The Effect of a Breakfast Rich in Slowly Digestible Starch on Glucose Metabolism: A Statistical Meta-Analysis of Randomized Controlled Trials

Designing healthier and more sustainable ultraprocessed foods

The food industry has been extremely successful in creating a broad range of delicious, affordable, convenient, and safe food and beverage products. However, many of these products are considered to be ultraprocessed foods (UPFs) that contain ingredients and are processed in a manner that may cause adverse health effects. This review article introduces the concept of UPFs and briefly discusses food products that fall into this category, including beverages, baked goods, snacks, confectionary, prepared meals, dressings, sauces, spreads, and processed meat and meat analogs. It then discusses correlations between consumption levels of UPFs and diet-related chronic diseases, such as obesity and diabetes. The different reasons for the proposed ability of UPFs to increase the risk of these chronic diseases are then critically assessed, including displacement of whole foods, high energy densities, missing phytochemicals, contamination with packaging chemicals, hyperpalatability, harmful additives, rapid ingestion and digestion, and toxic reaction products. Then, potential strategies to overcome the current problems with UPFs are presented, including reducing energy density, balancing nutritional profile, fortification, increasing satiety response, modulating mastication and digestion, reengineering food structure, and precision processing. The central argument is that it may be possible to reformulate and reengineer many UPFs to improve their healthiness and sustainability, although this still needs to be proved using rigorous scientific studies.

Complementary Nutritional Improvements of Cereal-Based Products to Reduce Postprandial Glycemic Response

High glycemic response (GR) is part of cardiometabolic risk factors. Dietary polyphenols, starch digestibility, and dietary fibers could play a role in modulating GR. We formulated cereal products with high dietary fibers, polyphenols, and slowly digestible starch (SDS) contents to test their impact on the glycemic index (GI) and insulin index (II). Twelve healthy subjects were randomized in a crossover-controlled study to measure the GI and II of four biscuits according to ISO-26642(2010). Two types of biscuits were enriched with dietary fibers and polyphenols and high in SDS, and two similar control biscuits with low levels of these compounds were compared. The subjects consumed 50 g of available carbohydrates from the biscuits or from a glucose solution (reference). Glycemic and insulinemic responses were monitored for 2 h after the start of the consumption. The two enriched biscuits led to low GI and II (GI: 46 ± 5 SEM and 43 ± 4 SEM and II: 54 ± 5 SEM and 45 ± 3 SEM) when controls had moderate GI and II (GI: 57 ± 5 SEM and 58 ± 5 SEM and II: 61 ± 4 SEM and 61 ± 4 SEM). A significant difference of 11 and 15 units between the GI of enriched and control products was obtained. These differences may be explained by the polyphenol contents and high SDS levels in enriched products as well as potentially the dietary fiber content. This study provides new proposals of food formulations to induce beneficial health effects which need to be confirmed in a longer-term study in the context of the SINFONI consortium.

Slow Digestible Starch in Native Pea Starch (Pisum sativum L.) Lowers Glycemic Response with No Adverse Effects on Gastrointestinal Symptoms in Healthy Adults

Diabetes prevalence achieved 470B in 2021. Diabetics are looking for foods that allow them to better manage the postprandial glycemia. Owing to its large amylose fraction, pea starch may contribute to formulate recipes with a lower glycemic index (GI). This study measured the rapidly, slowly digested and resistant fractions in pea starch and in a powder mix recipe. Starch fractions were determined according to the Englyst methodology. A nonblind repeat measure crossover design trial in healthy humans was used to study the GI of pea starch and maltodextrin powder mix recipes against glucose. Gastrointestinal symptoms were measured. Thirteen healthy volunteers aged 18-60 years with body mass index <30 kg/m2 and fasting blood glucose <6.1 mmol/L participated in the study. They consumed 25 g available carbohydrate portions of the test products. Blood glucose was measured at -5 and 0 min before consumption till 180 min after starting to eat. The slow digestible starch (SDS) content of native pea starch was 30% of the total starch content. The pea-based powder mix recipe contained 25% SDS in comparison with 9% for the maltodextrin-based recipe. The glucose response after pea starch was significantly lower compared with maltodextrin. The glucose response after pea starch recipe was significantly lower compared with maltodextrin recipe. There was no significant difference in mean scores for well-being and gastrointestinal symptoms after consumption of pea starch and maltodextrin or between the two recipes. In conclusion, this study has demonstrated the presence of high SDS content in pea starch, which reduced postprandial glycemic response compared with maltodextrin. The pea starch recipe did not induce any negative gastrointestinal symptoms. Pea starch may, therefore, prove to be a beneficial ingredient in developing food products for improving glycemic control without undesirable side effects.

Reply to Henschel et al. Comment on "Qiu et al. Effect of Protein-Rich Breakfast on Subsequent Energy Intake and Subjective Appetite in Children and Adolescents: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2021, 13, 2840"

We want to thank Henschel et al. [...].

Association of Slowly Digestible Starch Intake with Reduction of Postprandial Glycemic Response: An Update Meta-Analysis

Slowly digestible starch (SDS) has been shown to digest slowly throughout the entire small intestine, generating slow and prolonged release of glucose, according to the in vitro Englyst assay. The aim of this work was to conduct a meta-analysis of up-to-date evidence to evaluate the association between SDS consumption and a reduction in the postprandial glycemic response, including extended glycemic index (EGI) or glycemic profile (GP) parameters, during in vivo digestion. We searched the Web of Science, PubMed, Europe PMC, Cochrane Library, and Embase to identify related articles published up to September 2022. Human trials investigating the effect of the SDS amount on the postprandial glucose profile were estimated at the standard mean difference (SMD), with a 95% confidence interval (CI), using random effect models. The review followed the systematic reviews and meta-analyses (PRISMA) guidelines. The meta-analysis included a total of 65 participants. The results revealed that the EGI experienced a greater increase (SMD = 24.61, I2 = 79.2%, p < 0.01) after SDS intake, while the GP exhibited similar trends (SMD = 29.18, I2 = 73.3%, p < 0.01). High heterogeneity vanished in the subgroup and sensitivity analysis (EGI: I2 = 14.6%, p = 0.31; GP: I2 = 0.0%, p = 0.97). There was no evidence of publication bias for EGI (p = 0.41) or GP (p = 0.99).The present meta-analysis provides evidence that SDS intake is positively correlated with EGI and GP levels. The quantitative relationship of the reduction in the postprandial glycemic response and SDS consumption was used to quantify the slow digestion property on an extended time scale, and supplement the in vitro concept of SDS.

Processing, digestion property and structure characterization of slowly digestible gorgon nut starch

Slowly digestible gorgon nut starch (GN-SDS) was prepared by heating-cooling treatment (HCT), meanwhile its morphological and structural features were characterized in detail by SEM, DSC, XRD and IR detection. The optimized parameters of GN-SDS processing were as following: starch milk (20%) was heated at 100 °C for 20 min, and then cooled under 4 °C for 24 h. Under the optimized parameters, the SDS content increased from 20.49 to 61.74%. GN-SDS showed typical SDS characteristics in in vivo digestion with a low postprandial blood glucose. SEM images suggested that GN-S particles changed from uniform regular polyhedron with smooth surface to irregular gravel-like particles with coarse surface and obvious layered structure inside after HCT. The results of SEM, DSC, XRD and IR determination indicated that HCT changed the granule morphology, interior structure, gelatinization temperature and crystal type (A to B-type) of GN-S, and therefore made it hard to be digested accordingly.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10068-021-01007-6.

Structural factors governing starch digestion and glycemic responses and how they can be modified by enzymatic approaches: A review and a guide

Starch is the most abundant glycemic carbohydrate in the human diet. Consumption of starch-rich food products that elicit high glycemic responses has been linked to the occurrence of noncommunicable diseases such as cardiovascular disease and diabetes mellitus type II. Understanding the structural features that govern starch digestibility is a prerequisite for developing strategies to mitigate any negative health implications it may have. Here, we review the aspects of the fine molecular structure that in native, gelatinized, and gelled/retrograded starch directly impact its digestibility and thus human health. We next provide an informed guidance for lowering its digestibility by using specific enzymes tailoring its molecular and three-dimensional supramolecular structure. We finally discuss in vivo studies of the glycemic responses to enzymatically modified starches and relevant food applications. Overall, structure-digestibility relationships provide opportunities for targeted modification of starch during food production and improving the nutritional profile of starchy foods.

Postprandial effects of a whey protein-based multi-ingredient nutritional drink compared with a normal breakfast on glucose, insulin, and active GLP-1 response among type 2 diabetic subjects: a crossover randomised controlled trial

Postprandial hyperglycaemia is recognised as an important target in type 2 diabetes management. Dietary pattern, meal composition, and amount of food intake are major factors for maintaining postprandial blood glucose levels. The aim of this study was to investigate the effect of consuming a whey protein-based multi-ingredient nutritional drink (WD) on postprandial glycaemic, insulinaemic, and active glucagon-like peptide-1 (GLP-1) responses in comparison to a typical breakfast, which is boiled white rice with chicken (BC) in patients with type 2 diabetes mellitus (T2DM). Fifteen subjects with T2DM participated in a randomised, controlled, cross-over study. Two isocaloric diets with similar nutrient composition were randomly tested with at least 7 d in between. Glucose, insulin, and active GLP-1 were measured by standard methods with blood samples collected with a venous catheter for 240 min during a kinetic test. The incremental area under the curve (iAUC_{0–240 min}) for plasma glucose was significantly lower after the consumption of WD (WD: 3551 ± 546; BC: 9610 ± 848 mg min/dl; P < 0⋅01), while insulinaemic response tended to be lesser (iAUC_{0–240 min}) than those of BC. In addition, higher iAUC_{0–240 min} for active GLP-1 was obtained with WD diet (WD: 2230 ± 441; BC: 925 ± 183 pM min/ml; P < 0⋅01). This study showed that WD can be used to replace a regular breakfast for improving postprandial glucose response and active GLP-1 levels in people with T2DM. Further studies are required to elucidate the clinical efficacy of WD on long-term glycaemic control in people with T2DM.

Deep Dive Into the Effects of Food Processing on Limiting Starch Digestibility and Lowering the Glycemic Response

During processing of cereal-based food products, starch undergoes dramatic changes. The objective of this work was to evaluate the impact of food processing on the starch digestibility profile of cereal-based foods using advanced imaging techniques, and to determine the effect of preserving starch in its native, slowly digestible form on its in vivo metabolic fate. Four different food products using different processing technologies were evaluated: extruded products, rusks, soft-baked cakes, and rotary-molded biscuits. Imaging techniques (X-ray diffraction, micro-X-ray microtomography, and electronic microscopy) were used to investigate changes in slowly digestible starch (SDS) structure that occurred during these different food processing technologies. For in vivo evaluation, International Standards for glycemic index (GI) methodology were applied on 12 healthy subjects. Rotary molding preserved starch in its intact form and resulted in the highest SDS content (28 g/100 g) and a significantly lower glycemic and insulinemic response, while the three other technologies resulted in SDS contents below 3 g/100 g. These low SDS values were due to greater disruption of the starch structure, which translated to a shift from a crystalline structure to an amorphous one. Modulation of postprandial glycemia, through starch digestibility modulation, is a meaningful target for the prevention of metabolic diseases.

Starch digestibility modulation significantly improves glycemic variability in type 2 diabetic subjects: A pilot study

BACKGROUND AND AIMS

In type 2 diabetes (T2D) patients, the reduction of glycemic variability and postprandial glucose excursions is essential to limit diabetes complications, beyond HbA1c level. This study aimed at determining whether increasing the content of Slowly Digestible Starch (SDS) in T2D patients' diet could reduce postprandial hyperglycemia and glycemic variability compared with a conventional low-SDS diet.

METHODS AND RESULTS

For this randomized cross-over pilot study, 8 subjects with T2D consumed a controlled diet for one week, containing starchy products high or low in SDS. Glycemic variability parameters were evaluated using a Continuous Glucose Monitoring System. Glycemic variability was significantly lower during High-SDS diet compared to Low-SDS diet for MAGE (Mean Amplitude of Glycemic Excursions, p < 0.01), SD (Standard Deviation, p < 0.05), and CV (Coefficient of Variation, p < 0.01). The TIR (Time In Range) [140-180 mg/dL[ was significantly higher during High-SDS diet (p < 0.0001) whereas TIRs ≥180 mg/dL were significantly lower during High-SDS diet. Post-meals tAUC (total Area Under the Curve) were significantly lower during High-SDS diet.

CONCLUSION

One week of High-SDS Diet in T2D patients significantly improves glycemic variability and reduces postprandial glycemic excursions. Modulation of starch digestibility in the diet could be used as a simple nutritional tool in T2D patients to improve daily glycemic control. REGISTRATION NUMBER: in clinicaltrials.gov: NCT03289494.

Novel Short-Clustered Maltodextrin as a Dietary Starch Substitute Attenuates Metabolic Dysregulation and Restructures Gut Microbiota in db/db Mice

Molecular structure of starch in daily diet is closely associated with diabetes management. By enzymatically reassembling α-1,4 and α-1,6 glycosidic bonds in starch molecules, we have synthesized an innovative short-clustered maltodextrin (SCMD) which slowly releases glucose during digestion. Here, we investigated the potential benefits of the SCMD-containing diet using diabetic db/db mice. As compared to a diet with normal starch, this dietary style greatly attenuated hyperglycemia and repaired symptoms associated with diabetes. Additionally, in comparison with acarbose (an α-glucosidase inhibitor) administration, the SCMD-containing diet more effectively accelerated brown adipose activation and improved energy metabolism of db/db mice. Furthermore, the SCMD-containing diet was a more suitable approach to improving the intestinal microflora than acarbose administration, especially the proliferation of Mucispirillum, Akkermansia, and Bifidobacterium. These results reveal a novel strategy for diabetes management based on enzymatically rebuilding starch molecules in the daily diet.

Effect of Diet on Insulin Resistance in Polycystic Ovary Syndrome

OBJECTIVE

The effect of diet on insulin resistance (IR) in polycystic ovary syndrome (PCOS) is controversial. Thus, we conducted this systematic review and meta-analysis to evaluate whether diet could reduce IR in women with PCOS while providing optimal and precise nutrition advice for clinical practice.

DESIGN

The search was conducted in 8 databases through June 30, 2019. The systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A random-effects model was adopted to calculate the overall effects.

RESULTS

A total of 19 trials (1193 participants) were included. The analysis showed that diet was significantly related to improvements in IR and body composition (eg, homeostasis model assessment of insulin resistance, fasting insulin, fasting plasma glucose, body mass index [BMI], weight, and waist circumference) in PCOS patients. The Dietary Approaches to Stop Hypertension diet and calorie-restricted diets might be the optimal choices for reducing IR and improving body composition, respectively, in the PCOS population. Additionally, the effects were associated with the course of treatment. The longer the duration, the greater the improvement was. Compared with metformin, diet was also advantageous for weight loss (including BMI and weight) and had the same effects on insulin regulation.

CONCLUSION

Overall, our findings suggest that diet is an effective, acceptable and safe intervention for relieving IR, and professional dietary advice should be offered to all PCOS patients.

Design and Validation of a Diet Rich in Slowly Digestible Starch for Type 2 Diabetic Patients for Significant Improvement in Glycemic Profile

This study aimed at designing a-diet high in slowly digestible starch (SDS) by carefully selecting high-SDS starchy products and to validate its implementation, acceptance, and impact on the postprandial glycemic response in patients with type 2 diabetes (T2D). Starchy products were screened and classified as being either high (high-SDS) or low (low-SDS) in SDS (in vitro SDS method). A randomized controlled cross-over pilot study was performed: Eight patients with T2D consumed randomly a high-SDS or a low-SDS diet for one week each, while their glycemic profile was monitored for 6 days. Based on 250 food product SDS analyses and dietary recommendations for patients with T2D, the high-SDS and low-SDS diets were designed. The high-SDS diet significantly increased SDS intake and the SDS/carbohydrates proportion compared to the low-SDS diet (61.6 vs. 11.6 g/day and 30% vs. 6%; p < 0.0001, respectively). Increasing the SDS/carbohydrate proportion to 50% of the meal was significantly correlated with a 12% decrease in tAUC0-120 min and a 14% decrease in the glycemic peak value (p < 0.001 for both). A high-SDS diet can be easily designed by carefully selecting commercial starchy products and providing relevant recommendations for T2D to improve their glycemic profile.

Role of nutraceutical starch and proanthocyanidins of pigmented rice in regulating hyperglycemia: Enzyme inhibition, enhanced glucose uptake and hepatic glucose homeostasis using in vitro model

Dysregulation of glucose homeostasis result in hyperglycemia and pigmented rice, unique combination of high quality starch and phenolics has the potential in regulating it. In this study, pigmented rice was characterized in terms of nutraceutical starch (NS) and phenolic content. Further the effect of rice phenolics on carbolytic enzyme inhibition, glucose uptake, hepatic glucose homeostasis and anti-glycation ability was analyzed in vitro. The most relevant effect on enzyme inhibition (α-amylase: IC₅₀-42.34 µg/mL; α-glucosidase: IC₅₀:63.89 µg/mL), basal uptake of glucose (>39.5%) and anti-glycation ability (92%) was found in red rice (RR), than black rice (BR). The role of RR phenolics in regulating glucose homeostasis was deciphered using hepatic cell line system, which found up-regulation of glucose transporter 2 (GLUT2) and glycogen synthase 2 (GYS2); while expression of gluconeogenic genes were found down regulated. To our knowledge this study is the first report validating the role of starch-phenolic quality towards anti-hyperglycemic effect of RR.

The Rate of Glucose Appearance Is Related to Postprandial Glucose and Insulin Responses in Adults: A Systematic Review and Meta-analysis of Stable Isotope Studies

BACKGROUND

It is often assumed that lower postprandial glucose (PPG) and insulin (PPI) responses are induced by slower glucose influx from the gut (e.g., by delayed carbohydrate digestion). However, changes in the rate of appearance of glucose in the peripheral circulation [rate of appearance of exogenous glucose (RaE)] may be accompanied by changes in endogenous glucose production (EGP) and the rate of disappearance of total glucose into tissues (RdT). The quantitative relationships between reductions in RaE and PPG/PPI levels are unclear.

OBJECTIVES

The objective was to perform a meta-analysis to quantify the effect of changes in RaE on changes in PPG and PPI levels (primary) and EGP and RdT (secondary).

METHODS

We systematically searched the Scopus, Medline, and Cochrane library databases through 10 January 2019 for randomized, controlled, carbohydrate-rich interventions that aimed to reduce RaE in humans, measured using dual or triple stable isotope methods. The 2-h net incremental AUCs for all variables were extracted or calculated. Relationships between RaE and outcomes were quantified by weighted regression analyses.

RESULTS

There were 12 articles, including 17 comparisons, that satisfied the inclusion criteria. The subjects were mainly men (60%), with age and BMI ranges of 18-40 y and 20.0-27.5 kg/m2, respectively. A 10% reduction in RaE was associated with reductions in PPG levels, PPI levels, and the RdT of 7% (95% CI: 2%, 12%; P = 0.010), 8% (95% CI: 2%, 13%; P = 0.012), and 11% (95% CI: 4%, 17%; P = 0.005), respectively, but was not significantly associated with a change in EGP (13%; 95% CI: -7%, 33%; P = 0.176). All fluxes together explained 70% and 26% of the variances in PPG and PPI levels, respectively.

CONCLUSIONS

In adults, reducing glucose RaE by diet is associated with significant reductions in PPG levels, PPI levels, and the rate of glucose disposal. This trial was registered in the PROSPERO database with identifier CRD42018084824.

Glycemic Index of Slowly Digestible Carbohydrate Alone and in Powdered Drink-Mix

Consumer interest in food and beverages with carbohydrates offering steady glucose release and lower glycemic index (GI) continues to rise. Glycemic index is one of the metrics for carbohydrate quality. Slowly digestible carbohydrates (SDC) offer an ingredient solution to improve carbohydrate quality and meet consumer needs. SUSTRA^TM 2434 slowly digestible carbohydrate is a blend of tapioca flour and corn starch. The study objective was to determine the glycemic index of the SDC ingredient alone and in a powdered drink-mix. In a randomized, single-blind study, heathy adults (n = 14) consumed four test drinks, delivering 50 g available carbohydrates on separate days to measure GI. Participants either consumed dextrose in water (placebo), SDC ingredient in water, SDC drink-mix powder reconstituted in skim milk, or control drink-mix reconstituted in skim milk (without SDC). Post-prandial glucose response was measured over 4 h. SDC exhibited lower GI (0–2 h) and higher steady glucose release (beyond 2 h). SDC alone (GI = 27) and SDC in drink-mix (GI = 30.3) showed significantly lower GI (−27%) compared to dextrose (100) and the control drink-mix (41.5). SUSTRA^TM 2434 SDC is a low glycemic ingredient, suitable for product innovations with potential for low glycemic and steady glucose release claims.

Differences in endosperm cell wall integrity in wheat (Triticum aestivum L.) milling fractions impact on the way starch responds to gelatinization and pasting treatments and its subsequent enzymatic in vitro digestibility

Intact wheat endosperm cell walls reduce intracellular starch swelling and retard its in vitro digestion by acting as physical barriers to amylolytic enzymes.

Enrichment of soybean dietary fiber and protein fortified rice grain by dry flour extrusion cooking: the physicochemical, pasting, taste, palatability, cooking and starch digestibility properties

With the prevalence of chronic conditions in patients due to a dietary imbalance, the demand for inexpensive, nutritious and high dietary fiber extruded rice is increasing rapidly. However, the factors of quality and bioavailability are still the major constraints to its development. In this study, soybean dietary fiber (DF) and protein fortified rice grain were prepared via dry flour extrusion processing. The results showed that the extruded rice had a similar density to that of natural rice and a significantly lower whiteness degree and transparency. Notably, the cooking texture and palatability of extruded rice were affected by the added amount of DF, resulting in rice with a taste value close to 70 in DF 6-9% (w/w) samples. The pasting properties, microstructure, and molecular interactions according to RVA, SEM and FTIR analyses, respectively, were also significantly affected by the DF content. The soluble dietary fiber was significantly increased from 0.0021 g g-1 to 0.216 g g-1 in extruded rice. Importantly, the starch digestibility in vitro showed significantly lower readily digestible starch (RDS) and higher resistant starch (RS) in DF 6-15% (w/w) extruded rice than in natural rice and DF-0 rice, respectively. The glycemic index (GI) was reduced in DF > 6%. In this study, we provide a new high dietary fiber extruded rice product with good texture and palatability, and we reveal the effect of DF on the extruded rice properties.

Slowly Digestible Carbohydrate for Balanced Energy: In Vitro and In Vivo Evidence

There is growing interest among consumers in foods for sustained energy management, and an increasing number of ingredients are emerging to address this demand. The SUSTRA™ 2434 slowly digestible carbohydrate is a blend of tapioca flour and corn starch, with the potential to provide balanced energy after a meal. The aim of the study was to characterize this starch’s digestion profile in vitro (modified Englyst assay) and in vivo (intact and cecectomized rooster study), and to determine its effects on available energy, by measuring post-prandial glycemia in healthy adults (n = 14), in a randomized, double-blind, placebo-controlled, cross-over study, with two food forms: cold-pressed bar and pudding. The in vitro starch digestion yielded a high slowly digestible fraction (51%) compared to maltodextrin (9%). In the rooster digestibility model, the starch was highly digestible (94%). Consumption of slowly digestible starch (SDS), in an instant pudding or bar, yielded a significantly lower glycemic index compared to a control. At individual time points, the SDS bar and pudding yielded blood glucose levels with significantly lower values at 30–60 min and significantly higher values at 120–240 min, demonstrating a balanced energy release. This is the first study to comprehensively characterize the physiological responses to slowly digestible starch (tapioca and corn blend) in in vitro and in vivo studies.