Dietary carbohydrates: Pathogenesis and potential therapeutic targets to obesity-associated metabolic syndrome

Metabolic syndrome (MetS) is a common feature in obesity, comprising a cluster of abnormalities including abdominal fat accumulation, hyperglycemia, hyperinsulinemia, dyslipidemia, and hypertension, leading to diabetes and cardiovascular diseases (CVD). Intake of carbohydrates (CHO), particularly a sugary diet that rapidly increases blood glucose, triglycerides, and blood pressure levels is the predominant determining factor of MetS. Complex CHO, on the other hand, are a stable source of energy taking a longer time to digest. In particular, resistant starch (RS) or soluble fiber is an excellent source of prebiotics, which alter the gut microbial composition, which in turn improves metabolic control. Altering maternal CHO intake during pregnancy may result in the child developing MetS. Furthermore, lifestyle factors such as physical inactivity in combination with dietary habits may synergistically influence gene expression by modulating genetic and epigenetic regulators transforming childhood obesity into adolescent metabolic disorders. This review summarizes the common pathophysiology of MetS in connection with the nature of CHO, intrauterine nutrition, genetic predisposition, lifestyle factors, and advanced treatment approaches; it also emphasizes how dietary CHO may act as a key element in the pathogenesis and future therapeutic targets of obesity and MetS.

Nutraceuticals: Focus on Anti-Inflammatory, Anti-Cancer, Antioxidant Properties in Gastrointestinal Tract

In recent years, nutraceuticals have gained great popularity, owing to their physiological and potential health effects, such as anti-inflammatory, anti-cancer, antioxidant, and prebiotic effects, and their regulation of lipid metabolism. Since the Mediterranean diet is a nutritionally recommended dietary pattern including high-level consumption of nutraceuticals, this review aimed to summarize the main results obtained by our in vitro and in vivo studies on the effects of the major constituents of the Mediterranean diet (i.e., extra virgin olive oil compounds, polyunsaturated fatty acids, and fruit components). Based on experimental studies, the therapeutic purpose of nutraceuticals depends on their bioavailability, solubility, toxicity, and delivery system. This review provides more in-depth knowledge on the effects linked to nutraceuticals administration on human health, focusing the gastrointestinal tract and suggesting specific dietary components for personalized adjuvant therapies.

The role of dietary sugars, overweight, and obesity in type 2 diabetes mellitus: a narrative review

Nowadays, there is still a popular belief that dietary sugars, in particular sucrose, are directly linked to the development of type 2 diabetes mellitus (T2DM). Furthermore, since insulin action is impaired in T2DM, it is still believed that excluding dietary sugars from the diet can adequately treat T2DM. This might be based on the assumption that dietary sugars have a stronger impact on blood glucose levels than other carbohydrates. Therefore, the aim of this review is to discuss the effects of dietary sugars intake, including sugar-sweetened beverages (SSBs) against the background of overall energy intake and weight gain in the development of T2DM. Furthermore, the effect of dietary sugars, including SSBs on glycemic control will be discussed. Results from various systematic reviews and meta-analyses do not support the idea that the intake of sucrose and other dietary sugars is linked to T2DM. Long-chain or complex carbohydrates can have a greater impact on postprandial glycemic response than sucrose. SSBs do not affect glycemic control if substituted for other calorie sources. Current scientific evidence clearly points toward excess energy intake followed by excess body fat gain being most relevant in the development of T2DM.

Development of a Prediction Model to Estimate the Glycemic Load of Ready-to-Eat Meals

The glycemic index (GI) and glycemic load (GL) of a single food item has been used to monitor blood glucose level. However, concerns regarding the clinical relevance of the GI or GL have been raised on their applicability to a combination of several foods consumed as meal. This study aimed to investigate the glycemic response after consuming commercially purchased ready-to-eat meal and to develop the GL prediction formula using the composition of nutrients in each meal. Glycemic responses were measured in healthy adults with various mixed meals comprising approximately 25 g, 50 g, and 75 g of carbohydrates. After fasting, participants consumed test meals, and the glycemic response was measured for a subsequent 120 min. The GI and GL values for mixed meals were calculated as area under curve for each participant. For the prediction formula, 70 mixed meals were analyzed, of which the GI and GL values of 64 participants were used. The prediction formula produced was as follows: GL = 19.27 + (0.39 × available carbohydrate) – (0.21 × fat) – (0.01 × protein²) – (0.01 × fiber²). We hope that this prediction formula can be used as a useful tool to estimate the GL after consuming ready-to-eat meals.

Perspective: Defining Carbohydrate Quality for Human Health and Environmental Sustainability

Plant foods are universally promoted for their links to improved human health, yet carbohydrate-containing foods are often maligned based on isolated, reductionist methods that fail to assess carbohydrate foods as a matrix of nutrients and food components. Currently accepted positive carbohydrate quality indices include plant food, whole-grain content, and dietary fiber, while negative health outcomes are linked to high intakes of added sugar and high glycemic index. More recently, negative health aspects have been linked to ultra-processed foods, which are often high in carbohydrates. Yet, carbohydrate staples such as grains and dairy products are both enriched and fortified, resulting in these carbohydrate foods containing important nutrients of concern such as dietary fiber, potassium, vitamin D, and calcium. This Perspective analyzes carbohydrate metrics used in dietary guidance and labeling and finds limitations in accepted indices included in standardized quality carbohydrate definitions and also proposes additional indices to benefit both human and environmental health. As nutrition recommendations shift away from a single-nutrient focus to a more holistic dietary pattern approach that is flexible and adaptable for each individual, it is necessary to determine the quality components that make up these patterns. This review concludes that current approaches that demonize staple carbohydrate foods do little to promote the recommended patterns of foods known to improve health status and reduce disease risk.

A Practical Perspective for a Conservative Estimate of Blood Glucose Level during Restaurant Dining and Supermarket Shopping

Foods today are so diverse and enjoyable, making healthy choices difficult. In this perspective, an in vitro-in silico approach for obtaining a conservative estimate of the postprandial blood glucose concentration, which is a realistic estimate nevertheless, after intake of a certain portion of meals is proposed. The rationales and feasibilities of the approach are described and discussed to an extent. The key idea is to first measure the maximum amount of glucose released in an in vitro test under standardized conditions from a specified serving size of a meal or dish or a packaged product sold in a supermarket. The value can then be translated by a literate consumer to the highest estimate of blood glucose rise prior to purchasing or eating through an established in silico blood glucose prediction model in the medical field. The strategy proposed here would help health conscious (diabetics included) and other life quality conscious individuals to make quantitative decisions on consuming the portions of different foods of desire. This strategy may be more effective in reality compared to the conventional GI (Glycemic Index) and GL (Glycemic Load) concepts.

Glycemic index, glycemic load, and risk of coronary heart disease: a pan-European cohort study

BACKGROUND

High carbohydrate intake raises blood triglycerides, glucose, and insulin; reduces HDLs; and may increase risk of coronary heart disease (CHD). Epidemiological studies indicate that high dietary glycemic index (GI) and glycemic load (GL) are associated with increased CHD risk.

OBJECTIVES

The aim of this study was to determine whether dietary GI, GL, and available carbohydrates are associated with CHD risk in both sexes.

METHODS

This large prospective study-the European Prospective Investigation into Cancer and Nutrition-consisted of 338,325 participants who completed a dietary questionnaire. HRs with 95% CIs for a CHD event, in relation to intake of GI, GL, and carbohydrates, were estimated using covariate-adjusted Cox proportional hazard models.

RESULTS

After 12.8 y (median), 6378 participants had experienced a CHD event. High GL was associated with greater CHD risk [HR 1.16 (95% CI: 1.02, 1.31) highest vs. lowest quintile, p-trend 0.035; HR 1.18 (95% CI: 1.07, 1.29) per 50 g/day of GL intake]. The association between GL and CHD risk was evident in subjects with BMI (in kg/m2) ≥25 [HR: 1.22 (95% CI: 1.11, 1.35) per 50 g/d] but not in those with BMI <25 [HR: 1.09 (95% CI: 0.98, 1.22) per 50 g/d) (P-interaction = 0.022). The GL-CHD association did not differ between men [HR: 1.19 (95% CI: 1.08, 1.30) per 50 g/d] and women [HR: 1.22 (95% CI: 1.07, 1.40) per 50 g/d] (test for interaction not significant). GI was associated with CHD risk only in the continuous model [HR: 1.04 (95% CI: 1.00, 1.08) per 5 units/d]. High available carbohydrate was associated with greater CHD risk [HR: 1.11 (95% CI: 1.03, 1.18) per 50 g/d]. High sugar intake was associated with greater CHD risk [HR: 1.09 (95% CI: 1.02, 1.17) per 50 g/d].

CONCLUSIONS

This large pan-European study provides robust additional support for the hypothesis that a diet that induces a high glucose response is associated with greater CHD risk.

A moderate-carbohydrate diet with plant protein is inversely associated with cardiovascular risk factors: the Korea National Health and Nutrition Examination Survey 2013-2017

Background

Because a moderate-carbohydrate diet reportedly has minimal risks, the substitution of carbohydrate for protein has been emphasized. Few studies have explored the effect of moderate-carbohydrate diets with higher protein intake in Asians, who typically consume a high-carbohydrate low-fat diet. Therefore, this study evaluated the associations of moderate- versus high- carbohydrate diets with cardiovascular risk factors among Korean adults by protein source.

Methods

This study included 7965 adults (3196 men, 4769 women) aged ≥ 19 years who participated in the 2013–2017 Korea National Health and Nutrition Examination Survey. Dietary intake was assessed by a 24-h recall method and four types of diet were defined: a moderate-carbohydrate diet with plant protein (MCP) or animal protein (MCA) and a high-carbohydrate diet with plant protein (HCP) or animal protein (HCA).

Results

Compared with the MCP group, men in the other three groups had significantly higher odds ratios (ORs) for elevated total cholesterol, reduced high-density lipoprotein (HDL)-cholesterol, and metabolic syndrome. Among women, only the HCP group had an increased OR for reduced HDL-cholesterol, compared with the MCP group. Similar associations were observed in younger adults (19–49 years). In addition, younger adults in the MCA group exhibited higher ORs for elevated triglycerides in men and elevated total cholesterol in women, compared with those in the MCP group.

Conclusions

A moderate-carbohydrate diet with a high intake of plant protein was inversely associated with cardiovascular risk factors, especially among younger Korean adults. Further intervention studies are required to confirm this relationship and develop the optimal diet for cardiovascular health in the Korean population.

Glenn A, M. S. Wolever T, G. Josse R, L. O’Connor D, Thompson A, D. Noseworthy R, Seider M, Sobie M, Bhatti G, Cavanagh J, Jones E, B. Darling P. Evaluation of Glycemic Index Education in People Living with Type 2 Diabetes: Participant Satisfaction, Knowledge Uptake, and Application

The glycemic index (GI) has been included in the Canadian clinical practice guidelines for type 2 diabetes (T2D) management since 2003, and even longer in other parts of the world (e.g., Australia). Despite this, dietitians have reported that GI is "too difficult for patients to understand and apply." They have called for diverse GI-utility data and evidence-informed education materials. To address these concerns, we developed and evaluated a GI education workshop and supporting materials, using the Kirkpatrick Model, for a T2D population. Participants (n = 29) with T2D attended a dietitian-facilitated workshop and received education materials. A mixed-form questionnaire (GIQ) and 3-day-diet-record were used to capture patient demographics, satisfaction, knowledge, and application, prior to and immediately after the workshop, 1-week, and 4-weeks post-education. Dietary GI was significantly lower at 1 and 4 weeks post-education (mean ± SEM; both 54 ± 1), compared to pre-education (58 ± 1; p ≤ 0.001). Participants (28/29) were satisfied with the intervention. The GI knowledge score was significantly higher post-education at baseline (83.5 ± 3.4%; p ≤ 0.001), week one (87.5 ± 2.6%; p = 0.035), and week four (87.6 ± 3.8%; p = 0.011) when compared to pre-education (53.6 ± 5.1%). A significant reduction in dietary GI was achieved by participants living with T2D, after completing the workshop, and they were able to acquire and apply GI knowledge in a relatively short period.

GlucoTRIG: a novel tool to determine the nutritional quality of foods and meals in general population

BACKGROUND

This study aimed to develop a novel criterion, GlucoTRIG, to rank meals for healthiness, that considers both glycaemic (serum insulin) and lipaemic (serum triglycerides) responses.

METHODS

Healthy volunteers (n = 10) were recruited with the aim of deriving a standard GlucoTRIG value for a reference meal. Volunteers consumed the reference meal (2 regular slices of wholemeal bread; 250 mL chocolate flavoured milk; 7 g butter and 11 g peanut butter) comprising of carbohydrate, fat and protein (41, 40 and 16% energy respectively) on three different occasions with a minimum washout period of 3 days. The GlucoTRIG value was determined as the difference between the product of insulin and triglyceride obtained from venous blood samples at baseline and the product of insulin and triglyceride at 180 min.

RESULTS

There were no significant differences in the participants' dietary intakes and their metabolic parameters between three visits (P > 0.005). The GlucoTRIG value obtained from three mean values of the reference meal was found to be 19 ± 3.5. There were no significant (P = 0.2303) differences observed between the GlucoTRIG values for the three visits.

CONCLUSION

GlucoTRIG, consisting of both glycaemic and lipaemic responses, may be a physiologically relevant tool to rank foods and meals for reducing the risk of metabolic diseases.

TRIAL REGISTRATION

ACTRN12619000973112.

New Insight into Diabetes Management: From Glycemic Index to Dietary Insulin Index

BACKGROUND

Despite efforts to control hyperglycemia, diabetes management is still challenging. This may be due to focusing on reducing hyperglycemia and neglecting the importance of hyperinsulinemia; while insulin resistance and resultant hyperinsulinemia preceded diabetes onset and may contribute to disease pathogenesis.

OBJECTIVE

The present narrative review attempts to provide a new insight into the management of diabetes by exploring different aspects of glycemic index and dietary insulin index.

RESULTS

The current data available on this topic is limited and heterogeneous. Conventional diet therapy for diabetes management is based on reducing postprandial glycemia through carbohydrate counting, choosing foods with low-glycemic index and low-glycemic load. Since these indicators are only reliant on the carbohydrate content of foods and do not consider the effects of protein and fat on the stimulation of insulin secretion, they cannot provide a comprehensive approach to determine the insulin requirements.

CONCLUSION

Selecting foods based on carbohydrate counting, glycemic index or glycemic load are common guides to control glycemia in diabetic patients, but neglect the insulin response, thus leading to failure in diabetes management. Therefore, paying attention to insulinemic response along with glycemic response seems to be more effective in managing diabetes.

Glycemic Index and Microstructure Evaluation of Four Cereal Grain Foods

To determine the glycemic index (GI) of selected cereals and association with their microstructure. The GI of whole grain pilaf (WGP), instant brown rice (IBR), whole maize ugali (MWU), and refined maize ugali (RMU) was assessed in a randomized trial. Fourteen healthy participants with mean age of 25 years were administered 50 g portions of available carbohydrates from glucose and various test foods after an overnight fast on separate occasions. Capillary blood samples of participants were used to measure blood glucose over 2 hr. The GI was calculated as per standard protocol. The microstructure of test foods, determined by scanning electron microscopy was evaluated to understand the measured GI values. The GI (mean ± standard error) of IBR was the highest (87.8 ± 6.8) followed by RMU (74.7 ± 6.5) and WMU (71.4 ± 5.1). WGP had medium GI (58.9 ± 5.1; P < 0.01 vs. IBR). Microstructure examination of IBR revealed disruption of bran layer and presence of fissures indicating loss of intactness of bran. Stereozoom images for WGP revealed intact bran and germ. For RMU and WMU, the grain was milled leading to loss of integrity. IBR, RMU, and WMU have high GI values, which is likely due to disruption of bran layer, endosperm modification (IBR), and loss of grain matrix (WMU, RMU). WGP has medium GI probably due to fairly intact bran and germ. PRACTICAL APPLICATION: Wholegrain or whole meal flour may not necessarily be low in glycemic index (GI; low GI < 55; medium 55 to 69 and high GI ≥70). "Ugali" a commonly consumed cereal staple food in Tanzania made from either refined or whole meal maize flour was found to be a high GI food. Intact whole grain foods, such as whole grain pilaf (mixed intact whole grains) is a healthier alternative to milled whole grains such as whole meal maize flour. Instant quick cooking brown rice exhibited a high GI, due to the processing method, suggesting that regular brown rice may be a healthier option.

Effect of cooking on glycemic index, antioxidant activities, α-amylase, and α-glucosidase inhibitory properties of two rice varieties

This study was designed to investigate the influence of cooking on the glycemic index (GI), amylose, and amylopectin contents of two rice varieties. Two rice varieties (foreign long rice and ofada) were sourced for, divided into two, one portion cooked and the other used raw. The sugar, starch, amylose, and amylopectin contents as well as glycemic indices, antioxidant properties, and the ability of the rice to inhibit carbohydrate-hydrolyzing enzymes (α-amylase and α-glucosidase) were determined. In addition, polyphenol content was determined. The results revealed that cooking caused a significant increase in starch content of the rice varieties. In the same vein, cooking increases the amylopectin content but has no effect on the amylose content. In addition, cooking shows no effect on polyphenol content but significantly increases radical scavenging ability of rice varieties used in this study. Furthermore, cooking lower the α-amylase and α-glucosidase inhibitory properties of two rice varieties except for foreign rice. However, the inhibitory effect of both cooked and raw foreign and ofada rice on α-amylase and α-glucosidase coupled with their low GI may explain their important role in controlling blood glucose level.

Plantain flours as potential raw materials for the development of gluten-free functional foods

Plantain flour (Musa ssp., group AAB, sub-group clone Harton) was modified by acetylation, carboxymethylation, methylation, oxidation and phosphation, in order to determine which of these modifications produce a material with potential for the development of gluten-free products with improved nutritional properties. The structural, rheological and nutritional properties of the modified flours were investigated. The phosphated plantain flour, cross-linked with sodium trimetaphosphate (STMP), had a lower in vitro digestibility rate associated with resistant starch (RS) types RS2, RS4 and RS5. This latter was confirmed by the formation of the amylose-lipid complex as determined by XRD. All the flours tested had a C-type structure with the exception of the methylated plantain flour which produced a large quantity of reaction by-product (BaSO₄). The phosphated plantain flour represents a raw material with great potential for the development of gluten-free food (bread and cookie) with functional properties, i.e. health benefits.

Semaglutide improves postprandial glucose and lipid metabolism, and delays first-hour gastric emptying in subjects with obesity

AIM

To investigate the effects of semaglutide on fasting and postprandial glucose and lipid responses, and on gastric emptying.

MATERIALS AND METHODS

This was a randomized, double-blind, placebo-controlled, 2-period, crossover trial. Subjects with obesity (N = 30) received once-weekly subcutaneous semaglutide, dose-escalated to 1.0 mg, or placebo. After each 12-week treatment period, glucose and lipid metabolism were assessed before and after standardized meals. Gastric emptying (paracetamol absorption test) and peptide YY (PYY) response were also assessed.

RESULTS

Semaglutide treatment significantly lowered fasting concentrations of glucose and glucagon, and increased insulin vs placebo (estimated treatment ratio: 0.95 [95% confidence interval: 0.91, 0.98]; 0.86 [0.75, 0.98]; 1.45 [1.20, 1.75], respectively). Postprandial glucose metabolism significantly improved with semaglutide vs placebo (incremental area under the curve 0 to 5 hours [iAUC0-5h ]; estimated treatment difference: glucose -1.34 mmol h/L [-2.42, -0.27]; insulin -921 pmol h/L [-1461, -381]; C-peptide -1.42 nmol h/L [-2.33, -0.51]). Fasting and postprandial lipid metabolism improved with semaglutide vs placebo. First-hour gastric emptying after the meal was delayed with semaglutide vs placebo (AUC0-1h ; estimated treatment ratio: 0.73 [0.61, 0.87]); this may have contributed to the lower postprandial glucose increase in semaglutide-treated subjects. Overall gastric emptying (AUC0-5h ) was not statistically different between treatments. Fasting and postprandial PYY responses were significantly lower with semaglutide vs placebo (P = .0397 and P = .0097, respectively).

CONCLUSION

Semaglutide improved fasting and postprandial glucose and lipid metabolism. Overall gastric emptying was similar to that with placebo; however, the observed first-hour delay with semaglutide may contribute to a slower entry of glucose into the circulation.

Evaluation of the glycemic indices of three commonly eaten mixed meals in Okada, Edo State

People do not generally eat single or individual meals; rather they eat mixed meals, consisting of two or more individual meals. These mixed meals usually have glycemic indices which differ from that of the individual food type. This study was aimed at evaluating the glycemic indices of three commonly consumed mixed meals eaten in Okada; rice and beans (test food 1), rice and plantain (test food 2), beans and plantain (test food 3). Two hundred and forty healthy subjects aged between 18 and 30 participated in this study. They were randomized into three groups of eighty persons each, and fed with the standard food (50 g glucose) on day one and one of the test foods on day two, after an overnight fast. Blood samples were taken at 0, 30, 60, 90, and 120 min after the food had been eaten. The results showed that the Glycemic Index (GI) values for the test foods were high: 86.60 (test food 1), 89.74 (test food 2), 86.93(test food 3). The incremental increase in blood glucose was monitored and calculated for each food and when compared with that of the standard food (glucose), there was significant differences (p < .036) for test food 1 and (p < .068) for test food 3; both at 30 min. At 120 min, no significant differences in blood glucose levels were observed (p > .05). The results from this study indicated that the GI of the mixed meals was affected by the constituent nutrient and the response is also affected by the proportion of each nutrient. Our findings show that the selected test foods (mixed meals) consumed in Okada have high GI values.

Examining sex differences in glycemic index knowledge and intake among individuals with type 2 diabetes

AIM

We examined self-reported dietary behaviours and actual food intakes among adult men and women with type 2 diabetes participating in Alberta's Caring for Diabetes (ABCD) Study.

METHODS

Participants completed 3-day food records and questions about glycemic index (GI) concept knowledge and dietary behaviours. Daily average GI and glycemic load (GL) were calculated for all carbohydrates consumed. Dietary intake was analyzed using ESHA FoodPro (version 10.13.1). Sex differences in nutrient intakes were explored across categories of GI knowledge and dietary practices.

RESULTS

Participants (N=170) mean (SD) age 65.8 (9.6) years were 46.5% women, 90.6% Caucasian with a mean BMI of 31.3 (7.0)kg/m² and diabetes duration of 13.4 (8.6) years. Overall, 60% of men versus 40% of women consumed carbohydrates in quantities below Acceptable Macronutrient Distribution Ranges (AMDR). About 80% of men versus 90% of women consumed proteins above AMDR whereas 60% versus 65% of women consumed fats above AMDR. Fibre intake among men was lower than recommended (p<0.01). Men who reported having knowledge of the GI-concept also reported lower GI intake versus men who did not (p=0.03).

CONCLUSION

Sex differences exist in low-GI diabetes self-care dietary behaviours among adults with type 2 diabetes participating in this study. Gender-sensitive approaches for enhancing diabetes self-care low-GI dietary behaviour should be explored.

Soy, Soy Foods and Their Role in Vegetarian Diets

Soy is a basic food ingredient of traditional Asian cuisine used for thousands of years. In Western countries, soybeans have been introduced about a hundred years ago and recently they are mainly used for surrogate foods production. Soy and soy foods are common nutritional solutions for vegetarians, due to their high protein content and versatility in the production of meat analogues and milk substitutes. However, there are some doubts about the potential effects on health, such as the effectiveness on cardiovascular risk reduction or, conversely, on the possible disruption of thyroid function and sexual hormones. The soy components that have stimulated the most research interest are isoflavones, which are polyphenols with estrogenic properties highly contained in soybeans. In this review, we discuss the characteristics of soy and soy foods, focusing on their nutrient content, including phytoestrogens and other bioactive substances that are noteworthy for vegetarians, the largest soy consumers in the Western countries. The safety of use will also be discussed, given the growing trend in adoption of vegetarian styles and the new soy-based foods availability.

The nutritional property of endosperm starch and its contribution to the health benefits of whole grain foods

Purported health benefits of whole grain foods in lowering risk of obesity, type 2 diabetes, cardiovascular disease, and cancer are supported by epidemiological studies and scientific researches. Bioactive components including dietary fibers, phytochemicals, and various micronutrients present in the bran and germ are commonly considered as the basis for such benefits. Endosperm starch, as the major constituent of whole grains providing glucose to the body, has been less investigated regarding its nutritional property and contribution to the value of whole grain foods. Nutritional quality of starch is associated with its rate of digestion and glucose absorption. In whole grain foods, starch digestion and glucose delivery may vary depending on the form in which the food is delivered, some with starch being rapidly and others slowly digested. Furthermore, there are other inherent factors in whole grain products, such as phenolic compounds and dietary fibers, that may moderate glycemic profiles. A good understanding of the nutritional properties of whole grain starch is important to the development of food processing technologies to maximize their health benefits.

Postprandial lipemia: factoring in lipemic response for ranking foods for their healthiness

One of the limitations for ranking foods and meals for healthiness on the basis of the glycaemic index (GI) is that the GI is subject to manipulation by addition of fat. Postprandial lipemia, defined as a rise in circulating triglyceride containing lipoproteins following consumption of a meal, has been recognised as a risk factor for the development of cardiovascular disease and other chronic diseases. Many non-modifiable factors (pathological conditions, genetic background, age, sex and menopausal status) and life-style factors (physical activity, smoking, alcohol and medication use, dietary choices) may modulate postprandial lipemia. The structure and the composition of a food or a meal consumed also plays an important role in the rate of postprandial appearance and clearance of triglycerides in the blood. However, a major difficulty in grading foods, meals and diets according to their potential to elevate postprandial triglyceride levels has been the lack of a standardised marker that takes into consideration both the general characteristics of the food and the food’s fat composition and quantity. The release rate of lipids from the food matrix during digestion also has an important role in determining the postprandial lipemic effects of a food product. This article reviews the factors that have been shown to influence postprandial lipemia with a view to develop a novel index for ranking foods according to their healthiness. This index should take into consideration not only the glycaemic but also lipemic responses.

The development of low glycemic index cookie bars from foxtail millet (Setaria italica), arrowroot (Maranta arundinacea) flour, and kidney beans (Phaseolus vulgaris)

Wholegrain foods are becoming increasingly popular as a high fiber dietary supplement recommended for people with diabetes. In Indonesia, the incidence of diabetes mellitus has almost doubled recently and poses a significant health risk with the high prevalence of obesity and cardiovascular diseases. The present research aimed to develop cookie bars from foxtail millet, arrowroot flour, and kidney beans. The physical, chemical, and sensory properties were evaluated by selecting the best formula to test the glycemic index. Three formulae of cookie bars, which had different percentages of foxtail millet, kidney beans, and arrowroot flour were evaluated. The results showed that the three formulae (F1, F2, F3) had °Hue values of 53.77, 58.46, and 58.31, and breaking force of 8.37, 10.12, and 5.87 N, respectively. While all other nutritional content were significantly different between formulae, the total crude fat was not. The F2 cookie bar was selected and evaluated for the glycemic index because it has the best sensory properties, lowest total sugar and available carbohydrate content. F2 cookie bars that contain 15% foxtail millet, 15% arrowroot flour, and 30% of kidney beans have a glycemic index of 37.6 hence it could be classified as a low glycemic index cookie bar. In conclusion, our findings indicated that F2 cookie bars can be further developed as a suitable diabetic food since it has the best physico-chemical properties, sensory properties, and low glycemic index.

The Impact of Sleep Improvement on Food Choices in Adolescents With Late Bedtimes

PURPOSE

The aim was to investigate the effect of sleep improvement on desire for and intake of weight gain-promoting foods in adolescents with late bedtimes.

METHODS

A sample of 42 adolescents with late bedtimes was enrolled in an intervention designed to improve sleep. Their desire for and intake of food in the morning was assessed at before and after treatment.

RESULTS

Adolescents with earlier bedtimes at post-treatment relative to pretreatment increased their caloric intake of low glycemic index, fruit, and dairy foods at post-treatment. This effect was not observed in adolescents who did not improve their bedtime at post-treatment.

CONCLUSIONS

These findings suggest that advancing bedtimes earlier can improve breakfast choices, an important meal for obesity prevention during adolescence.

Dietary glycemic index, glycemic load and cancer: An overview of the literature

AIMS

The aim of this paper is to provide an overview of the current evidence for associations between dietary glycemic index (GI) and dietary glycemic load (GL), and the risk of various types of cancer, and to summarize mechanisms proposed to explain the associations found.

DATA SYNTHESIS

Medline was searched for cohort studies, case-control studies, and meta-analyses, published up to February 2016, that examined associations between dietary GI/GL and cancer. Findings from the main meta-analyses showed a weak-to-moderate association of high dietary GI/GL with increased risk of some cancers. High dietary GI but not GL was significantly and consistently associated with increased colorectal cancer risk in both cohort and case-control studies. Dietary GL was directly associated with breast and endometrial cancer risk in cohort studies. Positive associations between dietary GI or GL and cancer risk were found more frequently in case-control studies than cohort studies. The main mechanism for these associations is thought to be chronic hyperinsulinemia. Insulin is itself a mitogen and also increases the bioactivity of insulin-like growth factors which can promote cancer by inhibiting apoptosis and stimulating cell proliferation.

CONCLUSIONS

The review has uncovered consistent evidence that high dietary GI is associated with increased risk of colorectal cancer, and that high dietary GL is associated with increased risk of breast and endometrial cancer. However the risk increases are small or moderate.

State of the Art Reviews: Relationship Between Diet/ Physical Activity and Health

Obesity and 4 of the leading causes of death—heart disease, cancer, stroke, and type 2 diabetes mellitus—are related to lifestyle. The combination of a healthy weight, prudent diet, and daily physical activity clearly plays a role in primary, secondary, and tertiary prevention of these and other chronic diseases. Because nearly 65% of the adult population is overweight or obese, weight loss and maintenance are central to this review article. Improved lipid profiles, blood pressure, insulin sensitivity, and euglycemia are associated with weight loss or a normal body weight; thus, maintaining a healthy weight is a universal recommendation for health. The methods for improving lifestyle described in the section on obesity include assessing nutritional status and stages of change of the client, setting realistic goals, eating a diet high in fruits and vegetables with low-fat sources of dairy and protein, and achieving appropriate physical activity levels. The importance of physicians discussing weight with clients and vice versa is stressed. The common features of lifestyle-related diseases make them amenable to similar lifestyle interventions.

Reformulating cereal bars: high resistant starch reduces in vitro digestibility but not in vivo glucose or insulin response; whey protein reduces glucose but disproportionately increases insulin

BACKGROUND

Resistant starch (RS) and whey protein are thought to be effective nutrients for reducing glycemic responses.

OBJECTIVE

We aimed to determine the effect of varying the sucrose, RS, and whey protein content of cereal bars on glucose and insulin responses.

DESIGN

Twelve healthy subjects [mean ± SD age: 36 ± 12 y; mean ± SD body mass index (in kg/m²): 24.9 ± 2.7] consumed 40 g available-carbohydrate (avCHO) portions of 5 whole-grain cereal bars that contained varying amounts of RS and whey protein concentrate [WPC; 70% protein; RS:WPC, %wt:wt: 15:0 (Bar15/0); 15:0, low in sucrose (Bar15/0LS); 15:5 (Bar15/5); 10:5 (Bar10/5); and 10:10 (Bar10/10)] and 2 portion sizes of a control bar low in whole grains, protein, and RS [control 1 contained 40 g avCHO (Control1); control 2 contained total carbohydrate equal to Bar15/0LS (Control2)] on separate days by using a randomized crossover design. Glucose and insulin responses in vivo and carbohydrate digestibility in vitro were measured over 3 h.

RESULTS

Incremental area under the curve (iAUC) over 0-3 h for glucose (min × mmol/L) differed significantly between treatments (P < 0.001) [Bar15/0LS (mean ± SEM), 169 ± 14; Control2, 164 ± 20; Bar15/0, 144 ± 15; Control1, 140 ± 17; Bar10/5, 117 ± 12; Bar15/5, 116 ± 9; and Bar10/10, 100 ± 9; Tukey's least significant difference = 42, P < 0.05], but insulin iAUC did not differ significantly. Higher protein content was associated with a lower glucose iAUC (P = 0.028) and a higher insulin-to-glucose iAUC ratio (P = 0.002) All 5 RS-containing bars were digested in vitro ∼30% more slowly than the control bars (P < 0.05); however, in vivo responses were not related to digestibility in vitro. Glucose and insulin responses elicited by high-RS, whey protein-free bars were similar to those elicited from control bars.

CONCLUSIONS

The inclusion of RS in cereal bar formulations did not reduce glycemic responses despite slower starch digestion in vitro. Thus, caution is required when extrapolating in vitro starch digestibility to in vivo glycemic response. The inclusion of whey protein in cereal bar formulations to reduce glycemic response requires caution because this may be associated with a disproportionate increase in insulin as judged by an increased insulin-to-glucose iAUC ratio. This trial was registered at clinicaltrials.gov as NCT02537587.

Estimating the reliability of glycemic index values and potential sources of methodological and biological variability

BACKGROUND

The utility of glycemic index (GI) values for chronic disease risk management remains controversial. Although absolute GI value determinations for individual foods have been shown to vary significantly in individuals with diabetes, there is a dearth of data on the reliability of GI value determinations and potential sources of variability among healthy adults.

OBJECTIVE

We examined the intra- and inter-individual variability in glycemic response to a single food challenge and methodologic and biological factors that potentially mediate this response.

DESIGN

The GI value for white bread was determined by using standardized methodology in 63 volunteers free from chronic disease and recruited to differ by sex, age (18-85 y), and body mass index [BMI (in kg/m²): 20-35]. Volunteers randomly underwent 3 sets of food challenges involving glucose (reference) and white bread (test food), both providing 50 g available carbohydrates. Serum glucose and insulin were monitored for 5 h postingestion, and GI values were calculated by using different area under the curve (AUC) methods. Biochemical variables were measured by using standard assays and body composition by dual-energy X-ray absorptiometry.

RESULTS

The mean ± SD GI value for white bread was 62 ± 15 when calculated by using the recommended method. Mean intra- and interindividual CVs were 20% and 25%, respectively. Increasing sample size, replication of reference and test foods, and length of blood sampling, as well as AUC calculation method, did not improve the CVs. Among the biological factors assessed, insulin index and glycated hemoglobin values explained 15% and 16% of the variability in mean GI value for white bread, respectively.

CONCLUSIONS

These data indicate that there is substantial variability in individual responses to GI value determinations, demonstrating that it is unlikely to be a good approach to guiding food choices. Additionally, even in healthy individuals, glycemic status significantly contributes to the variability in GI value estimates. This trial was registered at clinicaltrials.gov as NCT01023646.

Dietary glycaemic index and glycaemic load among Australian children and adolescents: results from the 2011–2012 Australian Health Survey

This study aimed to examine the dietary glycaemic index (GI) and glycaemic load (GL) of Australian children and adolescents, as well as the major food groups contributing to GL, in the recent 2011–2012 Australian Health Survey. Plausible food intake data from 1876 children and adolescents (51 % boys), collected using a multiple-pass 24-h recall, were analysed. The GI of foods was assigned based on a step-wise published method using values from common GI databases. Descriptive statistics were calculated for dietary GI, GL and contribution to GL by food groups, stratified by age group and sex. Linear regression was used to test for trends across age groups for BMI, dietary GI and GL, and intakes of energy, nutrients and food groups. Pearson’s χ2 test was used to test for differences between age groups for categorical subject characteristic variables. Mean dietary GI and GL of participants were 55·5 (sd 5·3) and 137·4 (sd 50·8), respectively. The main contributors to dietary GL were starchy foods: breads, cereal-based dishes, breakfast cereals, flours, grains and potatoes accounted for 41 % of total GL. Sweetened beverages, fruit and vegetable juices/drinks, cake-type desserts and sweet biscuits contributed 15 %. No significant difference (at P<0·001) was observed between sexes. In conclusion, Australian children and adolescents appear to consume diets with a lower GI than European children. Exchanging high-GI foods for low-GI alternatives within core and non-core foods may improve diet quality of Australian children and adolescents.

Slowly digestible starch--a review

The link between carbohydrate intake and health is becoming increasingly important for consumers, particularly in the areas of glycemic index (GI) and extended energy-releasing starches. From a physiological point of view, slowly digestible starch (SDS) delivers a slow and sustained release of blood glucose along with the benefits resulting from low glycemic and insulinemic response. SDS has been implicated in several health problems, including diabetes, obesity, and cardiovascular diseases (metabolic syndromes). It may also have commercial potential as a novel functional ingredient in a variety of fields, such as nutrition, medicine, and agriculture. The present review assesses this form of digestion by analyzing methods to prepare and evaluate SDS, and factors affecting its transformation, its health benefits, and its applications.

Association between dietary carbohydrate intake, glycemic index and glycemic load, and risk of gastric cancer

PURPOSE

The association between dietary carbohydrate intake, glycemic index (GI) and glycemic load (GL), and risk of gastric cancer (GC) has been investigated by many studies. However, the results of these studies were controversial. The aim of our study was to systematically assess this issue.

METHODS

PUBMED and EMBASE were searched up to March 2015, and either a fixed- or a random-effects model was adopted to estimate overall relative risks (RRs). Dose-response, meta-regression, subgroup, and publication bias analyses were applied.

RESULTS

Twenty-six studies with approximately 540,000 participants were finally included in this meta-analysis. High level of dietary carbohydrate intake (pooled RR 1.17, 95 % CI 0.91-1.50), GI (pooled RR 1.17, 95 % CI 0.80-1.69), and GL (pooled RR 1.06, 95 % CI 0.90-1.26) were all nonsignificantly associated with incidence of GC. In addition, no significant dose-response relationship was observed between carbohydrate intake, GI and GL, and the risk of GC. However, further subgroup analyses based on gender and geographic region suggested a significant association between higher carbohydrate intake (pooled RR 1.52, 95 % CI 1.10-2.08), GL (pooled RR 1.41, 95 % CI 1.04-1.92), and GC risk in males subgroup, and between higher carbohydrate intake (pooled RR 1.69, 95 % CI 1.36-2.09) and GC risk in Asian studies.

CONCLUSIONS

No significant association was found between dietary carbohydrate intake, GI and GL, and risk of GC. However, significantly positive association was observed in the males subgroup and Asian studies.

Metabolic effects of Foofoo corn on healthy volunteers: influence of some traditional Cameroonian sauces

Background

Little data to guide diet prescription exists about the foods most frequently consumed in Africa. Moreover, the sauce accompanying a meal can significantly alter the metabolic effects of food. Our work was to study the influence of sauces on the metabolic effects of foofoo corn (Zea mays), one of the most commonly consumed foods in several countries in sub-Saharan Africa with a wide range of sauces.

Methods

Our study population consisted of ten healthy volunteers (five men, five women), aged from 21 to 28 years, with mean BMI of 23.9 (SD 1.9) kg/m². The study involved seven visits of three hours each, conducted every 2 days, including one devoted to the oral glucose tolerance test (OGTT) and six visits to the consumption of each of 6 meals tested, standardized to 75 g of carbohydrate intake. Blood samples were collected at 0, 15, 30, 60, 90, 120 and 180 min after consumption of meals for blood glucose and triglycerides levels. The glucose area under the curve of each tested meal, was used to calculate its glycemic index, using the OGTT as the reference. The accompanying sauces tested with foofoo corn were: okra sauce (Abelmoschus esculentus), the so-called yellow sauce (Elaeis guinensis), the pistachio sauce (Pistacia vera), the nkui (Triumpheta pentandra), ndolé (Vernonia amygdalima) and cabbage (Brassica oleracea).

Results

All meals had generally a low glycemic index, with a maximum of 22.59 % for okra and cabbage, followed by ndolè (20.18 %), the yellow sauce (13.10 %), pistachio sauce (11.60 %), and nkui (5.27 %). There was a difference in the effects of the diets on triglyceride levels only at 180 min (p = 0.03).

Conclusion

Whatever the accompanying sauce, foofoo corn has a low glycemic index. Some sauces, such as nkui give it a very low glycemic index and may be of great interest in diet prescription for patients with various metabolic disorders such as diabetes and obesity.

Associations between family religious practices, internalizing/externalizing behaviors, and body mass index in obese youth

The objective of the present study was to assess the associations among family religious practices, internalizing/externalizing behaviors, and body mass index in a sample of severely obese youth referred to an outpatient pediatric endocrinology clinic. The sample consisted of 43 obese youth (body mass index > 95th percentile) aged 6-16 years (mean age = 12.67 years). Approximately 93% of families endorsed their religious faith as Christian or Catholic. Parents of youth were administered a demographic questionnaire, religiosity questionnaire, and the Child Behavior Checklist. Three multiple linear regression models were examined with body mass index percentile, Child Behavior Checklist Internalizing Scale, and Child Behavior Checklist Externalizing Scale as outcome variables. A parent endorsing greater importance of religious faith in shaping family life was associated with lower child body mass index percentile (p < 0.05) in the present sample. Greater family attendance at religious services was associated with higher child body mass index percentile (p < 0.05). Our data suggest that church-based interventions may be one viable option for the delivery of lifestyle interventions in families of youth with severe obesity.

Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC)

BACKGROUND AND AIMS

The positive and negative health effects of dietary carbohydrates are of interest to both researchers and consumers.

METHODS

International experts on carbohydrate research held a scientific summit in Stresa, Italy, in June 2013 to discuss controversies surrounding the utility of the glycemic index (GI), glycemic load (GL) and glycemic response (GR).

RESULTS

The outcome was a scientific consensus statement which recognized the importance of postprandial glycemia in overall health, and the GI as a valid and reproducible method of classifying carbohydrate foods for this purpose. There was consensus that diets low in GI and GL were relevant to the prevention and management of diabetes and coronary heart disease, and probably obesity. Moderate to weak associations were observed for selected cancers. The group affirmed that diets low in GI and GL should always be considered in the context of diets otherwise understood as healthy, complementing additional ways of characterizing carbohydrate foods, such as fiber and whole grain content. Diets of low GI and GL were considered particularly important in individuals with insulin resistance.

CONCLUSIONS

Given the high prevalence of diabetes and pre-diabetes worldwide and the consistency of the scientific evidence reviewed, the expert panel confirmed an urgent need to communicate information on GI and GL to the general public and health professionals, through channels such as national dietary guidelines, food composition tables and food labels.

A high-protein breakfast induces greater insulin and glucose-dependent insulinotropic peptide responses to a subsequent lunch meal in individuals with type 2 diabetes

BACKGROUND

The previous meal modulates the postprandial glycemic responses to a subsequent meal; this is termed the second-meal phenomenon.

OBJECTIVE

This study examined the effects of high-protein vs. high-carbohydrate breakfast meals on the metabolic and incretin responses after the breakfast and lunch meals.

METHODS

Twelve type 2 diabetic men and women [age: 21-55 y; body mass index (BMI): 30-40 kg/m(2)] completed two 7-d breakfast conditions consisting of 500-kcal breakfast meals as protein (35% protein/45% carbohydrate) or carbohydrate (15% protein/65% carbohydrate). On day 7, subjects completed an 8-h testing day. After an overnight fast, the subjects consumed their respective breakfast followed by a standard 500-kcal high-carbohydrate lunch meal 4 h later. Blood samples were taken throughout the day for assessment of 4-h postbreakfast and 4-h postlunch total area under the curve (AUC) for glucose, insulin, C-peptide, glucagon, glucose-dependent insulinotropic peptide (GIP), and glucagon-like peptide 1 (GLP-1).

RESULTS

Postbreakfast glucose and GIP AUCs were lower after the protein (17%) vs. after the carbohydrate (23%) condition (P < 0.05), whereas postbreakfast insulin, C-peptide, glucagon, and GLP-1 AUCs were not different between conditions. A protein-rich breakfast may reduce the consequences of hyperglycemia in this population. Postlunch insulin, C-peptide, and GIP AUCs were greater after the protein condition vs. after the carbohydrate condition (second-meal phenomenon; all, P < 0.05), but postlunch AUCs were not different between conditions. The overall glucose, glucagon, and GLP-1 responses (e.g., 8 h) were greater after the protein condition vs. after the carbohydrate condition (all, P < 0.05).

CONCLUSIONS

In type 2 diabetic individuals, compared with a high-carbohydrate breakfast, the consumption of a high-protein breakfast meal attenuates the postprandial glucose response and does not magnify the response to the second meal. Insulin, C-peptide, and GIP concentrations demonstrate the second-meal phenomenon and most likely aid in keeping the glucose concentrations controlled in response to the subsequent meal. The trial was registered at www.clinicaltrials.gov/ct2/show/NCT02180646 as NCT02180646.

A case-control study of glycemic index, glycemic load and dietary fiber intake and risk of adenocarcinomas and squamous cell carcinomas of the esophagus: the Australian Cancer Study

Background

Glycemic index (GI) and glycemic load (GL) have been investigated as etiologic factors for some cancers, but epidemiological data on possible associations between dietary carbohydrate intake and esophageal cancer are scant. This study examined the association between GI, GL, and other dietary carbohydrate components and risk of adenocarcinomas and squamous cell carcinoma of the esophagus accounting for established risk factors.

Methods

We analyzed data from a population-based Australian case-control study (2002-05) comprising 299 adenocarcinoma (EAC), 337 gastro-esophageal junction adenocarcinoma (EGJAC), 245 squamous cell carcinoma (ESCC), and 1507 controls sampled from a population registry. Dietary information was obtained using a 135-item food frequency questionnaire (FFQ); GI and GL were derived from an Australian GI database. Multivariable logistic regression models were used to derive odds ratios (ORs).

Results

All three case groups tended to have a lower intake of fiber, and significantly higher intake of fat, total energy, and alcohol (ESCC only) compared to controls. GI was unrelated to all histological types. Higher GL was not associated with risk of EAC and EGJAC, but was inversely associated with risk of ESCC (adjusted model, p_trend = 0.006), specifically among men where we observed a 58% reduced risk of ESCC in the highest versus the lowest quartile. Increased intake of total carbohydrates and starch was related to similarly large risk reductions of ESCC. Fiber intake was strongly and inversely associated with risk of EAC, EGJAC and ESCC (all p_trend ≤0.001), indicating risk reductions of 28%-37% per 10 g/day.

Conclusions

This study suggests a reduced risk of esophageal SCC with higher GL level particularly in men, but provides no evidence for the role of GI in the development of esophageal cancer. In addition, increased fiber intake appears to be associated with lower risk of all histological types of esophageal cancer.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2407-14-877) contains supplementary material, which is available to authorized users.

Long-term effect of dietary fibre intake on glycosylated haemoglobin A1c level and glycaemic control status among Chinese patients with type 2 diabetes mellitus

OBJECTIVE

Dietary fibre has been linked to lower levels of glycosylated haemoglobin A1c (HbA1c) among diabetes patients. The present study aimed to evaluate the long-term effect of dietary fibre on HbA1c levels among Chinese patients with type 2 diabetes mellitus.

DESIGN

Two cross-sectional surveys were conducted in 2006 and 2011, with the second one being a repeat survey on a sub-sample from the initial one. In both surveys, an in-person interview was conducted to collect information on demographic characteristics and lifestyles following a similar protocol. Dietary intake was assessed with a validated FFQ. Anthropometric measures and biochemical assays were performed at the interview.

SETTING

Communities in Pudong New Area of Shanghai, China.

SUBJECTS

Chinese patients (n 934) with type 2 diabetes mellitus.

RESULTS

An inverse association was observed between dietary fibre and glycaemic status indicated by HbA1c level in both surveys, although it was significant only in the first survey. Among 497 patients participating in both surveys, dietary fibre intake at the first survey was inversely associated with uncontrolled glycaemic status at the second survey, with adjusted odds ratios across the tertiles of intake being 1·00, 0·72 (95 % CI 0·43, 1·21) and 0·58 (95 % CI 0·34, 0·99; P trend = 0·048). The change in fibre intake was slightly associated with glycaemic status, with each increase in tertile scores of intake linked to a 0·138 % (β = -0·138; 95 % CI -0·002, 0·278) decrease in HbA1c value and a 19 % (OR = 0·81; 95 % CI 0·65, 1·02) reduced risk of uncontrolled glycaemic status at the second survey.

CONCLUSIONS

Dietary fibre may have a long-term beneficial effect on HbA1c level among Chinese diabetes patients.

Effect of sorghum flour addition on in vitro starch digestibility, cooking quality, and consumer acceptability of durum wheat pasta

Whole grain sorghum is a valuable source of resistant starch and polyphenolic antioxidants and its addition into staple food like pasta may reduce the starch digestibility. However, incorporating nondurum wheat materials into pasta provides a challenge in terms of maintaining cooking quality and consumer acceptability. Pasta was prepared from 100% durum wheat semolina (DWS) as control or by replacing DWS with either wholegrain red sorghum flour (RSF) or white sorghum flour (WSF) each at 20%, 30%, and 40% incorporation levels, following a laboratory-scale procedure. Pasta samples were evaluated for proximate composition, in vitro starch digestibility, cooking quality, and consumer acceptability. The addition of both RSF and WSF lowered the extent of in vitro starch digestion at all substitution levels compared to the control pasta. The rapidly digestible starch was lowered in all the sorghum-containing pastas compared to the control pasta. Neither RSF or WSF addition affected the pasta quality attributes (water absorption, swelling index, dry matter, adhesiveness, cohesiveness, and springiness), except color and hardness which were negatively affected. Consumer sensory results indicated that pasta samples containing 20% and 30% RSF or WSF had acceptable palatability based on meeting one or both of the preset acceptability criteria. It is concluded that the addition of wholegrain sorghum flour to pasta at 30% incorporation level is possible to reduce starch digestibility, while maintaining adequate cooking quality and consumer acceptability.