¿Influye el consumo de comidas ricas en proteínas y grasas en la glucemia postprandial de pacientes con diabetes tipo 1 que realizan conteo de hidratos de carbono? / Does the consumption of meals rich in proteins and fats influence on the postprandial glucemia of patients with diabetes type 1 that follow carbohydrate counting?

Introducción: el tratamiento de la diabetes tipo 1 (DM1) requiere de la administración de insulina exógena; dentro de las variables a tener en cuenta para calcular la dosis se encuentra el contenido de hidratos de carbono (HC) de la comida a ingerir. Este macronutriente es considerado, desde hace varios años, el responsable del aumento de la glucemia postprandial (GPP). El conteo de hidratos de carbono (CHC) es el método más aceptado y utilizado actualmente en el tratamiento nutricional, aunque cada vez existe más evidencia de que hay otros macronutrientes, como las proteínas y las grasas, que pueden influir en la variación de la GPP. Objetivo: el objetivo de esta revisión bibliográfica es reunir los resultados de publicaciones científicas que analizaron la respuesta glucémica (RG) al consumo de comidas con alto contenido de proteínas y grasas y hacer un análisis de las diferentes intervenciones. Materiales y método: búsqueda bibliográfica en PUBMED, inicialmente 196 artículos. Luego de aplicar los criterios de inclusión y exclusión se seleccionaron 26 artículos realizados en personas con DM1 de los últimos 10 años (2007-2017) referidos al consumo de comidas altas en proteínas y grasas. Resultados: hay una significativa variación interpersonal en los requerimientos de insulina en respuesta a las grasas y proteínas dietarias, que puede fluctuar en un 65% ± 10%. En los estudios randomizados se logró determinar que en las comidas altas en grasas el pico de GPP fue demorado y la sensibilidad a la insulina fue menor. Uno de los estudios logró demostrar que el 100% de las comidas altas en grasa se asociaron con hiperglucemia tardía. En relación a las dos revisiones sistemáticas encontradas, se hace hincapié en la búsqueda de datos para mejorar el tratamiento intensificado de la DM1, siendo el control de la GPP el indicador principal, ponderando la importancia de considerar la ingesta proteica y grasa de manera adicional al CHC. Conclusión: se concluye que el efecto de una comida con un alto contenido en proteínas y grasas sobre la glucemia suele presentarse entre las 3 a 6 hs de consumidas, siempre teniendo en cuenta la respuesta individual y el modo de administrar la insulina. La tarea del equipo interdisciplinario es fundamental para conocer la respuesta individual en el paciente con DM1 ante el consumo de comidas altas en proteínas y grasas, pudiendo así orientar la toma de decisión(AU).

Introduction: the treatment of type 1 diabetes (DM1) requires the administration of exogenous insulin, being the carbohydrate (HC) content of the meal to be ingested one of the variables to be considered to calculate the insulin dose. For several years, this macronutrient has been considered responsible for the increase in postprandial glycemia (PPG). Carbohydrate Counting (CHC) is the most accepted and currently used method in the nutritional treatment, although there is enough evidence that other macronutrients, such as protein and fat, can influence on the variation of PPG. Objective: to gather the results of scientific publications which analysed the glycemic response (GR) to the consumption of high-protein and high-fat meals and to analyse de different interventions. After applying the inclusion and exclusion criteria, 24 articles were selected including those with individuals with DM1 from the past 10 years (with the exception of one) referring to the consumption of high-protein and high-fat meals. Results: there is a significant interpersonal variation in insulin requirements in response to dietary fat and protein, which can fluctuate by 65% +/- 10%. Randomized studies showed that in the high-fat meals, the peak of PPG was delayed and insulin sensitivity was lower. One of the studies showed that 100% of high-fat meals were associated with late hyperglycemia. Both systematic reviews emphasize the need to search for data to improve the intensive treatment of DM1, with the control of PPG being the main indicator, considering protein and fat intake, in addition to CHC. Conclusion: the effect on blood glucose of high-protein and high-fat meals usually occurs between 3 to 6 hours after being consumed, always considering the individual response and the insulin administration method. The task of the interdisciplinary team is essential to know the individual response in the DM1 patient to the consumption of high-protein and high-fat meals, thus being able to guide the decision-making process(AU).

Effect of cassia cinnamon intake on improvement of the glycemic response: An updated meta-analysis: Focus on preparation of dehydrated powder and water extract / 한국영양학회지

PURPOSE: This meta-analysis aimed to evaluate the effect of cassia cinnamon (Cinnamomum. cassia and C. aromaticum) on the glycemic response with a focus on the preparation of dehydrated powder and water extract. METHODS: We searched Pubmed, Cochrane, EMBASE, Science Direct, and the Korean Studies Information Service System (KISS) through May 2017. In the meta-analysis for the preparation of powder, eight trials reporting fasting blood glucose (FBG), four trials reporting HbA1c, and three trials reporting the postprandial glycemic response were included. For the water extract, six trials reporting FBG and four trials reporting HbA1c were eligible for this study. A random-effects model was used to calculate the pooled effect size. RESULTS: Cassia cinnamon powder intake significantly lowered FBG by −1.55 mmol/L (95% CI, −2.45, −0.64; p = 0.001) and the AUC of postprandial blood glucose level by −51.8 mmol/L·min (95% CI, −85.5, −18.1; p = 0.003). There was a significant difference in FBG between water extract of cinnamon and placebo of −0.76 mmol/L (95% CI, −1.09, −0.43; p = 0.000). However, blood HbA1c level was not significantly altered by any preparation of cinnamon. No statistical heterogeneity was observed for any analysis except in the case of FBG for cinnamon powder. Results of funnel plots and Egger's regression suggest a low likelihood of publication bias in all biomarkers (p > 0.05). CONCLUSION: According to this meta-analysis, there was possible evidence to support a relationship between cassia cinnamon intake and fasting glucose in both preparation of powder and water extract. Furthermore, new evidence of the health benefits on postprandial glucose regulation of cinnamon powder was obtained.

Short-Term Effect of Convenience Meal Intake on Glycemic Response and Satiety among Healthy College Students in South Korea

This study examined the effect of convenience meals purchased at convenience stores on glycemic response and satiety in healthy college students. A total of 9 non-obese volunteers (4 males and 5 females) aged 20 to 24 years participated in this study. On 3 separate days, participants consumed a standard diet (cooked rice and side dishes), type 1 convenience meal (kimbap and instant ramen), and type 2 convenience meal (sweet bread and flavored milk). Capillary blood-glucose response and satiety were measured every 30 minutes for 2 hours after consuming the 3 different test meals. Although mean fasting glucose levels were not different, glucose levels at 30 minutes and 120 minutes after the type 1 convenience meal intake were significantly higher than those in the standard meal (p < 0.05, p < 0.01). Total glucose response was higher after consumption of the type 1 convenience meal, followed by the type 2 convenience meal and standard meal (p < 0.05). Though the type 2 convenience meal contained higher calorie than the other meals, satiety of the type 2 convenience meal was lowest at 30 minutes and 60 minutes after consumption (p < 0.01, p < 0.05). This pilot study suggests that convenience meals may increase glycemic response or induce higher calorie intake with low satiety compared with nutritionally balanced Korean style meal.

Efecto del consumo de una fórmula con carbohidratos de liberación prolongada sobre la respuesta glicémica e insulina post-prandial en individuos sanos / Consumption effect of a formula with extended release carbohydrates on the glycemic response and post prandial insulin in healthy individuals

Existen fórmulas enterales específicas para mejorar el control glicémico en diabéticos; con carbohidratos cuya respuesta glicémica sería de interés indagar. Se determinó el efecto del consumo de una fórmula con carbohidratos de liberación prolongada sobre la respuesta glicémica e insulina post-prandial en 21 sujetos sanos; (11 hombres y 10 mujeres) entre (17 y 25 años), quienes consumieron en 2 ocasiones la fórmula enteral polimérica para diabéticos y el alimento de referencia (pan blanco), en una cantidad de 50 g de carbohidratos disponibles. La glicemia fue medida a los 0, 15, 30,45, 60, 75, 90, 105 y 120 min y las concentraciones de insulina en ayuno y a los 120 min. El área bajo la curva de glicemia fue calculada resultando más baja para la fórmula 11718,20. ± 1112,38 que para el pan blanco 13269,18 ± 1351,05, (p<0,001). El índice glicémico (IG) resultó intermedio (63,33±5,22), y más bajo al compararlo con los rangos de IG publicados para el alimento de referencia(80-96). Se produjo una menor concentración de glicemia posterior al consumo de la fórmula; sin incrementos en los requerimientos de insulina, presumiendo un uso adecuado en diabéticos y una respuesta de saciedad más prolongada. Este efecto y la hemoglobina glicosilada deberían estudiarse tras el consumo en períodos prolongados en sujetos con diabetes(AU)

There are specific formulas of enteral nutrition to improve glycemic control in diabetic patients containing different types of carbohydrates which glycemic response should be investigated. The consumption effect of a formula with carbohydrates with extended release was determined on the glycemic response and postprandial insulin in 21 healthy individuals (11 men and 10 women) from 17 to 25 years old, who consumed in two different time the polymeric enteral formula for diabetics and the reference food (white bread) in a quantity of 50 g of available carbohydrates. The glycemia was measured at 0, 15, 30, 45, 60, 75, 90, 105 and 120 min and the insulin concentrations in fasting and within 120 min. The area in the glycemic curve was measured being the lowest the formula 11718.20. ± 1112.38 than in white bread 13269.18 ± 1351.05 (P<0.001). The glycemic index (GI) resulted to be intermediate (63.33±5.22) and lower when compared to the GI ranks published for the reference food (80-96). A lower concentration of glycemia occurred after the consumption of the formula, without increments in the insulin requirements; thus, assuming an adequate use in diabetic and a more extended feeling of fullness. This effect and the glycated hemoglobin should be studied after the extended consumption in people with diabetes(AU)

Glycemic index and glycemic load of tropical fruits andthe potential risk for chronic diseases

The objective was to determine the glycemic index and glycemic load of tropical fruits and the potential risk for chronic diseases.Nine fruits were investigated: coconut water (for the purpose of this study, coconut water was classified as a “fruit”), guava,tamarind, passion fruit, custard apple, hog plum, cashew, sapodilla, and soursop. The GI and GL were determined accordingto the Food and Agriculture Organization protocol. The GL was calculated taking into consideration intake recommendation guidelines; 77.8% of the fruits had low GI although significant oscillations were observed in some graphs, which may indicate potential risks of disease. Coconut water and custard apple had a moderate GI, and all fruits had low GL. The fruits evaluatedare healthy and can be consumed following the daily recommended amount. However, caution is recommended with fruitscausing early glycemic peak and the fruits with moderated GI (coconut water and custard apple).

Produção e aceitação de massa fresca tipo talharim enriquecida com farinha de maracujá ( Passiflora edulis Sims f. flavicarpa ) e verificação do seu efeito na glicemia / Production and acceptance of a fresh tagliarini pasta fortified with passion fruit flour ( Passiflora edulis Sims f. flavicarpa ) and verification of its effect on the blood glucose levels

OBJECTIVE: To evaluate the sensory acceptance and glycemic response of fresh tagliarini pasta made with passion fruit peel flour. METHODOLOGY: passion fruit peels were dried in the temperatures of 45 °C, 50 °C, and 55 °C, in triplicate. After triturated in a blender the lighter flour was submitted to chemical composition and microbial analyzes. Two recipes were then processed; one containing 25% and another with 35% of passion fruit peel flour. The other ingredients were: white wheat flour, egg, olive oil and water. After homogenization the mixes were worked in a cylinder and cut to obtain the tagliarini form. After cooking them, both tagliarini pastas passed through a sensory test with 130 untrained volunteers. The best formulation was selected for a glycemic response test, in which 20 volunteers received the equivalent of 50 g of carbohydrate; blood glucose levels were measured in the premeal and postprandial periods. RESULTS: The chemical composition analysis showed that fiber was the main flour component, and moisture content and microbiological quality were in compliance with the current legislation. The most accepted formulation (25%) was applied in a glycemic response test. The baseline blood glucose in the experimental group was 93.1 ± 5.31 mg/dL, while the control group was 90.55 ± 8.95 mg/dL. Thirty minutes after consuming the blood glucose, the average in the experimental group was 97.0 ± 9.8 mg/dL and remained constant until 2 hours following the pasta consumption. These values were significantly lower than the average blood glucose measured in the control group after 30 and 60 minutes. This group presented an increase in 19.8 ± 10.1 mg/dL and in 17.8 ± 14.5 mg/dL, respectively. CONCLUSION: The results suggest that passion fruit peel flour can be used in pasta in order to nutritionally fortify the product and help in the glycemic control

OBJETIVO: Avaliar a aceitação sensorial e resposta glicêmica de massa fresca tipo talharim formulada com farinha da casca do maracujá. METODOLOGIA: Cascas de maracujá foram desidratadas nas temperaturas de 45 °C, 50 °C e 55 °C, em triplicata, após trituração em liquidificador; a farinha de coloração mais clara foi submetida às análises de determinação da composição centesimal e microbiológica. Duas formulações de massas foram processadas por meio da mistura dos ingredientes: farinha de trigo sem fermento, ovo, farinha de maracujá nas proporções de 25% ou 35%, azeite e água. Depois da homogeneização, a mistura foi passada em cilindro para extrusão e, em seguida, cortada para obter a forma do talharim. Depois da cocção, as duas massas tipo talharim foram submetidas a teste sensorial com 130 provadores não treinados. A formulação de melhor aceitação foi selecionada para pesquisa da resposta glicêmica, na qual 20 voluntários receberam uma porção com o equivalente a 50 g de carboidrato; a glicemia foi aferida nos períodos pré-prandial e pós-prandial. RESULTADOS: As análises de composição química mostraram as fibras como principal componente, com umidade e qualidade microbiológica adequados à legislação vigente. A formulação de melhor aceitação (25%) foi aplicada para o teste glicêmico. A glicemia basal do grupo experimental foi 93,1 ± 5,31 mg/dL, e a do grupo controle 90,55 ± 8,95 mg/dL. Trinta minutos após a ingestão, a média do grupo experimental foi de 97,0 ± 9,8 mg/dL, mantendo-se constante até 2 horas depois. Esses valores foram mais baixos do que as médias aferidas no grupo controle após 30 e 60 minutos, sendo que esse grupo apresentou um incremento glicêmico de 19,8 ± 10,16 mg/dL e de 17,8 ± 14,49 mg/dL, respectivamente. CONCLUSÃO: Os resultados encontrados sugerem que farinha da casca do maracujá pode ser aplicada em massas alimentícias para auxiliar no controle glicêmico

Respuesta de glucosa e insulina: Comparación entre dos tipos de desayunos y prueba de tolerancia oral con 75g. De glucosa

Objetivos: Comparar las respuestas glucémicas e insulinémicas de dos desayunos, con la prueba estándar de tolerancia a la glucosa oral (PTGO). Métodos: En 14 sujetos sanos se realizó la PTGO, con 75 gr de glucosa. Luego, con un intervalo de una semana, se efectuaron las pruebas de tolerancia con dos tipos de desayunos, elaborados con alimentos de uso común en nuestro medio y cuya principal diferencia fue el tipo de carbohidrato. A los 0, 30, 60 y 120 minutos se cuantificó la concentración de glucosa, por el método de glucosa-oxidasa y la insulina por radioinmunoanálisis. Se calculó el área bajo la curva para la respuesta de glucosa e insulina. Para el análisis estadístico se aplicó un análisis de varianza y las pruebas post-test, para determinar la diferencia entre los grupos. Resultados: Se observó que la respuesta de glucosa con el desayuno 1 fue significativamente menor (p<0,05) a los 30 y 60 minutos y con el desayuno 2 a los 60 minutos (p<0.05) en comparación con la obtenida con la PTGO. El área bajo la curva (ABC) de glucemia no fue diferente entre los 2 tipos de desayunos y fue significativamente menor que con la PTGO. La respuesta de insulina fue significativamente mas baja a los 120 minutos (p<0.05) con el desayuno 1 (arepa) en relación con el desayuno 2 (pan) y con la PTGO. El ABC de insulinemia no fue diferente entre los desayunos y la PTGO. Conclusiones: La respuesta de glucemia postprandial con mezcla de nutrientes es menor que la obtenida con la PTGO, por lo que no debe ser usada con fines diagnósticos.

Objectives: To compare the glycemic and insulinemic responses of two breakfasts with the standard oral glucose tolerance test (OGTT). Methods: In 14 healthy subjects, the OGTT with 75 g of glucose was performed. After an interval of one week, tolerance tests with two types of breakfasts elaborated with common food in our country, and whose main difference was the type of carbohydrate, were carried out. At 0, 30, 60 and 120 minutes, glucose concentration by the glucose oxidase method and insulin by radioimmunoassay were measured. Areas under the curve (AUC) for glucose and insulin response were calculated. An analysis of variance test was applied to determine the difference between the groups. Results: It was noted that the glucose response to breakfast 1 was significantly lower (p <0.05) at 30 and 60 minutes and to breakfast 2 at 60 minutes (p <0.05) compared with that obtained with OGTT. The glucose AUC was not different between the 2 types of breakfasts and was significantly lower than the obtained with OGTT. The insulin response was significantly lower at 120 minutes (p <0.05) with breakfast 1 (arepa) in relation to breakfast 2 (bread) and the OGTT. The insulin AUC was not different between breakfasts and the OGTT. Conclusions: The postprandial blood glucose response to mix of nutrients is lower than that obtained with the OGTT, so it should not be used for diagnostic purposes.

Avaliação da potencialidade da farinha de banana verde como ingrediente funcional: estudo in vivo e in vitro / Evaluation of the unripe banana flour potential as a functional ingredient: In vivo and in vitro studies

A cada dia cresce o interesse por alimentos ricos em carboidratos não disponíveis em virtude da relação inversa entre seu consumo e o risco de doenças crônicas não transmissíveis (DCNT). No presente trabalho, foi avaliado o potencial fisiológico da farinha de banana verde (FBV) como ingrediente funcional. Em ratos adultos, foi realizado ensaio de média duração (28 dias) para avaliação do efeito trófico da FBV sobre o intestino grosso e de parâmetros relacionados à tolerância à glicose. Em humanos, foram realizados ensaios clínicos de curta e média duração para avaliação dos efeitos sobre resposta glicêmica; liberação de hormônios gastrintestinais relacionados à saciedade; status antioxidante; fome e saciedade; e funcionamento intestinal. A FBV foi produzida com banana verde, Musa acuminata, de acordo com patente depositada pelo grupo (Patente (RPI - 1941), 2008). A FBV é uma fonte concentrada de carboidratos não disponíveis, com 56% de AR e 8% de FAT na base integral. A adição de FBV nas rações provocou efeito trófico no ceco dos animais, evidenciado por aumento no índice metafásico, número de células da cripta e profundidade das criptas. Além disso, a ração com FBV proporcionou melhora nos parâmetros relacionados à tolerância à glicose. Em voluntários saudáveis, a ingestão de uma única refeição adicionada de 8 g de FBV proporcionou aumento na saciedade e boa correlação entre os parâmetros fome/saciedade e níveis plasmáticos de grelina e insulina, melhorou o funcionamento intestinal, além de resultar em alta fermentabilidade in vitro em relação à lactulose. Após ingestão diária da FBV por 14 dias, os resultados da ingestão de RC0 (refeição controle antes do tratamento) e de RC14 (RC0 após 14 dias de tratamento) mostraram que ocorre melhora na tolerância à glicose, evidenciada pela menor liberação de insulina durante o GTT. O efeito positivo sobre funcionamento intestinal, sobre saciedade e sobre liberação de hormônios gastrintestinais no plasma permaneceu...

The study of unavailable carbohydrates has been of great concern due to their inverse relation with the risk for non-transmissible chronic diseases (NTCD). In the present study, the functional potential of unripe banana flour (UBF) was evaluated. In rats, a medium-term assay was carried in order to evaluate parameters related to glucose tolerance and the trophic effect of UBF on the large bowel. In healthy volunteers, short and medium-term clinical assays were carried to evaluate the effects of UBF on glycemic response; release of gastrointestinal hormones related to satiety (ghrelin, leptin and insulin); antioxidant status; hunger and satiety; and intestinal health. UBF was produced with unripe banana, Musa acuminata, subgroup Cavendish, maturation stage I, in industrial scale and according to a patent deposited by the group (Patent (RPI - 1941), 2008). UBF is a concentrated source of unavailable carbohydrates, with 56% RS and 8% DF (wet weight). Adding UBF in rat rations resulted in a trophic effect in the animals' cecum, which was evidenced by increase in the metaphasic index, number of crypt cells and crypt depth. Moreover, the ration with UBF resulted in better glucose tolerance parameters. In healthy volunteers, adding UBF (8 g) to an only meal provided significant satiety and good correlation between the parameters hunger/ satiety and plasmatic levels of ghrelin and insulin, improved bowel habit, as well as resulted in high in vitro fermentability in relation to lactulose. After daily intake of UBF for 14 days, the results of the intake of RC0 (control meal before treatment) and RC14 (RC0 after 14 days treatment) showed that there is a positive post-prandial variation in the plasmatic concentrations of gastrointestinal hormones, as well as improvement in glucose tolerance, evidenced by lower insulin release during GTT. The positive effect on bowel habit, satiety and release of gastrointestinal hormones in plasma was kept after prolonged intake of UBF...

Effects of Sasa Borealis Leaf Extract on the Glucose Tolerance of Major Foods for Carbohydrate

Sasa borealis leaf has been known to have anti-diabetic properties. In this study, we tried to evaluate the effects of Sasa borealis leaf extract (SBE) on the inhibition of alpha-glucosidase activity and postprandial glycemic response following ingestion of four carbohydrate-rich foods; cooked rice, ramen (instant noodle), noodle, and bread. Fourteen healthy female adults consumed 50 g of glucose (control) or one of the four foods containing 50 g of available carbohydrate with or without 2,000 mg of SBE. The activity of alpha-glucosidase was inhibited dose-dependently by SBE. With SBE, blood glucose concentration at 15 min and the positive area under the curve (AUC) of postprandial glycemic response at 15 min and 30 min after consuming each of the four foods were reduced significantly. As the result, total positive AUC during 120 min was decreased in case of taking cooked rice or bread. Glycemic index and glycemic load of the four foods were declined from 13% to 23% with SBE. The results of this study suggest that SBE may be effective for postprandial glucose control by inhibiting alpha-glucosidase activity.

SLOW DIGESTIBILITY OF CEREAL STARCH AND POSTPRANDIAL GLYCEMIC RESPONSE / 营养学报

Objective To analyze slowly the digestibility and postprandial glycemic response after consum of different cereal starch. Method Starch was quantified into different nutritional fractions using the in vitro Englyst test. Ten healthy subjects consumed 7 kinds of carbohydrate foods with 50 g normal maize starch, waxy maize starch, wheat starch, sticky rice starch, rice starch, potato starch or glucose. Blood samples from postprandial zero to 120 min after consumption of test materials were collected for measurement of glucose, glycemic index and extended glycemic index. Results Native cereal starch was ideal slowly digestible starch (SDS) and the proportion of SDS was about 50% based on Englyst test. The GI value of cereal starch was more than 90% and belonged to high glycemic index foods, but EGI was positive, regarding glucose powder as 100%. Conclusion Cereal starch with slow digestibility and similar glycemic response was a better carbohydrate material to provide a slow and prolonged release of blood glucose and maintenance of glucose homeostasis, which was potentially beneficial to health.