Effect of pasta in the context of low-glycaemic index dietary patterns on body weight and markers of adiposity: a systematic review and meta-analysis of randomised controlled trials in adults

Dietary Assessment and Metabolomic Methodologies in Human Feeding Studies: A Scoping Review

Dietary metabolomics is a relatively objective approach to identifying new biomarkers of dietary intake and for use alongside traditional methods. However, methods used across dietary feeding studies vary, thus making it challenging to compare results. The objective of this study was to synthesize methodological components of controlled human feeding studies designed to quantify the diet-related metabolome in biospecimens, including plasma, serum, and urine after dietary interventions. Six electronic databases were searched. Included studies were as follows: 1) conducted in healthy adults; 2) intervention studies; 3) feeding studies focusing on dietary patterns; and 4) measured the dietary metabolome. From 12,425 texts, 50 met all inclusion criteria. Interventions were primarily crossover (n = 25) and parallel randomized controlled trials (n = 22), with between 8 and 395 participants. Seventeen different dietary patterns were tested, with the most common being the "High versus Low-Glycemic Index/Load" pattern (n = 11) and "Typical Country Intake" (n = 11); with 32 providing all or the majority (90%) of food, 16 providing some food, and 2 providing no food. Metabolites were identified in urine (n = 31) and plasma/serum (n = 30). Metabolites were quantified using liquid chromatography, mass spectroscopy (n = 31) and used untargeted metabolomics (n = 37). There was extensive variability in the methods used in controlled human feeding studies examining the metabolome, including dietary patterns tested, biospecimen sample collection, and metabolomic analysis techniques. To improve the comparability and reproducibility of controlled human feeding studies examining the metabolome, it is important to provide detailed information about the dietary interventions being tested, including information about included or restricted foods, food groups, and meal plans provided. Strategies to control for individual variability, such as a crossover study design, statistical adjustment methods, dietary-controlled run-in periods, or providing standardized meals or test foods throughout the study should also be considered. The protocol for this review has been registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/DAHGS).

The Effectiveness of a Low Glycemic Index/Load Diet on Cardiometabolic, Glucometabolic, and Anthropometric Indices in Children with Overweight or Obesity: A Systematic Review and Meta-Analysis

(1) Background: This systematic review and meta-analysis aims to evaluate the impact of a low glycemic index (LGI) and low glycemic load (LGL) diet on children with overweight and obesity, analyzing any changes in anthropometric, cardiometabolic, and glucometabolic parameters. (2) Methods: Three electronic databases (PubMed, Scopus, CENTRAL), as well as clinical trial registries and reference lists of the included studies, were searched for eligible randomized control trials (RCTs). Two independent reviewers performed the screening of the studies, data extraction, and risk of bias assessment. Mean difference (MD) and 95% confidence intervals (CI) using a random effects model were calculated for each outcome. (3) Results: Eleven RCTs (n = 634) examining the effect of LGI diet versus control were identified. The synthesized data provided from the RCTs indicate no difference between intervention and control groups regarding primary outcomes (body weight (MD: -0.14; 95% CI -1.93 to 1.64, 5 trials), body mass index (BMI) (MD: -0.31; 95% CI -0.85 to 0.23, 6 trials), BMI z-score (MD: -0.03; 95% CI -0.09 to 0.02, 5 trials), and waist circumference (MD: -0.52; 95% CI -2.35 to 1.31, 5 trials)) and other measures of cardiometabolic and glucometabolic parameters. The majority of trials were classified as "some concerns". (4) Conclusions: LGI and LGL diets do not seem to be associated with changes in adiposity, cardiometabolic or glucometabolic markers in children with overweight or obesity. Further research comparing the LGI diet to a high glycemic index diet, with proper methodological standards, is required to clarify the benefits of a LGI diet in this population.

Impact of Pasta Intake on Body Weight and Body Composition: A Technical Review

Pasta is a staple carbohydrate across many cultures but has been implicated in overweight and obesity due to its position as a refined carbohydrate. Yet, the unique structure of pasta and its low glycemic response suggest it may contribute to a healthy body weight. The purpose of this review is to summarize the literature on the effects of pasta and dietary patterns high in pasta on body weight and body composition outcomes, and evaluate potential mechanisms by which pasta may influence body weight. A search of PubMed and CENTRAL identified 38 relevant studies examining pasta intake and body weight outcomes or potential mechanisms. Observational studies generally report no association or an inverse association of pasta intake with body weight/body composition outcomes. One clinical trial reported no difference in weight loss between a hypocaloric diet with high intake vs. low intake of pasta. Pasta may influence body weight via its low glycemic response, but evidence of effects on appetite, appetite-related hormones, and gastric emptying is limited and inconclusive. In conclusion, observational and limited clinical data suggest pasta is either inversely or not associated with overweight or obesity in healthy children and adults, and does not contribute to weight gain within the context of a healthy diet.

One-year nutrition counselling in the context of a Mediterranean diet reduced the dietary inflammatory index in women with breast cancer: a role for the dietary glycemic index

Background: the Mediterranean diet, the low dietary glycemic index (GI) and the dietary inflammation index (DII®) have been associated with lower risk of breast cancer (BC) incidence and mortality. Objective: to investigate whether one-year nutrition counselling in the context of a Mediterranean diet, with or without low-GI carbohydrates counselling, may influence the DII in women with BC. Methods: data were obtained from participants of DEDiCa trial randomized to a Mediterranean diet (MD, n = 112) or a Mediterranean diet with low-GI carbohydrates (MDLGI, n = 111). The diet-derived DII and GI were calculated from 7-day food records while Mediterranean diet adherence from PREDIMED questionnaire. Differences between study arms were evaluated through Fisher's exact test or Mann-Whitney test and associations with multivariable regression analyses. Results: Mediterranean diet adherence significantly increased by 15% in MD and 20% in MDLGI with no difference between arms (p < 0.326). Dietary GI significantly decreased from 55.5 to 52.4 in MD and 55.1 to 47.6 in MDLGI with significant difference between arms (p < 0.001). DII significantly decreased by 28% in MD and 49% in MDLGI with no difference between arms (p < 0.360). Adjusting for energy intake (E-DII) did not change the results. Higher Mediterranean diet adherence and lower dietary GI independently contributed to DII lowering (β-coefficient -0.203, p < 0.001; 0.046, p = 0.003, respectively). Conclusions: DII and E-DII scores decreased significantly after one-year with 4 nutrition counselling sessions on the Mediterranean diet and low GI. Increased adherence to the Mediterranean diet and low GI independently contributed to the DII changes. These results are relevant given that lowering the inflammatory potential of the diet may have implications in cancer prognosis and overall survival.

Acupuncture and related therapies for atopic eczema: A protocol for systematic review and network meta-analysis

BACKGROUND

Atopic eczema (AE) is a chronic relapsing dermatological disease characterized by pruritus, dryness, erythema, and lichenification. Acupuncture as an alternative treatment can relieve symptoms, reduce the recurrence, and improve the quality of life (QoL) with less adverse reactions in treating AE. This network meta-analysis (NMA) will comprehensively access the efficacy and safety of different acupuncture therapies for patients with AE, and rank the different acupuncture therapies, in order to present evidence-based medicine evidence for clinical application extensively.

METHOD AND ANALYSIS

This study will search 8 electronic databases from the establishment of the database to August 30th, 2022. The screening of literature, data extraction, and risk of bias assessment will be conducted by 2 researchers, respectively. The quality of evidence will be judged by the Grading of Recommendations Assessment, Development and Evaluation system. This NMA will be analyzed with Stata Version. 14.0 and WinBUGS Version.1.4.3.

RESULTS

This study will comprehensively access the efficacy and safety of different acupuncture therapies for patients with AE on the severity, itch intensity, emotional symptoms, QoL, and recurrence rate. Moreover, it will further identify which acupuncture therapy is the most effective.

CONCLUSION

The findings of this NMA may help patients and therapists choose the best acupuncture therapy in treating AE and furnish reliable evidence for guidelines.

REGISTRATION NUMBER

PROSPERO CRD42020203437.

Oral Chinese patent medicines for acute myocardial infarction after percutaneous coronary intervention: A protocol for systematic review and network meta-analysis

BACKGROUND

Acute myocardial infarction (AMI) is a serious and fatal heart disease with one of the highest mortality rates in the world. In some countries, percutaneous coronary intervention (PCI) is the preferred reperfusion strategy after AMI, but it cannot achieve safe and effective treatment of AMI after PCI remains a challenging clinical problem. The potential of oral Chinese patent medicines to treat AMI after PCI has been demonstrated, but which type of oral Chinese patent medicines may be preferred remains controversial. The aim of this network meta-analysis was to investigate the efficacy and safety of multiple oral Chinese patent medicines in the treatment of AMI after PCI.

METHODS

We will conduct a literature search from China National Knowledge Infrastructure, formerly Chinese Biomedical Database (SinoMed), Wanfang Data, Chongqing VIP, PubMed, Embase, Web of Science and Cochrane Library (The Cochrane Database of Systematic Reviews) from their inception until to November 1, 2022, with language restricted to Chinese and English. Then, the study selection process will follow the Preferred Reporting Items for Meta-Analyses guideline, and the quality assessment will be conducted with Cochrane Collaboration's tool. Pairwise and network meta-analysis will be conducted using the WinBUGS V.1.4.3.37 and STATA V.13. Additionally, sensitivity analysis, subgroup analysis, quality assessment, Small-study effects and publication bias will be performed.

ETHICS AND DISSEMINATION

This work is based on published research and therefore does not require ethical approval. This review will be published in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42020188065.

The Effect of the Addition of Low-Alkaloid Lupine Flour on the Glycemic Index In Vivo and the Physicochemical Properties and Cooking Quality of Durum Wheat Pasta

The aim of this research was to determine the effect of the addition of lupine flour (LF) on the values of the glycemic index (GI) and glycemic load (GL), physicochemical properties, and cooking quality of durum semolina pasta. The pasta was enriched with 0–25% of lupine flour (LF0-LF25). Additionally, 7.5 and 20% of oat β-glucans, 5% of vital gluten, and 20% of millet flour were used in a selected sample. The addition of 7.5% β-glucans and 5% vital gluten to the product resulted in only a slight decrease in the GI of the products. A significant decrease in pasta GI was noted after the addition of 20% of lupine flour. The product enriched with 20% of lupine flour, 20% of β-glucans, and 20% of millet flour had the lowest glycemic index and glycemic load (GI = 33.75%, GL = 7.2%, respectively). At the same time, the lupine-flour-enriched products were characterized by an increased concentration of protein, fat, ash, and dietary fiber. The addition of lupine flour at the level of up to 20% yielded functional products characterized by good cooking quality.

Potential use of banana peel (Musa cavendish) as ingredient for pasta and bakery products

The consumption of fruits and vegetables involves the disposal of the inedible parts, conveying challenges such as waste management and environment pollution. In recent years, there have been multiple studies aimed at finding alternatives that reduce the negative impact of food/agricultural waste. Since most studies done with by-products recommend their careful selection, the aim of this study was to verify if discarded banana peels could be disinfected until microbiologically safe and to determine if they could still provide nutrients to formulate food products with sensory characteristics acceptable to a consumer market after disinfection. Banana peels were collected from markets, restaurants, and greengrocers. They were disinfected, dried, and pulverized to obtain a flour which was subjected to microbiological and proximal analysis. Once its microbial safety was assured, this flour was incorporated into bakery and pasta products, replacing wheat flour with 5–20% banana peel flour (BPF). The sensory evaluation of the different products was carried out and, after verifying that the products were sensory acceptable, the proximal analysis was implemented. The formulated products were suitable for the addition of BPF up to 10%, in which the Acceptability Index was higher than 80% and significant increases in fiber and fat were achieved. We conclude that waste banana peel flour can be incorporated into bread and pasta products for human consumption to provide nutrients which might contribute to reduce this type of waste and to recover nutrients from otherwise disposed banana peels.

Comparative efficacy of Chinese herbal injections for treating severe pneumonia: A protocol for systematic review and Bayesian network meta-analysis of randomized controlled trials

Background

Severe pneumonia (SP) has a high mortality and is responsible for significant healthcare cost. Chinese herbal injections (CHIs) have been widely used in China as a novel and promising treatment option for SP. Therefore, this study will assess and rank the effectiveness of CHIs to provide more sights for the selection of SP treatment.

Method

Seven databases will be searched, including PubMed, the Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, and the Chinese Scientific Journal Database (VIP) from their inception up to October, 2021. The literatures screening, data extraction and the quality assessment of included studies will be conducted independently by two reviewers. Then Bayesian network meta-analysis (NMA) will be performed by WinBUGS 14.0 and STATA 14.0 software. Surface under the cumulative ranking curve (SUCRA) probability values will be applied to rank the examined treatments. The risk of bias of each included study will be evaluated using the Revised Cochrane risk-of-bias tool for randomized trials (ROB 2). Publication bias will be reflected by a funnel plot.

Results

The results of this NMA will be disseminated through a peer-reviewed journal publication.

Conclusion

Our study findings maybe reveal which CHI or CHIs will be better in the treatment of SP and provide more therapy strategies for clinical practitioners and patients.

PROSPERO registration number

CRD42021244587.

Strengths and limitations of this study

Bayesian network meta-analysis (NMA) can integrate direct evidence with indirect evidence of severe pneumonia treated by Chinese herbal injections to generate a clinically useful ranking of these regimens.

This NMA will address Chinese herbal injections for SP and its findings may help to provide more sights for selection of SP treatment.

Evidence drawn from an NMA is limited and should be interpreted with caution.

We only included studies in Chinese and English languages, which may increase the publication bias.

Impact of food processing on postprandial glycaemic and appetite responses in healthy adults: a randomized, controlled trial

Chickpeas are among the lowest glycaemic index carbohydrate foods eliciting protracted digestion and enhanced satiety responses. In vitro studies suggest that mechanical processing of chickpeas significantly increases starch digestion. However, there is little evidence regarding the impact of processing on postprandial glycaemic response in response to chickpea intake in vivo. Therefore, the aim of this study was to determine the effect of mechanical processing on postprandial interstitial glycaemic and satiety responses in humans. In a randomised crossover design, thirteen normoglycaemic adults attended 4 separate laboratory visits following an overnight fast. On each occasion, one of four test meals, matched for available carbohydrate content and consisting of different physical forms of chickpeas (whole, puree, and pasta) or control (mashed potato), was administered followed by a subsequent standardised lunch meal. Continuous glucose monitoring captured interstitial glucose responses, accompanied by periodic venous blood samples for retrospective analysis of C-peptide, glucagon like peptide-1 (GLP-1), ghrelin, leptin, resistin, and cortisol. Subjective appetite responses were measured by Visual Analogue Scale (VAS). Postprandial glycaemic responses were comparable between chickpea treatments albeit significantly lower than the control (p < 0.001). Similarly, all chickpea treatments elicited significantly lower C-peptide and GLP-1 responses compared to the control (p < 0.05), accompanied by enhanced subjective satiety responses (p < 0.05), whilst no significant differences in satiety hormones were detected among different intervention groups (p > 0.05). Chickpea consumption elicits low postprandial glycaemic responses and enhanced subjective satiety responses irrespective of processing methods.

Pasta-Making Process: A Narrative Review on the Relation between Process Variables and Pasta Quality

Pasta is an increasingly popular food worldwide and different formulations have been developed to improve its nutritional profile. Semolina that is high both in protein and gluten content is recognized as the ideal raw material to produce conventional dry pasta. When alternative raw materials are used, an understanding of the relationship between processing variables and pasta quality is crucial in order to optimize the redesign of the production process. This review aims to: (1) investigate the main challenges of the pasta-making process, highlighting the processing variables that most affect pasta quality; and (2) indicate the unknown factors that influence the pasta-making process and which need to be studied. After overviewing the last twenty years of research in the pasta sector, the interplay/relationship between processing variables and pasta quality is examined, together with the main innovations proposed for each step of pasta processing. An analysis of all the variables involved in the process and their influence on each other will elucidate how to optimize certain parameters to ensure the production of pasta with the desired characteristics.

Low-Glycemic Index Diets as an Intervention in Metabolic Diseases: A Systematic Review and Meta-Analysis

We aimed to investigate the effects of a low-glycemic index (GI) diet on the body mass and blood glucose of patients with four common metabolic diseases by conducting a systematic review and meta-analysis of studies comparing a low-GI diet (LGID) and other types of diet. Search terms relating to population, intervention, comparator, outcomes, and study design were used to search three databases: PubMed, Embase, and the Cochrane Library. We identified 24 studies involving 2002 participants. Random-effects models were used for 16 studies in the meta-analysis and stratified analyses were performed according to the duration of the intervention. The systematic review showed that LGIDs slightly reduced body mass and body mass index (BMI) (p < 0.05). BMI improved more substantially after interventions of >24 weeks and there was no inter-study heterogeneity (I² = 0%, p = 0.48; mean difference (MD) = -2.02, 95% confidence interval (CI): -3.05, -0.98). Overall, an LGID had superior effects to a control diet on fasting blood glucose (FBG) and glycosylated hemoglobin. When the intervention exceeded 30 days, an LGID reduced FBG more substantially (MD = -0.34, 95% CI: -0.55, -0.12). Thus, for patients with metabolic diseases, an LGID is more effective at controlling body mass and blood glucose than a high-GI or other diet.

Development of Novel Pasta Products with Evidence Based Impacts on Health-A Review

Pasta made from durum wheat is a widely consumed worldwide and is a healthy and convenient food. In the last two decades, there has been much research effort into improving the nutritional value of pasta by inclusion of nonconventional ingredients due to the demand by health-conscious consumers for functional foods. These ingredients can affect the technological properties of the pasta, but their health impacts are not always measured rather inferred. This review provides an overview of pasta made from durum wheat where the semolina is substituted in part with a range of ingredients (barley fractions, dietary fibre sources, fish ingredients, herbs, inulin, resistant starches, legumes, vegetables and protein extracts). Impacts on pasta technological properties and in vitro measures of phytonutrient enhancement or changes to starch digestion are included. Emphasis is on the literature that provides clinical or animal trial data on the health benefits of the functional pasta.

Nonsurgical weight loss interventions: A systematic review of systematic reviews and meta-analyses

Access to bariatric surgery to treat obesity is limited and has long wait times. Many adults are seeking nonsurgical weight loss support. Our study objective was to conduct a systematic review of nonsurgical weight loss interventions. PubMed, EMBASE, CINAHL, PsycInfo, and the CochraneLibrary were searched. Inclusion criteria were adults 18 + with a BMI > 25 enrolled in minimum a 3-month nonsurgical weight loss intervention. Studies were independently extracted and assessed for quality using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR2). Pooled analyses were extracted, graded for evidence quality, and summarized. A total of 1065 studies were assessed for eligibility; 815 screened and 236 full-texts assessed. Sixty-four meta-analyses met eligibility criteria: 1180 RCTs with 184,605 study participants. Studies were categorized as diets (n = 13), combination therapies (n = 10), alternative (n = 16), technology (n = 10), behavioral (n = 5), physical activity (n = 6), and pharmacotherapy (n = 3). In 80% of studies, significant weight losses were reported ranging from 0.34-8.73 k in favor of the intervention. The most effective nonsurgical weight loss interventions were diets, either low-carbohydrate or low-fat diets, followed for 6 months; combination therapy including meal replacements plus enhanced support; and pharmacotherapy followed for 12 months. Although significant weight losses were reported for other types of interventions such as physical activity and technology, the majority of studies reported weight losses less than 2 kgs.

Pasta Structure Affects Mastication, Bolus Properties, and Postprandial Glucose and Insulin Metabolism in Healthy Adults

Background

Structure and protein–starch interactions in pasta products can be responsible for lower postprandial glycemic responses compared with other cereal foods.

Objectives

We tested the effect on postprandial glucose metabolism induced by 2 pasta products, couscous, and bread, through their structural changes during mastication and simulated gastric digestion.

Methods

Two randomized controlled trials (n = 30/trial) in healthy, normal-weight adults (mean BMI of 23.9 kg/m² (study 1) and 23.0 kg/m² (study 2)) evaluated postprandial glucose metabolism modulation to portions of durum wheat semolina spaghetti, penne, couscous, and bread each containing 50 g available carbohydrate. A mastication trial involving 26 normal-weight adults was conducted to investigate mastication processes and changes in particle size distribution and microstructure (light microscopy) of boluses after mastication and in vitro gastric digestion.

Results

Both pasta products resulted in lower areas under the 2-h curve for blood glucose (−40% for spaghetti and −22% for penne compared with couscous; −41% for spaghetti and −30% for penne compared with bread), compared with the other grain products (P < 0.05). Pasta products required more chews (spaghetti: 34 ± 18; penne: 38 ± 20; bread: 27 ± 13; couscous: 24 ± 17) and longer oral processing (spaghetti: 21 ± 13 s; penne: 23 ± 14 s; bread: 18 ± 9 s; couscous: 14 ± 10 s) compared with bread or couscous (P < 0.01). Pastas contained more large particles (46–67% of total particle area) compared with bread (0–30%) and couscous (1%) after mastication and in vitro gastric digestion. After in vitro gastric digestion, pasta samples still contained large areas of nonhydrolyzed starch embedded within the protein network; the protein in bread and couscous was almost entirely digested, and the starch was hydrolyzed.

Conclusions

Preservation of the pasta structure during mastication and gastric digestion explains slower starch hydrolysis and, consequently, lower postprandial glycemia compared with bread or couscous prepared from the same durum wheat semolina flour in healthy adults.

The postprandial in vivo trials were registered at clinicaltrials.gov as NCT03098017 and NCT03104686.

In Vivo and In Vitro Starch Digestibility of Fresh Pasta Produced Using Semolina-Based or Wholemeal Semolina-Based Liquid Sourdough

The use of wholemeal flour and sourdough fermentation in different food matrices has received considerable attention in recent years due to its resulting health benefits. In this study, a semolina-based and a wholemeal semolina-based sourdough were prepared and added to the formulation of gnocchetti-type fresh pasta. Four types of gnocchetti were made, using semolina plus semolina-based sourdough (SS), semolina plus wholemeal semolina-based sourdough (SWS), semolina alone (S), and semolina plus wholemeal semolina (WS). The latter two were used as controls. The digestibility of starch was studied both in vitro and in vivo, and the glycemic response (GR) and glycemic load (GL) were determined. Starch digestibility, both in vivo and in vitro, was higher in wholemeal semolina than semolina pasta and the resulting GR values (mg dL⁻¹ min⁻¹) were also higher (2209 and 2277 for WS and SWS; 1584 and 1553 for S and SS, respectively). The use of sourdough significantly reduced the rapidly digestible starch (RDS) content and increased the inaccessible digestible starch (IDS) content. The addition of sourdough to the formulation had no effect on the GR values, but led to a reduction of the GL of the pasta. These are the first data on the GR and GL of fresh pasta made with sourdough.

Benefits of Low Carbohydrate Diets: a Settled Question or Still Controversial?

PURPOSE OF REVIEW

The purpose of this review was to provide an update on the available data on the benefits of low-carbohydrate (low-carb) diets for weight management and type 2 diabetes (T2DM) and determine if low-carb diets were a settled question or still controversial.

RECENT FINDINGS

Most of the recent published literature in this area consists of reviews of past trials, with a relatively smaller number of recent trials. Low-carb is most commonly compared to low-fat, with problematically inconsistent definitions of both. There are numerous challenges in trying to draw clear conclusions about efficacy and effectiveness. Short-term vs. long-term effects can differ, which is likely impacted by adherence. Adherence is very different between metabolic chamber or feeding studies vs. free-living. Body weight alone is a crude measure that fails to capture potentially important differences in lean-mass, fat-mass, and body water. Benefits for glycemic control need to be balanced with impacts on non-glycemic outcomes such as LDL-cholesterol, the microbiome, and inflammation. It is important to differentiate between low-carb and very-low carbohydrate diets (VLCD). To date no large-scale long-term clinical trials have been conducted testing whether low-carb diets can prevent T2DM. Many issues regarding benefits and risks of low-carb diets remain controversial or unresolved, particularly for VLCD. Some of the recent, better studies highlighted in this review suggest strategies for resolving these controversies.

Pasta meal intake in relation to risks of type 2 diabetes and atherosclerotic cardiovascular disease in postmenopausal women : findings from the Women's Health Initiative

OBJECTIVE

To evaluate the association between pasta meal intake and long-term risk of developing diabetes or atherosclerotic cardiovascular disease (ASCVD, including coronary heart disease (CHD) and stroke) in postmenopausal women.

DESIGN

Prospective cohort study.

SETTING

Women's Health Initiative (WHI) in the USA.

PARTICIPANTS

84 555 postmenopausal women aged 50-79 in 1994, who were free of diabetes, ASCVD and cancer at baseline who were not in the dietary modification trial of the WHI, completed a validated food frequency questionnaire, and were evaluated for incident diabetes and ASCVD outcomes during the follow-up until 2010.

MAIN OUTCOME MEASURE

Diabetes and ASCVD.

RESULTS

Cox proportional hazards models were used to estimate the association (HR) between quartiles of pasta meal consumption (residuals after adjusting for total energy) and the risk of incidence diabetes, CHD, stroke or ASCVD, accounting for potential confounding factors, with testing for linear trend. We then statistically evaluated the effect of substituting white bread or fried potato for pasta meal on disease risk. When comparing the highest to the lowest quartiles of residual pasta meal intake, we observed significantly reduced risk of ASCVD (HR=0.89, 95% CI 0.83 to 0.96, p trend=0.002), stroke (HR=0.84, 95% CI 0.75 to 0.93, p trend=0.001), CHD (HR=0.91, 95% CI 0.83 to 1.00, p trend=0.058) and no significant alteration in diabetes risk (HR=1.02, 95% CI 0.96 to 1.07, p trend=0.328). Replacing white bread or fried potato with pasta meal was statistically associated with decreased risk of stroke and ASCVD.

CONCLUSIONS

Pasta meal intake did not have adverse effects on long-term diabetes risk and may be associated with significant reduced risk of stroke and ASCVD. The potential benefit of substituting pasta meal for other commonly consumed starchy foods on cardiometabolic outcomes warrants further investigation in additional high-quality and large prospective studies of diverse populations.

Traditional and Non-Conventional Pasta-Making Processes: Effect on In Vitro Starch Digestibility

Pasta is a carbohydrate-rich food with a low glycemic index (GI) and is one of the main sources of slowly digestible starch (SDS). The presence of bran fractions (BFs) in pasta may enhance its health potential, owing to the content of fiber, micronutrients, and bioactive compounds; however, at the same time, BF may affect starch digestibility. In this study, the bioaccessibility of starch in pasta made with BF-enriched semolina (BF pasta), or only with micronized debranned kernel (DK pasta), and a control pasta made with traditional semolina was evaluated by applying two different in vitro models. The control pasta showed a percentage of SDS about four-fold higher than that of the BF pasta and 1.5-fold higher than that of the DK pasta (p < 0.05). The amount of starch released during simulated gastrointestinal digestion was slightly lower, but not significantly different, for the control pasta than for both the BF and DK pasta. These results suggest that the presence of a higher amount of dietary fiber in BF pasta can affect the structure of the food matrix, interfering with the formation of the gluten network, water absorption, and starch granule accessibility, while micronization could enhance starch digestibility due to starch gelatinization. These findings emphasize the need to optimize the process for producing fiber-rich pasta without affecting its low starch digestibility and, consequently, its GI.

Determinants of US University Students' Willingness to Include Whole Grain Pasta in Their Diet

College students’ lifestyle and eating habits strongly affect their health. Among many healthy eating behaviors, including whole grain food in the diet is known as providing health benefits such as maintaining a steady blood sugar, lower cholesterol, and since it is rich in fiber and minerals, it is essential for the well-being. However, consumers’ intakes of whole grain products remain below recommendation, including college students. This study aims to evaluate determinant factors contributing to college students’ willingness to include whole grain pasta in their diets. A sample of 499 students enrolled in a US college participated in this study. Most students perceived whole grain pasta as healthy and filling and somewhat tasty. Availability and price were not barriers for consumption. Logistic regression results suggested that factors affecting students’ willingness to consume whole grain pasta in the future were the desire to eat, cognitive and affective attitudes, perception of whole grain pasta, as well as having already chosen pasta thanks to its availability at the dining. Two student segments were identified according to their healthy eating perception: Uninvolved and Health-conscious. Cognitive attitudes such as beneficial and essential had positive effects on consumption in both segments, suggesting that information provision covering specific health/nutritional benefits of whole grains for students is crucial.

Can a different pasta making process preserve the starch’s ultrastructure, increasing its digestibility?

BACKGROUND: Pasta plays an important role in human nutrition, nevertheless its organoleptic, structural and bromatologic properties have not been completely studied. OBJECTIVE: The study aims to compare the ultrastructure pasta cross-sections produced with reduced mechanic stress and low heat exposure technique (Pietro Massi Technology ™) to common samples obtained with traditional technology in order to assess if a different process can alter the ultrastructure of starch and then, its digestibility. METHODS: A comparative study was performed on the ultrastructure of pasta using scanning electron microscopy (S.E.M). 55 were pasta cross-sections made with Pietro Massi technology, 33 were samples from different pasta factory produced using traditional process, for a total of 88 samples analysed. RESULTS: According to an Index based on what it was observed at one slide at S.E.M we classified samples and compared the number of grains, caves and canals visible, their dimensions in μm and average size of grains. The number of grains in group 1 (9.06±5.01) in group 2 (5.71±5.77), in group 3 (5.93±7.65) resulted significative more elevated compared to group 4 (0.73±2.58); in group 1 and group 2 the number of caves observed was higher than group 4. The size in μm of canals resulted significantly more elevated in group 1 than group 3 (p = 0.008), group 2(p = 0.013), and group 4 (p = 0.02). CONCLUSION: The analysis of average size of caves and canals in μm, the number of caves and grains demonstrated in samples obtained with Massi technology elevated values compared to samples obtained with traditional technique. The number of caves, grains and canals visible in the starch surface demonstrate the high quality of this pasta because they likely ensure penetration of water during cooking, facilitating at the same time the penetration of pancreatic amylases during digestion, suggesting a better digestibility in pasta produced according to this methodology.

The importance of glycemic index on post-prandial glycaemia in the context of mixed meals: A randomized controlled trial on pasta and rice

BACKGROUND AND AIMS

Post-prandial glycemic response (PPGR) depends on the intrinsic characteristic of the carbohydrate-rich foods as well as on the amount and type of other nutrients. This study aimed to explore whether the addition of condiments can affect the difference in PPGR between a low and a medium-high Glycemic Index (GI) food.

METHODS AND RESULTS

Spaghetti (S) and rice ® were consumed plain and after adding tomato sauce and extra virgin olive oil (TEVOO), or pesto sauce (P). The GI of R (63 ± 3) was statistically higher than that of S (44 ± 7) (p = 0.003). The Incremental Area Under the Curve (IAUC) for R was significantly greater than S (124.2 ± 12.1 and 82.1 ± 12.9 mmol∗min/L respectively) (p = 0.016) for blood glucose but not for insulin (1192.6 ± 183.6 and 905.2 ± 208.9 mU∗min/L, respectively) (p = 0.076). There were no significant differences after the addition of either TEVOO or P. The postprandial peaks of blood glucose and insulin for R (6.7 ± 0.3 mmol/L and 36.4 ± 4.9 mU/L, respectively) were significantly higher compared to S (6.0 ± 0.2 mmol/L and 26.7 ± 3.6 mU/L, respectively) (p = 0.033 and p = 0.025). The postprandial peak for insulin remained significantly higher with P (36.8 ± 3.7 and 28.6 ± 2.9 mU/L for R + P and S + P, p = 0.045) but not with EVOO (p = 0.963). Postprandial peaks for blood glucose were not significantly different with condiment.

CONCLUSIONS

The differences in PPGR were significant between spaghetti and rice consumed plain, they reduced or disappeared with fat adding, depending on the type of condiment used. REGISTRATION NUMBER: (www.clinicaltrial.gov):NCT03104712.

Low-carbohydrate diets and cardiometabolic health: the importance of carbohydrate quality over quantity

Carbohydrates are increasingly being implicated in the epidemics of obesity, diabetes, and their downstream cardiometabolic diseases. The "carbohydrate-insulin model" has been proposed to explain this role of carbohydrates. It posits that a high intake of carbohydrate induces endocrine deregulation marked by hyperinsulinemia, leading to energy partitioning with increased storage of energy in adipose tissue resulting in adaptive increases in food intake and decreases in energy expenditure. Whether all carbohydrate foods under real-world feeding conditions directly contribute to weight gain and its complications or whether this model can explain these clinical phenomena requires close inspection. The aim of this review is to assess the evidence for the role of carbohydrate quantity vs quality in cardiometabolic health. Although the clinical investigations of the "carbohydrate-insulin model" have shown the requisite decreases in insulin secretion and increases in fat oxidation, there has been a failure to achieve the expected fat loss under low-carbohydrate feeding. Systematic reviews with pairwise and network meta-analyses of the best available evidence have failed to show the superiority of low-carbohydrate diets on long-term clinical weight loss outcomes or that all sources of carbohydrate behave equally. High-carbohydrate diets that emphasize foods containing important nutrients and substances, including high-quality carbohydrate such as whole grains (especially oats and barley), pulses, or fruit; low glycemic index and load; or high fiber (especially viscous fiber sources) decrease intermediate cardiometabolic risk factors in randomized trials and are associated with weight loss and decreased incidence of diabetes, cardiovascular disease, and cardiovascular mortality in prospective cohort studies. The evidence for sugars as a marker of carbohydrate quality appears to be highly dependent on energy control (comparator) and food source (matrix), with sugar-sweetened beverages providing excess energy showing evidence of harm, and with high-quality carbohydrate food sources containing sugars such as fruit, 100% fruit juice, yogurt, and breakfast cereals showing evidence of benefit in energy-matched substitutions for refined starches (low-quality carbohydrate food sources). These data reflect the current shift in dietary guidance that allows for flexibility in the proportion of macronutrients (including carbohydrates) in the diet, with a focus on quality over quantity and dietary patterns over single nutrients.

Comparison of effects of different dietary interventions on cognitive function in Alzheimer's disease: protocol for systematic review and network meta-analysis

INTRODUCTION

Alzheimer's disease (AD) is the most common neurodegenerative disease and is characterised by cognitive impairment. Non-pharmacological treatments such as diet therapy have been widely investigated in studies on AD. Given the synergistic effects of nutrients present in foods, considering overall dietary composition rather than focusing on a single nutrient may be more useful for evaluating the relationship between diet and AD cognition. The present study aimed to assess the efficacy of different dietary interventions (eg, ketogenic and Mediterranean diets) on cognitive function in patients with AD in a systematic review and pairwise and network meta-analyses of randomised controlled trials or clinical trials.

METHODS AND ANALYSIS

Two reviewers will independently conduct searches of PubMed, Cochrane Central Register of Controlled Trials, Embase, CINAHL, PsycINFO and China National Knowledge Infrastructure databases. Data will be extracted from selected studies and risk of bias will be assessed using the revised Cochrane risk-of-bias tool, and evidence quality will be assessed according to the Grading of Recommendations, Assessment, Development and Evaluation framework. The primary outcome of interest is cognitive function in patients with AD; secondary outcomes include biochemical biomarkers of AD and oxidative stress and/or inflammatory biomarkers in cerebrospinal fluid or plasma. For each outcome, random-effects pairwise and network meta-analyses will be carried out to determine the pooled relative effect of each intervention relative to every other intervention.

ETHICS AND DISSEMINATION

As this study is based solely on published literature, no ethics approval is required. The research will be published in a peer-reviewed journal.

Nutritional Quality of Pasta Sold on the Italian Market: The Food Labelling of Italian Products (FLIP) Study

Pasta represents a staple food in many populations and, in recent years, an increasing number of pasta items has been placed on the market to satisfy needs and trends. The aims of this work were: (i) to investigate the nutritional composition of the different types of pasta currently sold in Italy by collecting the nutrition facts on their packaging; (ii) to compare energy, nutrient and salt content per 100 g and serving in fresh and dried pasta; (iii) to compare the nutrition declaration in pairs of products with and without different declarations (i.e., gluten free (GF), organic, and nutrition claims (NC)). A total of 756 items, made available by 13 retailers present on the Italian market, were included in the analysis. Data showed a wide difference between dried and fresh pasta, with high inter-type variability. A negligible amount of salt was observed in all types of pasta, except for stuffed products, which had a median high quantity of salt (>1 g/100 g and ~1.5 g/serving). Organic pasta had higher fibre and lower protein contents compared to conventional pasta. GF products were higher in carbohydrate and fat but lower in fibre and protein than not-GF products, while only a higher fibre content was found in pasta with NC compared to products not boasting claims. Overall, the results show high variability in terms of nutrition composition among the pasta items currently on the market, supporting the importance of reading and understanding food labels for making informed food choices.

Durum Wheat Grain Yield and Quality under Low and High Nitrogen Conditions: Insights into Natural Variation in Low- and High-Yielding Genotypes

The availability and management of N are major determinants of crop productivity, but N excessive use has an associated agro-ecosystems environmental impact. The aim of this work was to investigate the influence of N fertilization on yield and grain quality of 6 durum wheat genotypes, selected from 20 genotypes as high- and low-yielding genotypes. Two N levels were applied from anthesis to maturity: high (½ Hoagland nutrient solution) and low (modified ½ Hoagland with one-third of N). Together with the agronomic characterization, grain quality analyses were assessed to characterize carbohydrates concentration, mineral composition, glutenin and gliadin concentrations, polyphenol profile, and anti-radical activity. Nitrogen supply improved wheat grain yield with no effect on thousand-grain weight. Grain soluble sugars and gluten fractions were increased, but starch concentration was reduced, under high N. Mineral composition and polyphenol concentrations were also improved by N application. High-yielding genotypes had higher grain carbohydrates concentrations, while higher concentrations in grain minerals, gluten fractions, and polyphenols were recorded in the low-yielding ones. Decreasing the amount of N to one-third ensured a better N use efficiency but reduced durum wheat agronomic and quality traits.

Importance of functional food compounds in cardioprotection through action on the epigenome

Food constituents can either promote cardiovascular health or serve in its demise. In view of the lack of more effective pharmacological interventions in cardiovascular disease (CVDs), attention has focused on the potential protective effects of diet. Food components and their metabolites are emerging as major regulators of the human epigenome, which is being linked to CVDs. In this review, we summarize data from studies that suggest an important role for bioactive food compounds in cardioprotection and the potential for harnessing the epigenome as a nutrient sensor target in CVDs. While clinical data strongly support a role for effective diet intervention in CVDs protection, studies linking changes to human epigenome are now warranted for mechanistic insight and development of personalized care.

Effect of cooking, 24 h cold storage, microwave reheating, and particle size on in vitro starch digestibility of dry and fresh pasta

The aim of this study was to investigate the effect of preparation method and particle size on digestion of starch in fresh and dry pasta types. Pasta samples were boiled, refrigerated and re-heated, with samples collected after each stage, and then prepared as small (2 mm) and large (5 mm) particles for subsequent starch digestibility testing and logarithm of slope analyses. There were significant main effects of particle size (F_1,24 = 568.895, p < 0.001, η_p² = 0.960) and processing treatment (F_2,24 = 19.897, p < 0.001 η_p² = 0.624) on starch digestibility overall, however the main effect of pasta type was not significant at the p < 0.05 level (F_1,24 = 2.978, p = 0.097, η_p² = 0.110). Particle size had the largest effect on digestibility, and the extent of starch digestion was at least 50% lower in samples prepared as large particles compared with small particles. The most digestible sample was the boiled fresh-type pasta prepared as small particles (C_∞ = 57.9%) and cold storage alone and/or with subsequent re-heating significantly reduced the extent of digestion in this sample to ∼40.6%. In the dry pasta type, processing treatment had no significant effects on starch digestibility. The rate constant, k, was not significantly altered by processing treatment or pasta type (k = 0.0275 min^-1, mean of all samples). These findings suggest that cold-storage and re-heating treatments have limited potential to impact on glycaemic responses and highlight the importance of masticated particle size as a potential rate-limiting factor in digestibility studies.

Body weight of individuals with obesity decreases after a 6-month high pasta or low pasta Mediterranean diet weight-loss intervention

BACKGROUND & AIMS

The effect of pasta consumption within a low-energy Mediterranean diet on body weight regulation has been scarcely explored. This paper investigates the effect of two Mediterranean diets, which differed for lower or higher pasta intake, on body weight change in individuals with obesity.

METHODS & RESULTS

Forty-nine volunteers finished a quasi-experimental 6-month two-parallel group dietary intervention. Participants were assigned to a low-energy high pasta (HP) or to a low-energy low Pasta (LP) group on the basis of their pasta intake (HP ≥ 5 or LP ≤ 3 times/week). Anthropometrics, blood pressure and heart rate were measured every month. Weight maintenance was checked at month 12. Body composition (bioelectrical impedance analysis, BIA), food intake (24-h recall plus a 7-day carbohydrate record) and the perceived quality of life (36-item short-form health survey, SF-36) were assessed at baseline, 3 and 6 months. Blood samples were collected at baseline and month 6 to assess glucose and lipid metabolism. After 6-month intervention, body weight reduction was -10 ± 8% and -7 ± 4% in HP and LP diet, respectively, and it remained similar at month 12. Both dietary interventions improved anthropometric parameters, body composition, glucose and lipid metabolism, but no significant differences were observed between treatment groups. No differences were observed for blood pressure and heart rate between treatments and among times. HP diet significantly improved perception of quality of life for the physical component.

CONCLUSIONS

Independent of pasta consumption frequency, low-energy Mediterranean diets were successful in improving anthropometrics, physiological parameters and dietary habits after a 6-month weight-loss intervention. This trial was registered at clinicaltrials.gov as NCT03341650.

Can Manipulation of Durum Wheat Amylose Content Reduce the Glycaemic Index of Spaghetti?

Resistant starch (RS) in foods has positive benefits for potentially alleviating lifestyle diseases. RS is correlated positively with starch amylose content. This study aimed to see what level of amylose in durum wheat is needed to lower pasta GI. The silencing of starch synthases IIa (SSIIa) and starch branching enzymes IIa (SBEIIa), key genes involved in starch biosynthesis, in durum wheat cultivar Svevo was performed and spaghetti was prepared and evaluated. The SSIIa and SBEIIa mutants have a 28% and 74% increase in amylose and a 2.8- and 35-fold increase in RS, respectively. Cooked pasta was softer, with higher cooking loss but lower stickiness compared to Svevo spaghetti, and with acceptable appearance and colour. In vitro starch digestion extent (area under the digestion curve) was decreased in both mutants, but much more in SBEIIa, while in vivo GI was only significantly reduced from 50 to 38 in SBEIIa. This is the first study of the glycaemic response of spaghetti prepared from SBEIIa and SSIIa durum wheat mutants. Overall pasta quality was acceptable in both mutants but the SBEIIa mutation provides a clear glycaemic benefit and would be much more appealing than wholemeal spaghetti. We suggest a minimum RS content in spaghetti of ~7% is needed to lower GI which corresponded to an amylose content of ~58%.

Pasta Consumption and Connected Dietary Habits: Associations with Glucose Control, Adiposity Measures, and Cardiovascular Risk Factors in People with Type 2 Diabetes-TOSCA.IT Study

BACKGROUND

Pasta is a refined carbohydrate with a low glycemic index. Whether pasta shares the metabolic advantages of other low glycemic index foods has not really been investigated. The aim of this study is to document, in people with type-2 diabetes, the consumption of pasta, the connected dietary habits, and the association with glucose control, measures of adiposity, and major cardiovascular risk factors.

METHODS

We studied 2562 participants. The dietary habits were assessed with the European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire. Sex-specific quartiles of pasta consumption were created in order to explore the study aims.

RESULTS

A higher pasta consumption was associated with a lower intake of proteins, total and saturated fat, cholesterol, added sugar, and fiber. Glucose control, body mass index, prevalence of obesity, and visceral obesity were not significantly different across the quartiles of pasta intake. No relation was found with LDL cholesterol and triglycerides, but there was an inverse relation with HDL-cholesterol. Systolic blood pressure increased with pasta consumption; but this relation was not confirmed after correction for confounders.

CONCLUSIONS

In people with type-2 diabetes, the consumption of pasta, within the limits recommended for total carbohydrates intake, is not associated with worsening of glucose control, measures of adiposity, and major cardiovascular risk factors.

Dietary modifications for weight loss and weight loss maintenance

Worldwide obesity rates remain at a rise, and to treat obesity is at the top of the global public health agenda. In 2013, the AHA/ACC/TOS obesity management guidelines were published, in essence suggesting that any dietary scheme seems to be effective for weight loss, as long as it can induce a sustainable energy deficit. In the present review, we update and critically discuss available information regarding dietary modifications for weight loss and weight loss maintenance, published after the 2013 guidelines. Regarding weight loss, we found no proof to support that a single dietary scheme, be it nutrient-, food group- or dietary pattern- based, is more efficacious of the other for achieving weight loss. For weight loss maintenance, published interventions point towards the same direction, although inconclusively. Most research explores the effect of weight loss regimes on weight loss maintenance and not the effect of the diet during weight loss maintenance, and this literature gap should be more thoroughly investigated.

Positioning the Value of Dietary Carbohydrate, Carbohydrate Quality, Glycemic Index, and GI Labelling to the Canadian Consumer for Improving Dietary Patterns

The objectives of this qualitative study was to: (1) understand Canadian consumers’ knowledge and perception of dietary carbohydrates, carbohydrate quality, and the glycemic index (GI); and (2) determine Canadian’s receptiveness to GI labelling to assist with identifying and consuming foods of higher carbohydrate quality. Focus groups were recruited in Vancouver, Toronto, and Montreal and grouped according to body mass index (BMI) (NBW, normal body weight; PO, previously obese; and OW/OB, overweight/obese) and diagnosis with prediabetes and diabetes (PO (Vancouver) and OW/OB (Montreal and Toronto). Subjects in all groups linked excess consumption of carbohydrate with weight gain. PO and OW/OB groups were conflicted between perceived negative consequences and feelings of pleasure associated with carbohydrate consumption. Subjects were largely unfamiliar with the term ‘carbohydrate quality’, but were often associated with classifying carbohydrates as ‘good’ or ‘bad’. The concept of the GI resonated well across groups after exposure to corresponding educational materials. However, NBW groups largely felt that the GI was irrelevant to their dietary choices as they did not have a history of diabetes. PO and OW/OB groups associated the GI with diabetes management. The concept of a GI labelling program to help facilitate healthier carbohydrate choices was well received across all groups, especially when the low GI was interpreted as giving permission to consume foods they enjoyed eating. Results suggest that the GI could be used as a consumer-facing labelling program in Canada and assist with de-stigmatizing carbohydrate foods by helping to facilitate the consumption of carbohydrate foods that align with healthy dietary patterns.

A Short Study Exploring the Effect of the Glycaemic Index of the Diet on Energy intake and Salivary Steroid Hormones

Background: The glycaemic index or load (GI or GL) is a concept for ranking carbohydrate-rich foods based on the postprandial blood glucose response compared with a reference food (glucose). Due to the limited research investigating the effect of the GI or GL of the diet on salivary steroidal hormones, this explorative short study was conducted. Methods: 12 female participants consumed a low GI and a high GI diet for three days each, followed by a washout period between each intervention. Saliva was collected at baseline, and following the low or high GI diets. Cortisol and testosterone concentrations were measured by enzyme-linked immuno-sorbent assay (ELISA). Results: GI and GL were significantly different between the low and high GI diets (p < 0.001). There was a small but significant increase in salivary cortisol after the high GI diet (7.38 to 10.93 ng/mL, p = 0.036). No effect was observed after the low GI diet. Higher levels of testosterone were produced after the low GI diet (83.7 to 125.9 pg/mL, p = 0.002), and no effect was found after the high GI diet. The total intake of calories consumed on the low GI diet was significantly lower compared to the high GI diet (p = 0.019). Conclusions: A low GI diet was associated with a small but significant increase in salivary testosterone, while a high GI diet increased cortisol levels. Altering the GI of the diet may influence overall energy intake and the health and wellbeing of female volunteers.