. La curva ROC área bajo la curva 0,995 IC 95 % (0,979-1) se evidencia un punto de corte en 1934, es decir que el resultado del índice leuco-glucémico mayor de este valor tiene una sensibilidad del 88,9 % y una especificidad del 100 % para detectar a los posibles occisos. Conclusiones: el índice leuco-glucémico puede ser un elemento a tener en cuenta en el pronóstico de estos. Tiene una elevada sensibilidad y especificidad en la detección de pacientes con riesgo de morir por insuficiencia cardiaca (AU).

ABSTRACT Introduction: currently, risk factors are looked for to predict results in emergency medicine. The prognosis indexes have been widely applied to heart failure, with uneven results. Objectives: to test the leuko-glycaemic index as mortality indicator in heart failure, as well as to calculate the cut-off value. Material and methods: a retrospective, longitudinal analytical study was carried out with all the patients who entered the Emergency Intensive Care Unit of the Military Hospital "Carlos J. Finlay" because of decompensated heart failure, from January 2017 until June 2017, and fulfilled the inclusion and exclusion criteria. Results: the average age was 79±12 years. Global mortality was around 29 %. The sample was composed by 17 women and 14 men. The error rate in mortality prediction by leuko-glycaemic index is only 5.6 %. The area below the ROC curve is 0,995; IC 95 % (0,979;1); it is evidenced a cut-off point in 1934; therefore, leuko-glycaemic index result higher than this value has a sensibility of 88.9 % and a specificity of 100 % to detect possible deceases. Conclusions: leuko-glycaemic index may be an element to take into account in this prognosis. It has a high sensibility and specificity in detecting patients at risk of dying due to heart failure (AU).

A study on clinical profile of acute coronary syndrome in type 2 diabetes mellitus patients with relevance to HbA1c

Background: Cardiovascular disease (CVD) has emerged as the dominant chronic disease in many parts of the world. At the beginning of the twenty-first century, CVD accounts for nearly half of all deaths in the developed world and 25% in the developing world. Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. Vascular diseases account for most morbidity and mortality in patients with DM. Aim and objectives: To study the clinical profile of type 2 diabetic patients presenting with Acute Coronary Syndrome (ACS) with reference to HbAlc level. Materials and methods: After selecting appropriate samples for the study based on the inclusion criteria, a detailed history was elicited and clinical examination was done as per the proforma. The necessary investigations were done as per the proforma. The clinical profile of these patients was then analyzed and correlated with reference to HbAlc level and statistical analysis performed using paired’ test. Results: The prevalence of microvascular diabetic complications was high with nephropathy amounting to 62% and retinopathy amounting to 58%. Neuropathy was not documented. About 32% of patients were free of microvascular complications. Other macrovascular diabetic complications were not documented. Among complications of ACS, 24% developed hypotension and no other complication was noted. Remaining 76% did not suffer any complications. No mortality was documented. Patients with systolic dysfunction constituted 82% and diastolic dysfunction 66%. The percentage of patients with HbA1c >7% constituted 62% which was very high and only 32% of patients had their HbA1c level in the control range. K. Babu Raj, G. Sivachandran. A study on clinical profile of acute coronary syndrome in type 2 diabetes mellitus patients with relevance to HbA1c. IAIM, 2018; 5(8): 1-8. Page 2 Conclusion: A majority of diabetic patients developing acute coronary syndrome have poor glycaemic control as reflected by their HbAlc levels. The coronary event is likely to occur sooner after the detection of diabetes if good glycaemic control is not achieved. Exercise, in the form of regular day to day activities, does not achieve satisfactory glycaemic control and cannot prevent the development of adverse complications of diabetes.

Effect of Extent of Gelatinisation of Starch on the Glycaemic Responses of Carbohydrate Rich Breakfast Meals

Introduction: Previous studies have shown that roti and pittu, which are South Asian foods, when prepared with the same composition of wheat flour and coconut scrapings had significantly different (p<0.05) glycaemic index (GI) values. The only difference was in the processing where roti (GI 57) was dry-heated (roasted) and pittu (GI 80) was wet-heated (steam cooked). The present study was carried out to investigate the association between GI and the properties of starch during processing for the observed variations of GI values of roti and pittu prepared with different flour varieties. Methods: The characteristics of isolated starch granules, molecular size distribution pattern of carbohydrates, amylose, amylopectin contents and change in temperature during the cooking of ‘pittu’ and ‘roti’ were analysed. Results: The results indicate that the contribution to GI from starch gelatinisation correlates positively and corroborates with reported data. Thus the significantly low GI values of roti compared to pittu could be mainly attributed to less disintegrated and less swollen starch granules of flour used in the preparation of roti. This was observed irrespective of the variety of flour. Conclusion: This study confirms that wet heat gelatinises starch to a greater extent than dry heat and provides evidence of a possibility that foods processed using dry heat to be associated with lower GI values, than the wet processed foods if other factors are constant.

Lowering Dietary Glycaemic Index through NutritionEducation among Malaysian Women with a History of Gestational Diabetes Mellitus

Introduction: Gestational diabetes mellitus (GDM) increases risks for type 2 diabetes and cardiovascular diseases. Low glycaemic index (GI) diets improve cardio-metabolic outcomes in insulin-resistant individuals. We examined the feasibility of lowering GI through GI-based-education among Asian post-GDM women. Methods: A 3-month investigation was carried out on 60 Malaysian women with a mean age of 31.0±4.5 years and a history of GDM. Subjects were randomised into two groups: LGIE and CHDR. The CHDR group received conventional healthy dietary recommendations only. The LGIE group received GI based-education in addition to conventional healthy dietary recommendations. At baseline and after 3-months, dietary intake of energy and macronutrient intakes including GI diet and glycaemic load was assessed using 3-day food records. Diabetes-Diet and GI-concept scores and physical activity levels were assessed using a questionnaire. Adherence to dietary instructions was measured at the end of 3 months. Results: At the end of 3 months, the LGIE group had significant reductions in energy intake (241.7±522.4Kcal, P=0.037, ES=0.463), total carbohydrate (48.7±83.5g, P=0.010, ES=0.583), GI (3.9±7.1, P=0.017, ES=0.549) and GL (39.0±55.3, P=0.003, ES=0.705) and significant increases in protein (3.7±5.4g, 0.003, ES=0.685) and diet fibre (4.6±7.3g, P=0.06). The CHDR group had a significant reduction in fat only (5.7±9.4g, P=0.006, ES=0.606). There was a 30% increase in GI-concept scores in the LGIE group (p< 0.001). Changes in GI-concept scores correlated significantly to the reduction in dietary GI (r = -0.642, P=0.045). Dietary adherence was comparable in both groups. Conclusion: GI-education improves GI-concept knowledge and helps lower dietary glycaemic index among women with a history of GDM.

Estimation of glycaemic index of peach palm (Bactris gasipaes) cooked fruits and chips, and pitahaya (Hylocereus spp.) pulp

The glycaemic index (GI) is a physiological measure of a food’s potential to increase postprandial blood glucose, as compared to the effect produced by food taken as reference, such as glucose or white bread. Currently researchers and consumers are interested in low GI foods, since their consumption is associated with better weight control and reduced risk of incidence of chronic diseases, like diabetes. In the present study, the GI value for peach palm cooked fruit, peach palm chips and pitahaya pulp was estimated. The methodology established by the FAO / WHO for determining the GI of food was used. A total of 12 healthy, non-smoking volunteers were selected and they ingested the fore mentioned foods on different occasions, in 25 g portions of available carbohydrates, after 12-14h overnight fast. Blood glucose levels were measured in 30 min intervals up to 120 min after ingestion. Average GI value was 48 ± 11 for the pitahaya pulp and 35 ± 6 for the peach palm cooked fruit, which may be classified as low glyceamic index foods. The GI of peach palm chips was 60 ± 7, corresponding to a food with a moderate GI. The processing for producing the chips caused an increase in the GI value when compared to the cooked fruit, probably because the stages of milling, moulding and baking promote availability of starch during hydrolysis by the digestive enzymes.

Estimación del índice glicémico del fruto cocido y de chips de pejibaye (Bactris gasipaes) y de la pulpa de pitahaya (Hylocereus spp.). El índice glicémico (GI) es una medida fisiológica del potencial de un alimento para incrementar la glucosa sanguínea, en comparación con el efecto producido por un alimento de referencia, tal como la glucosa o el pan blanco. Los investigadores y consumidores tienen interés en los alimentos de bajo GI, dado que su consumo está asociado con un mejor control del peso corporal y una reducción del riesgo de enfermedades crónicas como la diabetes. En el presente estudio se determinó el valor de GI del fruto cocido de pejibaye, de los chips horneados de pejibaye y de la pulpa de pitahaya. Se seleccionaron 12 voluntarios, aparentemente sanos, no fumadores, los cuales consumieron los alimentos evaluados y el alimento de referencia (pan blanco), en una porción que contuviera 25 g de carbohidratos disponibles, después de un período de ayuno de 12-14 h. Los niveles de glucosa en sangre fueron medidos en intervalos de 30 min hasta 120 min después de la ingesta. Se obtuvo un valor promedio de GI de 48 ± 11 para la pitahaya y de 35 ± 6 para el pejibaye cocido, los cuales pueden ser clasificados como alimentos de bajo índice glicémico. El valor de GI de los chips de pejibaye fue de 60 ± 7, lo que corresponde a un alimento de GI moderado. Se encontró que el procesamiento para la obtención de los chips produjo un aumento en el valor del GI, en comparación con el obtenido para la fruta cocida, probablemente debido a que las etapas de molienda, moldeo y horneo favorecen la disponibilidad del almidón para su hidrólisis por parte de las enzimas digestivas.

Sri Lankan Rice Mixed Meals: Effect on Glycaemic Index and Contribution to Daily Dietary Fibre Requirement

Introduction: The glycaemic index (GI) concept ranks starchy foods according to the blood glucose responses following ingestion. When considering commonly consumed Sri Lankan meals, only a few can be categorised as low GI. However, a significant negative correlation between the GI of Sri Lankan meals and fibre content has been observed indicating the potential to reduce the GI of meals by incorporating naturally occurring sources of fibre. Thus, the objective of this study was to study the effect of increased edible quantities of fibre on the GI of rice meals consumed in Sri Lanka. Methods: Meal 1 consisted of rice with several meal accompaniments (lentil curry, boiled egg, coconut gravy and Centella asiatica (gotukola) leaves salad). Meal 2 contained similar constituents as meal 1 and a Lasia spinosa (kohila) rhizome salad. The composition of meal 3 was similar to meal 2 but contained Trichosanthes cucumerina (snake gourd) salad instead of Lasia spinosa salad. Meal 3 contained similar fibre contents as meal 1 and similar meal size as meal 2. The glycaemic indices of the three meals were determined with healthy individuals (n=10, age =20-30 yrs, BMI=24±3 kg/m2) using bread as the standard. Results: Meals 1 and 3 contained total dietary fibre (TDF) contents of 15.2g. Meal 2 contained 16.3g TDF. The GI values of the three meals were 63±5, 57±5, 61±5 respectively and were not significantly different from one another (p>0.05). The GI of the rice mixed meal 2 was reduced by 9% when total edible dietary fibre content of the actual meal was increased by 7.2%. Conclusion: The study results show that the GI of rice mixed meals may be reduced by including naturally occurring sources of fibre with starchy staples while fulfilling daily dietary fibre requirement of an adult at low cost.