Gelatinisation and milling whole-wheat increases postprandial blood glucose: randomised crossover study of adults with type 2 diabetes

Wheat milling across history altered sugar bioaccessibility assessed using TIM-1 in vitro digestion model

The differences in wheat flour characteristics caused by ancient (pestle and mortar), old (stone hand mill), and modern (roller and cyclone) milling techniques and their effect on in vitro starch digestibility of wheat porridge using the simulated TIM Gastrointestinal Model (TIM-1) were investigated. Ancient flour (AF) was the coarsest flour (∼70 % is >1000 µm), followed by old wholemeal flour (OWF) and old refined flour (ORF) with similar particle size distribution showing one prominent peak (at ∼1000 µm for OWF and ∼800 µm for ORF). Modern refined flour (MRF) had a monomodal distribution centered at a particle size of ∼100 μm, while modern wholemeal flour (MWF) particle size was distributed between 40 and 600 μm. MRF and MWF porridges had higher cumulative sugar bioaccessibility than OWF and AF porridges, with ORF porridge having an intermediate cumulative sugar bioaccessibility. Characterizing the cumulative sugar bioaccessibility profile with a shifted logistic model allows identifying that the maximum sugar bioaccessibility and rate of sugar release were significantly higher (p < 0.05) for MRF and MWF compared to OWF and AF porridges, while the induction times were shorter, demonstrating the importance of processing on modulating starch digestibility.

Joint Association of Dietary Protein Intake and Eating Habits with the Risk of Gestational Diabetes Mellitus: A Case-Control Study

Because the associations between different dietary protein sources and the risks of gestational diabetes mellitus (GDM) are inconsistent, and those of eating habits with GDM have rarely been explored, we aimed to investigate the independent and joint association of major dietary protein sources and eating habits with GDM in a case-control study including 353 GDM cases and 718 controls in China. Dietary protein intake and eating habits prior to GDM diagnosis were collected through questionnaires at 24~28 gestational weeks. Multivariate logistic regression was used to evaluate the independent and joint associations of dietary protein intake and eating habits with GDM. The Anderson model was used assess if there is an additive interaction between them. Animal protein, red meat protein and dairy products protein intake were significantly and positively associated with GDM. Among the eating habits, preferences for hot food, firm food and soft food were significantly associated with higher odds of GDM. Individuals with unhealthy eating habits and high dietary protein simultaneously had the highest odds of GDM, and the ORs were 2.06 (1.25, 3.41) for the total protein, 2.97 (1.78, 4.96) for animal meat, 3.98 (2.41, 6.57) for the red meat protein and 2.82 (1.81, 4.41) for the dairy protein; the p values for the trend were all significant (p < 0.001). However, no additive interaction was detected. In conclusion, our study found that dietary protein intake and eating habits prior to GDM diagnosis were both independently and jointly associated with the odds of GDM.

The effects of wholegrain processing on appetite: randomised crossover trial in adults with type 2 diabetes

Aims: Recent observational data indicate higher ultra-processed food intakes are associated with a broad range of adverse health outcomes. Experimental studies on why this might be are lacking. We have considered the effects of wholegrain processing on measures of appetite in free-living adults with type 2 diabetes. Materials and methods: Participants were randomised to two interventions of two-weeks duration, separated by washout. Interventions were nutrient-matched wholegrain foods that differed by the amount of processing. Self-reported hunger and satiety were indicated on visual analogue scales before or after meals for four days at baseline and the end of each intervention. Metabolite markers of appetite were measured pre and post intervention in fasting plasma. Results: 31 adults (63 ± 13 years old, BMI 32.4 ± 7, HbA1c 7.5 ± 3.4% (59 ± 14 mmol mol-1)) commenced the trial, 28 (90%) completed both interventions. Wholegrain consumption, as measured by alkylresorcinols, was balanced between interventions. Self-reported pre-meal hunger was consistently lower at breakfast (MD, mean difference 0.49/10 95% CI 0.03 to 0.94), lunch (MD 0.67/10 95% CI 0.09 to 1.25), and dinner (MD -0.71/10 95% CI 0.19 to 1.23) during the intervention of less processed whole grains when compared with pre-intervention measures, however this did not result in a difference between interventions. Change in metabolite markers of appetite did not differ between interventions. Conclusions: A significant difference in hunger or satiety between less and more processed whole grains over intervention periods of two weeks was not detected within the current trial. Further experimental studies are needed to consider the potential effects of food processing on physiological processes such as appetite to provide mechanistic understanding behind observations of highly processed food intakes and adverse health outcomes.

Update on Nutrition in Diabetes Management

Nutrition is a corner stone of diabetes management, and should be regarded as fundamental to achieving blood glucose control. The current advice for nutrition in diabetes management is discussed, with a focus on body weight, macro and micro nutrients, foods and food groups, dietary patterns, and the lifestyle context. More recent evidence on topics such as body weight and dietary patterns indicate flexibility in what can be recommended, which enables patient preference and may aid adherence. Importantly, a healthy diet for those with diabetes is also appropriate to recommend for their families and the general population.

In Vitro Digestive Analysis of Digestible and Resistant Starch Fractions, with Concurrent Glycemic Index Determination, in Whole Grain Wheat Products Minimally Processed for Reduced Glycaemic Impact

Eight wheat products differing in texture (porridge vs. bread), grain fineness (fine, kibbled, intact), and cooking (raw vs. cooked), with pre-measured glycaemic indexes (GI), were analysed by in vitro amylolytic digestion to determine effects of processing to reduce GI on quantities of starch fractions differing in digestibility. The accuracy and precision of the in vitro analysis was assessed from its ability to concurrently predict clinical GI. In porridges, kernel intactness and lack of cooking reduced GI while increasing Type 1 (inaccessible) and Type 2 (ungelatinised) resistant starch. Porridge in vitro GI values (GI_iv), calculated from the area under in vitro digestion curves minus estimated blood glucose disposal, were: raw fine, 26.3; raw kibbled, 12.6; cooked fine, 63.9; cooked kibbled, 44.1; and correlated closely with clinical GI values (R² = 0.97). In bread, the negative association of kernel intactness and resistant starch with GI was seen in vitro but not in vivo. Bread GI_iv values were: roller milled flour, 67.4; stoneground flour 61.1; kibbled grain, 53.0; kibbled + intact kernel, 49.5; but correlation with clinical values was low (R² = 0.47), and variability in the clinical results was high (clinical CV = 72.5%, in vitro CV = 3.7%). Low glycaemic potency of wheat by minimal processing was achieved by maintaining particle size, avoiding hydrothermal treatment, avoiding crushing and using a food matrix requiring little chewing for ingestion. Use of in vitro digestive analysis for high precision measurement of starch fractions with potential secondary health benefits was validated by accurate concurrent prediction of the glycaemic index but needed to account for effects of chewing.

Role of Whole Grain Consumption in Glycaemic Control of Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Observational studies have indicated beneficial effects of whole grain consumption on human health. However, no evidence based on randomized controlled trials has been established. Our objective was to perform a systematic review and meta-analysis of randomized controlled trials to assess the effects of whole grain consumption in glycaemic control of diabetic patients.

METHODS

A comprehensive search in four databases (Web of Science, Pubmed, Scopus and Cochrane library) was conducted to collect potential articles which measured the roles of whole grain consumption on glycaemic control up to October 2021.

RESULTS

A total of 16 eligible trials involving 1068 subjects were identified to evaluate the pooled effect. The overall results indicated that compared with the control group, whole grain intake presented a significantly reduced concentration in fast plasma glucose (WMD = -0.51 mmol/L, 95% CI: -0.73, -0.28; I2 = 88.6%, p < 0.001), a homeostasis model assessment of insulin resistance (WMD = -0.39 μU × mol/L2, 95% CI: -0.73, -0.04; I2 = 58.4%, p = 0.014), and glycosylated haemoglobin (WMD = -0.56%, 95% CI: -0.88, -0.25, I2 = 88.5%, p < 0.001), while no significant difference was observed in fast plasma insulin level between groups (SMD = -0.05, 95% CI: -0.25, 0.14; I2 = 40.7%, p = 0.120). In terms of incremental area under the curve (iAUC), data suggested that whole grain effected a significant decrease in Glucose-iAUC (WMD = -233.09 min × mmol/L, 95% CI: -451.62, -14.57; I2 = 96.1%, p < 0.001) and Insulin-iAUC (SMD = -4.80, 95% CI: -8.36, -1.23; I2 = 89.9%, p = 0.002), although only in a small number of studies. Of note, there is evidence for modest unexplained heterogeneity in the present meta-analysis.

CONCLUSION

Whole grain consumption confers a beneficial effect on glucose metabolism in patients with diabetes. Regrettably, since relevant studies were scarce, we failed to provide confident evidence of whole grain consumption on acute effects including Glucose-iAUC and Insulin-iAUC, which should be addressed in further trials.

Effect of Wholegrain Flour Particle Size in Bread on Glycaemic and Insulinaemic Response among People with Risk Factors for Type 2 Diabetes: A Randomised Crossover Trial

Wholegrain flour produced by roller-milling is predominantly comprised of fine particles, while stoneground flour tends to have a comparatively smaller proportion of fine particles. Differences in flour particle size distribution can affect postprandial glycaemia in people with type 2 diabetes and postprandial insulinaemia in people with and without type 2 diabetes. No prior studies have investigated the effect of wholegrain flour particle size distribution on glycaemic or insulinaemic response among people with impaired glucose tolerance or risk factors for type 2 diabetes. In a randomised crossover study, we tested the 180-min acute glycaemic and insulinaemic responses to three wholegrain breads differing in flour particle size and milling method: (1) fine roller-milled flour, (2) fine stoneground flour, and (3) coarse stoneground flour. Participants (n = 23) were males and females with risk factors for type 2 diabetes (age 55-75 y, BMI >28 kg/m², completing less than 150 min moderate to vigorous intensity activity per week). Each test meal provided 50 g available carbohydrate, and test foods were matched for energy and macronutrients. There was no significant difference in blood glucose iAUC (incremental area under the curve) between the coarse stoneground flour bread and the fine stoneground flour bread (mean difference -20.8 (95% CI: -51.5, 10.0) mmol·min/L) and between the coarse stoneground flour bread and the fine roller-milled flour bread (mean difference -23.3 (95% CI: -57.6, 11.0) mmol·min/L). The mean difference in insulin iAUC for fine stoneground flour bread compared with the fine roller-milled flour bread was -6.9% (95% CI: -20.5%, 9.2%) and compared with the coarse stoneground flour bread was 9.9% (95% CI: -2.6%, 23.9%). There was no evidence of an effect of flour particle size on postprandial glycaemia and insulinaemia among older people with risk factors for type 2 diabetes, most of whom were normoglycaemic.