Food prototype containing resistant starch type 4 on postprandial glycemic response in healthy adults

The impact of slowly digestible and resistant starch on glucose homeostasis and insulin resistance

PURPOSE OF REVIEW

This review will summarize recent studies assessing the effect of slowly digestible starch (SDS) and resistant starch (RS) on glucose metabolism in healthy, prediabetic or type 2 diabetic adults.

RECENT FINDINGS

Currently, a particular interest in starch and its digestibility has arisen, with data showing a positive effect of SDS and RS on the glucose homeostasis of healthy, at-risk, prediabetic and type 2 diabetic patients but research is ongoing.

SUMMARY

Carbohydrates (CHO) and especially starch play a major role in the prevention and management of metabolic diseases such as type 2 diabetes (T2D). This largely depends on the quality and the digestibility (rate and extent) of the ingested starchy products, beyond their quantity. SDS have been poorly studied but display a beneficial effect on reducing glucose excursions in healthy and insulin-resistant subjects and a relevant potential to improve glucose control in type 2 diabetic individuals. As for RS, the results appear to be encouraging but remain heterogeneous, depending the nature of the RS and its role on microbiota modulation. Further studies are needed to confirm the present results and investigate the potential complementary beneficial effects of SDS and RS on long-term glucose homeostasis to prevent cardiometabolic diseases.

Harnessing the power of resistant starch: a narrative review of its health impact and processing challenges

Starch is a primary energy storage for plants, making it an essential component of many plant-based foods consumed today. Resistant starch (RS) refers to those starch fractions that escape digestion in the small intestine and reach the colon where they are fermented by the microflora. RS has been repeatedly reported as having benefits on health, but ensuring that its content remains in food processing may be challenging. The present work focuses on the impact RS on health and explores the different processes that may influence its presence in foods, thus potentially interfering with these effects. Clinical evidence published from 2010 to 2023 and studying the effect of RS on health parameters in adult populations, were identified, using PUBMED/Medline and Cochrane databases. The search focused as well on observational studies related to the effect of food processes on RS content. While processes such as milling, fermentation, cooking and heating seem to have a deleterious influence on RS content, other processes, such as cooling, cooking time, storage time, or water content, may positively impact its presence. Regarding the influence on health parameters, there is a body of evidence suggesting an overall significant beneficial effect of RS, especially type 1 and 2, on several health parameters such as glycemic response, insulin resistance index, bowel function or inflammatory markers. Effects are more substantiated in individuals suffering from metabolic diseases. The effects of RS may however be exerted differently depending on the type. A better understanding of the influence of food processes on RS can guide the development of dietary intake recommendations and contribute to the development of food products rich in RS.

A type 4 resistant potato starch alters the cecal microbiome and gene expression in mice fed a western diet based on NHANES data

Four major types of resistant starch (RS1-4) are present in foods, all of which can alter the microbiome and are fermented in the cecum and colon to produce short-chain fatty acids (SCFAs). Type 4 RSs are chemically modified starches, not normally found in foods, but have become a popular food additive as their addition increases fiber content. Multiple studies, in humans and rodents, have explored how different RS4 affect post-prandial glucose metabolism, but fewer studies have examined the effects of RS4 consumption on the microbiome. In addition, many RS studies conducted in rodents use high-fat diets that do not approximate what is typically consumed by humans. To address this, mice were fed a Total Western Diet (TWD), based on National Health and Nutrition Examination Survey (NHANES) data that mimics the macro and micronutrient composition of a typical American diet, for six weeks, and then supplemented with 0, 2, 5, or 10% of the RS4, Versafibe 1490™ (VF), a phosphorylated and cross-linked potato starch, for an additional three weeks. The cecal contents were analyzed for SCFA content and microbiota composition. Butyrate production was increased while branched chain SCFA production decreased. The alpha-diversity of the microbiome decreased in mice fed the TWD with 10% VF 1490 added while the beta-diversity plot showed that the 5% and 10% VF groups were distinct from mice fed the TWD. Similarly, the largest changes in relative abundance of various genera were greatest in mice fed the 10% VF diet. To examine the effect of VF consumption on tissue gene expression, cecal and distal colon tissue mRNA abundance were analyzed by RNASeq. Gene expression changes were more prevalent in the cecum than the colon and in mice fed the 10% VF diet, but the number of changes was substantially lower than we previously observed in mice fed the TWD supplemented with native potato starch (RPS). These results provide additional evidence that the structure of the RS is a major factor determining its effects on the microbiome and gene expression in the cecum and colon.

Cross-linked phosphorylated RS4 wheat starch reduces glucose and insulin responses after 3 days of pre-feeding in healthy adults: an acute, double-blind, randomized controlled clinical trial

When this project was designed, there was no evidence that adding resistant starch to available carbohydrate (avCHO) reduced glycaemic and insulinaemic responses (GIR). We compared GIR elicited by a cookie containing cross-linked phosphorylated RS4 wheat starch (Fibersym®) (RS4XL) versus an avCHO-matched control-cookie (CC) after n = 15 adults had consumed RS4XL or CC daily for 3-days using a double-blind, randomised, cross-over design. The difference in glucose iAUC over 0-2 h (primary endpoint) (mmol × min/L) after RS4XL, (mean ± SEM) 106 ± 16, versus CC, 124 ± 16, was not significant (p = 0.087). However, RS4XL reduced 0-90 min glucose iAUC (72 ± 9 vs 87 ± 9, p = 0.022), peak glucose concentration (6.05 ± 0.36 vs 6.57 ± 0.31 mmol/L, p = 0.017) and 0-2 h insulin iAUC (189 ± 21 vs 246 ± 24 nmol × h/L, p = 0.020). These results show that RS4XL reduced postprandial glycaemic and insulinaemic responses when added to avCHO, but do not prove that the products of its colonic fermentation are required for this effect.

Resistant starch improves cardiometabolic disease outcomes: A narrative review of randomized trials

Healthy dietary patterns with adequate fiber improve cardiometabolic (CM) outcomes and attenuate disease progression. Resistant starch (RS) is a fermentable fiber that affects CM outcomes; however, studies are heterogeneous and inconsistent. Thus, the purpose of this narrative review is to assess the impact of RS intake by type and amount on CM outcomes while considering subject characteristics and trial duration. Randomized crossover or parallel studies (n = 31) were selected and compared according to acute (1 day; n = 12), medium (>1-30 days; n = 8), or long (>30 days; n = 11) duration. Most acute trials in healthy adults showed improvements in postprandial glycemic outcomes irrespective of RS type or amount. However, a more pronounced reduction occurred when test meals did not match for available carbohydrate. Daily RS intake had a minimal effect on CM outcomes in medium duration trials, but insulin resistant adults had better glycemic control at 4 weeks. Several longer duration trials (8-12 weeks) showed favorable CM outcomes with daily RS intake in adults with type 2 diabetes (T2D), but not in those at risk for T2D. Furthermore, some studies reported improved lipids, inflammatory biomarkers, and heart rate. Future studies should consider matching for available carbohydrates between the RS and control groups to understand the gut microbiome's role. Furthermore, energy and fiber should be considered. Overall, the acute intake of RS improves glycemic outcomes, and consuming RS at for least 4 and up to 8 to 12 weeks in adults with prediabetes and T2D, respectively, appears to improve CM outcomes.

Effect of resistant starch types as a prebiotic

Since the role of intestinal microbiota in metabolism was understood, the importance of dietary components such as fibres and prebiotics, which affect the modulation of microbiota, has been increasing day by day. While all prebiotic components are considered dietary fibre, not every dietary fibre is considered a prebiotic. While fructooligosaccharides, galactooligosaccharides, inulin, and galactans are considered prebiotics, other fermentable carbohydrates are considered candidate prebiotic components based on in vitro and preclinical studies. Resistant starch, one of such carbohydrates, is considered a potential prebiotic component when it is made resistant to digestion naturally or chemically. In this review, both in vitro and in vivo studies in which the prebiotic capacity of type II, type III, and type IV resistant starch isolated from food and produced commercially was assessed were analyzed. According to the results of current studies, certain types of resistant starch are thought to have a high prebiotic capacity, and they may be candidate prebiotic components although positive results have not been achieved in all studies. KEY POINTS: • Resistant starch is undigested in the small intestine and is fermented in the large intestine. • Resistant starch fermentation positively affects the growth of Bifidobacterium and Lactobacillus. • Resistant starch can be considered a prebiotic ingredient.

Glycemic and Insulinemic Responses of Healthy Humans to a Nutrition Bar with or without Added Fibersym® RW, a Cross-Linked Phosphorylated RS4-Type Resistant Wheat Starch

The current study compared postprandial glycemic and insulinemic responses to four nutrition bars containing two different doses of resistant starch type-4. Normoglycemic adults (n = 17) completed six treatments, consuming either 50 g or 30 g digestible carbohydrate as: dextrose beverages (DEX), control puffed wheat bars (PWB), or RS4 test bars (RS4). Glucose (mg/dL) and insulin (µIU/mL) were measured at baseline and 10, 20, 30, 60, 90, and 120 min. There was a main effect of dose and treatment on glucose incremental area under the curve (iAUC, ps < 0.001), such that RS4 (50 g: 941, 95% confidence interval (CI): 501, 1519; 30 g: 481, 95% CI: 186, 914) was lower than PWB (50 g: 1746, 95% CI: 1109, 2528; 30 g: 693, 95% CI: 331, 1188) and DEX (50 g: 1940, 95% CI: 1249, 2783; 30 g:1432, 95% CI: 883, 2114). There was a main effect of dose and treatment on insulin iAUC (ps < 0.001), such that RS4 (50 g: 1993, 95% CI: 1347, 2764; 30 g: 943, 95% CI: 519, 1493) was lower than PWB (50 g: 3501, 95% CI: 2625, 4502; 30 g: 1789, 95% CI: 1193, 256) and DEX (50 g: 3143, 95% CI: 2317, 4095; 30 g: 2184, 95% CI: 1519, 2970). Results demonstrate significantly lower glycemic and insulinemic responses following consumption of nutrition bars containing RS4, regardless of dose, when compared with puffed wheat bars and dextrose.

Research Progress on Hypoglycemic Mechanisms of Resistant Starch: A Review

In recent years, the prevalence of diabetes is on the rise, globally. Resistant starch (RS) has been known as a kind of promising dietary fiber for the prevention or treatment of diabetes. Therefore, it has become a hot topic to explore the hypoglycemic mechanisms of RS. In this review, the mechanisms have been summarized, according to the relevant studies in the recent 15 years. In general, the blood glucose could be regulated by RS by regulating the intestinal microbiota disorder, resisting digestion, reducing inflammation, regulating the hypoglycemic related enzymes and some other mechanisms. Although the exact mechanisms of the beneficial effects of RS have not been fully verified, it is indicated that RS can be used as a daily dietary intervention to reduce the risk of diabetes in different ways. In addition, further research on hypoglycemic mechanisms of RS impacted by the RS categories, the different experimental animals and various dietary habits of human subjects, have also been discussed in this review.

Short-term effects of sugar-free apricot jam, cocoa powder and dried cranberry cereal bar on glycaemic responses in healthy adults: a randomised clinical trial

High sugar intake has been associated with adverse effects on health, with some types of breakfast being highly linked to overweight and obesity. The aim was to compare the effects of four sugar-free breakfast items, apricot jam with white bread (JWB), white bread (WB), cocoa with fat-free milk (CM), and dried cranberry cereal bar (CB), compared to d-glucose on the glycaemic responses. Using a cross-over design, twelve healthy individuals (25 ± 4 years; BMI 22 ± 2 kg/m²) received isoglucidic test meals (25 g of available carbohydrate) and 25 g glucose reference, in random order. Glycaemic index/load (GI/GL) were calculated, and capillary blood glucose samples were collected at 0–120 min after meal consumption. Subjective appetite was assessed with visual analogue scales. Sugar-free apricot jam and cocoa powder contained traces of available carbohydrates and were consumed along with bread and fat-free milk, respectively. JWB and WB were classified as medium GI, low-to-medium GL; CM as medium GI, low GL; and CB as high GI, low-to-medium GL. Subjective hunger was lower after JWB, fullness was higher after CM and pleasure was higher after CB (P for all < 0⋅05). In conclusion, sugar-free apricot jam with and without WB and cocoa powder with fat-free milk are suitable healthy breakfast options leading to improved glycaemic and subjective appetite responses.

Nutritional Bar with Potato-Based Resistant Starch Attenuated Post-Prandial Glucose and Insulin Response in Healthy Adults

Resistant starch is a non-digestible starch fraction and is classified as fiber. Beyond naturally occurring fiber sources, starches can be modified to resist digestion, increase their fiber content and provide physiological benefits. The current study examined acute postprandial glycemic responses of VERSAFIBE™ 1490 resistant starch type-4, containing 90% total dietary fiber (TDF, AOAC (Association of Official Analytical Collaboration International) 991.43 method). In a double-blind, randomized, placebo-controlled, cross-over study, healthy adults (n = 38) consumed a nutritional bar containing either control (2 g), medium (21 g) or high (30 g) fiber. The test bars were matched with control for available carbohydrates, fat and protein. Venous glucose, insulin, and capillary glucose were measured. Mean ± SEM capillary glucose incremental area-under-curve (iAUC0)-120 min in min*mmol/L was lower (p < 0.005) for both fiber bars (136.2 ± 9.2 and 137.0 ± 10.4 for the medium and high fiber bars, respectively) compared to the control bar (174.9 ± 13.5). Mean venous insulin iAUC0-120 min in min*pmol/L was also lower for medium (8096.3 ± 894.5) and high fiber (7533.8 ± 932.9) bars, respectively, compared to the control bar (11871.6 ± 1123.9, p < 0.001). Peak capillary glucose and venous insulin concentrations were also significantly reduced (p < 0.001) after consumption of both fiber bars compared to the control bar. The results of this study suggest that nutritional bars containing potato based RS4 fiber reduced post-consumption glycemic and insulinemic responses when consumed by generally healthy adults.