The Antioxidant Capacity of Breast Milk and Plasma of Women with or without Gestational Diabetes Mellitus

Women with gestational diabetes (GD) have reduced antioxidant capacity; however, the relationship between maternal diet, maternal biochemical capacity, breast milk concentration, and infant intake has not been adequately explored in the literature. An exploration of underlying mechanism(s) is warranted, particularly for nutrient antioxidants impacted by maternal intake. These nutrients may provide a means for modifying maternal and infant antioxidant capacity. Oxygen radical absorbance capacity (ORAC), alpha-tocopherol, ascorbic acid, and beta-carotene concentrations were measured in breast milk of women with and without GD. Plasma, three-day diet records, and breast milk were collected at 6 to 8 weeks postpartum. Student’s t-test was used to compare breast milk ORAC, nutrient antioxidant concentration and plasma ORAC between women with and without GD. Pearson correlations were used to determine associations among antioxidant concentrations in breast milk and dietary antioxidant intake. Breast milk antioxidant concentrations were associated with maternal intake of beta-carotene (r = 0.629, p = 0.005). Breast milk and plasma ORAC and antioxidant vitamin concentrations were not significantly different between GD and NG women. Breast milk ORAC associated with breast milk alpha-tocopherol for NG (r = 0.763, p = 0.010), but not GD women (r = 0.385, p = 0.35), and with breast milk ascorbic acid for GD (r = 0.722, p = 0.043) but not NG women (r = 0.141, p = 0.70; interaction p = 0.041). In GD participants, breast milk ORAC was significantly associated with plasma ORAC (r = 0.780, p = 0.039). ORAC and antioxidant vitamin concentrations in breast milk in women with GD were comparable to women with NG; however, the relationships between breast milk ORAC and vitamin concentrations differed in GD versus NG women for alpha-tocopherol and ascorbic acid.

Comparison of Postprandial Glycemic and Insulinemic Response of allSWEET®, Non-GMO Allulose, Consumed Alone or When Consumed With Sucrose: a Randomized, Controlled Trial

Objectives

Allulose is a naturally occurring monosaccharide with an approximate sweetness of 70% of sucrose without raising postprandial glucose and insulin levels. allSWEET® has been in the marketplace since 2015 but it has not been confirmed to attenuate glycemic and insulinemic response when consumed with sucrose. This study will therefore evaluate the effect of consuming allSWEET® alone or when consumed with Sucrose on postprandial glucose and insulin levels.

Methods

Using a double-blind, randomized, controlled design, 15 healthy participants (7M:8F, Age: 51 ± 15 years, BMI: 26.9 ± 4.1 kg/m²) consumed one of three 250 mL beverages over a period of 10 minutes containing either 15g of allSWEET®, 15g of allSWEET® + 30g sucrose, or 30g of sucrose. Blood samples were collected fasting and at 15, 30, 45, 60, 90 and 120min after the start of the test meal.

Results

Glucose incremental area under the curve (iAUC), measured over a a two-hour period was significantly lower after both allSWEET® (0.6 ± 0.2 mmol/Lxmin) and allSWEET® + sucrose (86.0 ± 9.5 mmol/Lxmin) compared to sucrose alone (118.1 ± 11.3 mmol/Lxmin). Postprandial glucose levels were significantly lower after allSWEET® + sucrose and allSWEET® when compared to sucrose alone at 15 and 30 minutes. Insulin iAUC was significantly lower after both allSWEET® (103.7 ± 27.8 uU/Lxmin) and allSWEET® + sucrose (1282.1 ± 126.2 uU/Lxmin) compared to sucrose alone (1828.2 ± 239.1 uU/Lxmin). Postprandial insulin was significantly lower after allSWEET® and allSWEET® + sucrose when compared to sucrose alone at 15 and 30 minutes.

Conclusions

This study demonstrates that when taken alone, allSWEET® does not elicit a glycemic or insulinemic response. In addition, when allSWEET® is added to sucrose it attenuates both the overall and early glucose and insulin responses. allSWEET® may therefore have a beneficial role as a sugar substitute for acute glycemic and insulinemic control. Registration: Clinical trials.gov NCT05185960

Funding Sources

Anderson Advanced Ingredients.

Equivalent Glycemic Load (EGL) of Atkins Chocolate Peanut Butter Bar and Atkins Chocolate Ready-to-Drink Shake in People With Type 2 Diabetes

Objectives

It is difficult to estimate the glycemic impact of low-carbohydrate (low-CHO) foods from the information in the Nutrition Facts Table. We developed equivalent glycemic load (EGL) to quantify the glycemic impact of low-CHO foods in people without diabetes. The current objective was to determine the feasibility and safety of measuring EGL in people with type 2 diabetes (T2D).

Methods

Overnight fasted adults with T2D treated by diet or oral agents and A1c < 8.1% consumed 1 serving of Atkins Chocolate Peanut Butter Bar (CPB) or Atkins Milk Chocolate Shake (MCS) or 45 g white bread (WB) in random order on 3 separate days. CPB/MCS, respectively, contained 150/160 kcal, 14/9 g fat, 16/15 g protein, 23/5 g CHO and 12/3 g fiber. We took finger-stick blood fasting and every 30 min for 3 h after starting to eat. Serum glucose was measured by glucometer (analytic CV = 8.6%) and by the Vitros Chemistry System (Vitros, CV = 1.6%). In each subject F/(WB/Cwb) was calculated where F = incremental area under the curve (iAUC) for the food, WB = iAUC after WB and Cwb = 20.8 (the amount of CHO in WB). EGL = mean F/(WB/Cwb), after excluding values >2 SD from the mean.

Results

We screened 18 subjects; 4 were ineligible (A1c >8.0%), 14 were enrolled and 2 dropped out. The remaining 12 subjects (5 males, 7 females; aged 43–75 (mean ± SD, 63 ± 11) yr; BMI 23.0–56.0 (35.2 ± 9.0) kg/m²) completed in the study. By Vitros, the EGLs (mean [95% confidence interval] for CPB, 4.1 [2.0, 6.2] g (n = 11), and MCD, 3.8 [1.6, 6.0] g (n = 11) were similar to those by glucometer CPB, 5.8 [2.5, 9.1] g (n = 12) and MCD, 3.0 [0.8, 5.2] g (n = 11). There were no episodes of hypoglycemia during the study. Loose stools were experienced by 1 subject after CPB and by a different subject after MCS, events considered to be possibly related to the study products.

Conclusions

The results suggest it is feasible and safe to measure EGL in people with T2D not taking insulin.

Funding Sources

Simply Good Foods USA, Inc.

Effect of Consuming a High Protein, High Fiber Shake on Measures of Satiety: A Randomized, Controlled, Cross-Over Study in Healthy Overweight and Obese Subjects

Objectives

To estimate the time for hunger scores to return to baseline levels for the Control and high protein, high fiber shakes.

Methods

A total of 80 subjects were recruited for this double-blind, randomized, controlled study (50F:30 M; BMI 30.3 ± 3.7 kg/m²). Overnight fasted subjects consumed equicaloric portions (120 kcal) of the high protein, high fiber Chocolate Nutrisystem shake (NSh) and a low protein, low fiber chocolate beverage (Control). For pre-menopausal females, both visits were scheduled during the follicular phase of their menstrual cycle. The motivation-to-eat questionnaire was completed before and at 15. 30, 45, 60, 90, 120, 150, 180, 210 and 240 min after starting to consume the test meal. Throughout the 4.5 h visit, participants were seated quietly and were not be allowed to use any electronic devices. Time to baseline and differences in scores for the 4 satiety questions (Hunger, Desire to Eat, Prospective Consumption and Fullness) and the Average Appetite were analyzed.

Results

Five subjects dropped out and n = 75 were included in the final analysis. Per protocol analysis: Time to baseline for hunger scores after NSh, 183 ± 11 min, was the same as Control, 183 ± 12 min (n = 53; NS), however time to return to baseline for Fullness after NSh, 218 ± 10 min, was greater than Control, 198 ± 10 min, (n = 63; p = 0.036). When all 75 subjects were included in the analysis, there was no difference for hunger, but time to baseline for Fullness after NSh, 3 h and 20 min (200 ± 11 min) was significantly longer than Control, 2 h and 54 min (174 ± 11 min, p = 0.037). The % of subjects whose ratings were still above baseline after 4 h did not significantly differ for Hunger, Desire to Eat, Prospective Consumption or Average Appetite but was higher for Fullness after NSh, 44%, than Control, 28% (p = 0.041).

Conclusions

Hunger scores remained above baseline for over 3 h after a serving of Chocolate Nutrisystem shake and levels of fullness persisted for over 3.5 h. Fullness levels were significantly greater after consumption of the Nutrisystem shake than Control. The Nutrisystem shake may therefore be a helpful aid to increasing feelings of fullness.

Funding Sources

Nutrisystem Inc.

The Effect of Oat β-Glucan on Postprandial Blood Glucose and Insulin Responses: A Systematic Review and Meta-Analysis

Objectives

The efficacy of oat beta-glucan (OBG), a viscous soluble fibre, on postprandial glycemic outcomes may depend on the nature of the control and the dose and molecular weight (MW) utilized. We undertook a systematic review and meta-analysis of acute clinical trials to determine whether these features mediate the glycemic and insulinaemic responses to OBG.

Methods

MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through October 27, 2020. We included acute, single-meal feeding, controlled trials investigating the effect of OBG (concentrate or oat bran) added to a carbohydrate-containing meal compared to a comparable meal (matched control) or a different carbohydrate-containing meal (unmatched control). Two reviewers extracted the data and assessed the risk of bias and certainty of

evidence (GRADE). The primary outcome was incremental area under the curve (iAUC) for blood glucose. Data were pooled using the generic-inverse variance method with random effects model and expressed as ratio of means with [95% Cis].

Results

One hundred and three  trial comparisons (N = 538) were included. OBG reduced glucose iAUC and iPeak by 23% (0.77 [0.74, 0.81]) and 28% (0.72 [0.64, 0.76]) and insulin by 22% (0.78 [0.72, 0.85]) and 24% (0.76 [0.65, 0.88]), respectively. Dose, molecular-weight and comparator were significant effect modifiers of glucose iAUC and iPeak. Significant linear dose-response relationships were observed for all outcomes. OBG molecular-weight &gt; 300 kg/mol significantly reduced glucose iAUC and iPeak, whereas, molecular-weight &lt; 300 kg/mol did not.  Reductions in glucose iAUC (27 vs 20%, p = 0.03) and iPeak (39 vs 25%, p &lt; 0.01) were significantly larger with different vs comparable control-meals. Outcomes were similar in participants with and without diabetes. All outcomes had high certainty-of-evidence.

Conclusions

Current evidence indicates that the addition of OBG to carbohydrate-containing meals reduces the postprandial glycemic and insulinaemic responses. However, the magnitude of glucose reduction depends on OBG dose, molecular-weight and the comparator.

Funding Sources

INQUIS Clinical Research Ltd. (formerly GI Labs), and PepsiCo Global R&D

Effect of Important Food Sources of Fructose-Containing Sugars on Biomarkers of Inflammation: A Systematic Review and Meta-Analysis of Controlled Trials

Objectives

Excess calories as fructose may initiate pathways increasing biomarkers of inflammation. Whether this effect is mediated by the food matrix at different energy levels is unknown. We conducted a systematic review and meta-analysis of controlled feeding trials of the effect of food sources of fructose-containing sugars at different energy control levels on biomarkers of inflammation (NCT02716870).

Methods

We searched MEDLINE, Embase, and the Cochrane Library through January 15 2020 for controlled trials ≥7d. Trial designs were prespecified based on energy control: substitution (energy-matched replacement of sugar in the diet); addition (excess energy from sugar added to diets); subtraction (energy from sugar subtracted from diets); ad libitum (energy from sugar freely replaced in the diet). The primary outcome was C-reactive protein (CRP). Secondary outcomes were tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6). Independent reviewers extracted data and assessed the risk of bias. Certainty of evidence was assessed by GRADE.

Results

We included 48 trials (109 trial comparisons, n = 2108) assessing the effect of 10 food sources (SSBs, sweetened dairy, sweetened dairy alternatives (soy), fruit, 100% fruit juice, dried fruit, sweetened cereal grains/bars, sweets, added nutritive sweetener, and mixed sources) across the 4 levels of energy control. Total fructose-containing sugars had no effect on any outcome in any level of energy control. There was evidence of interaction by food source; in substitution trials, sweetened dairy alternative (soy) decreased CRP. In addition trials, fruit decreased while added nutritive sweetener increased TNF-α. The certainty of evidence was low for the effect of sweetened dairy alternative (soy) on CRP in substitution trials, and generally moderate for all other comparisons.

Conclusions

Food source more than energy control appears to mediate the effect of fructose-containing sugars on inflammation. The evidence provides some indication that sweetened dairy alternatives (soy) and fruit decrease and added nutritive sweeteners increase biomarkers of inflammation. More high-quality randomized trials of different fructose containing food sources are needed to improve our estimates.

Funding Sources

Diabetes Canada.

Effect of Important Food Sources of Fructose-Containing Sugars on Non-alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Controlled Trials

Objectives

Fructose as a source of excess calories increases non-alcoholic fatty liver disease (NAFLD) markers. Whether this effect is mediated by the food matrix is unknown. We thus conducted a systematic review and meta-analysis of controlled feeding trials assessing the effect of important food sources of fructose-containing sugars at different energy control levels on NAFLD markers.

Methods

MEDLINE, Embase, and Cochrane Library were searched through January 18, 2021 for controlled trials ≥7-days. Four trial designs were prespecified based on energy control: substitution (energy-matched replacement of sugars by other macronutrients); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced by other macronutrients). The primary outcome was intrahepatocellular lipid (IHCL). Secondary outcomes were alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Independent reviewers extracted data and assessed risk of bias. Certainty of evidence was assessed by GRADE.

Results

We included 44 trials (65 trial comparisons, n = 1941) assessing the effect of 8 food sources (sugar-sweetened beverages [SSBs]; sweetened dairy alternative [soy]; fruit juice; fruit; dried fruit; baked goods, desserts and sweets; added nutritive sweetener; and mixed sources) across 4 energy levels. Total fructose-containing sugars increased IHCL in addition trials (standardized mean difference = 1.69 [95% CI, 1.00–2.37], P &lt; 0.001), but no effect in substitution, subtraction and ad libitum trials. There was evidence of interaction by food source in addition trials with SSBs increasing IHCL and ALT, and mixed sources increasing AST. The overall certainty of evidence was high for SSBs on IHCL and ALT in addition trials and high to very low for all other comparisons.

Conclusions

Energy control and food source appear to mediate the effect of fructose-containing sugars on NAFLD markers. High certainty evidence suggests that SSBs providing excess energy increase NAFLD markers, while the evidence is less certain that mixed sources share the same effect and other food sources do not. More high-quality randomized trials of different food sources are needed to improve our estimates (ClinicalTrials.gov identifier, NCT02716870).

Funding Sources

Primary funding: Diabetes Canada.

Important Food Sources of Fructose-Containing Sugars and Adiposity: A Systematic Review and Meta-Analysis of Controlled Feeding Trials

Objectives

Sugar-sweetened beverages (SSBs) have been linked to weight gain. It is unclear if other food sources of fructose-containing sugars behave similarly. We conducted a systematic review and meta-analysis of controlled feeding trials to assess the effect of different food sources of fructose-containing sugars on body weight and markers of adiposity.

Methods

MEDLINE, Embase, and the Cochrane Library were searched through January 2020 for controlled feeding trials ≥2 weeks on the effect of fructose-containing sugars. Trial designs were prespecified by energy control: substitution (energy matched replacement of sugars in diets); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced in diets). The primary outcome was body weight. Secondary outcomes were body mass index, body fat and waist circumference. Independent reviewers extracted data and assessed risk of bias. Certainty of evidence was assessed using GRADE. (NCT02558920)

Results

We identified 119 controlled trials (368 trial comparisons, N = 5263) assessing the effect of 10 food sources (SSBs, sweetened dairy alternative (soy), fruit juice, fruit drink, fruit, dried fruit, sweetened cereal grains/bars, sweets, added sweeteners and mixed sources). Total fructose-containing sugars increased body weight (mean difference, 0.29 kg [95% confidence interval, 0.05 to 0.53 kg], P = 0.017) and body fat in addition trials with no effect in other analyses or outcomes. There was evidence of interaction by food source in substitution trials with fruit reducing and mixed sources increasing some outcomes and in addition trials with 100% fruit juice reducing and SSBs and mixed sources increasing some outcomes. The overall certainty of evidence was moderate for the decreasing effect of fruit and fruit juice and the increasing effect of SSBs and mixed sources and high-to-very low for other comparisons.

Conclusions

Energy control and food source may mediate the effect of fructose-containing sugars on adiposity. The evidence provides good indication that fruit and 100% fruit juice decrease and SSBs and mixed sources increase markers of adiposity. More high-quality randomized trials of different foods are needed to improve our estimates.

Funding Sources

American Society for Nutrition, Diabetes Canada, CIHR, Mitacs.

Important Food Sources of Fructose-Containing Sugars and Fasting Serum Uric Acid Levels: A Systematic Review and Meta-Analysis of Controlled Feeding Trials

Objectives

Fructose as a source of excess calories increases uric acid. Whether this effect is mediated by the food matrix at different levels of energy is unknown. We aim to conduct a systematic review and meta-analysis of controlled feeding trials on the effect of food sources of fructose-containing sugars at different energy levels on uric acid (NCT02716870).

Methods

MEDLINE, Embase and the Cochrane Library were searched through January 27, 2020 for controlled trials ≥7-days assessing the effect of food sources of fructose-containing sugars on uric acid. Trial designs were prespecified based on energy control: substitution (energy matched replacement of sugars by other macronutrients); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced by other macronutrients) trials. Independent reviewers extracted data and assessed risk of bias. Certainty of evidence was assessed using the GRADE approach.

Results

Eligibility was met by 41 trials (72 trial comparisons, N = 2109) assessing the effect of 9 food sources (sugar-sweetened beverages [SSBs], sweetened dairy, fruit drink [lemonade], 100% fruit juice, fruit, dried fruit [raisins], baked goods desserts and sweets, added nutritive [caloric] sweetener and mixed sources) across the 4 energy levels. Total fructose-containing sugars increased uric acid in substitution trials (mean difference, 0.15 mg/dL [95% confidence interval, 0.03 to 0.27 mg/dL], P = 0.012) with no effect in addition, subtraction or ad libitum trials. There was evidence of interaction by food source with SSBs and baked goods, desserts and sweets increasing uric acid in substitution and SSBs increasing and 100% fruit juice decreasing uric acid in addition trials. The overall certainty of evidence was moderate for the increasing effect of SSBs in substitution and addition trials and low to very low for all other comparisons.

Conclusions

Food source more than energy control mediate the effect of fructose-containing sugars on uric acid. SSBs and baked goods, desserts and sweets appear to increase, and 100% fruit juice appear to decrease uric acid. More high-quality trials of different food sources of fructose-containing sugars are needed to improve our estimates.

Funding Sources

Diabetes Canada.

Important Food Sources of Fructose-Containing Sugars and Postprandial Lipids: A Systematic Review and Meta-Analysis of Controlled Feeding Trials

Objectives

Fructose providing excess calories has been shown to increase postprandial triglycerides (TAG). Whether this effect holds for different food sources of fructose-containing sugars is unclear. We conducted a systematic review and meta-analysis of controlled feeding trials on the effect of different food sources of fructose-containing sugars at different levels of energy control on postprandial blood lipids (NCT02716870).

Methods

MEDLINE, EMBASE, and Cochrane Library were searched through June 1st, 2020 for controlled feeding trials ≥7-days assessing the effect of food sources of fructose-containing sugars on postprandial lipids. Trial designs were prespecified based on energy control: substitution (energy matched replacement of sugars by other macronutrients); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced by other macronutrients) trials. Independent reviewers extracted data and assessed risk of bias. Outcomes were postprandial TAG and apoB48. Certainty of evidence was assessed using GRADE.

Results

We included 29 trials (60 trial comparisons, N = 943) assessing 5 food sources (SSBs, fruit, sweets and desserts, added caloric sweetener and mixed sources) across 4 levels of energy control. Total fructose-containing sugars increased postprandial TAG in substitution (MD: 0.17 mmol/L [95% CI: 0.05, 0.30], P = 0.007), addition (0.38 mmol/L [0.13, 0.62], P = 0.003), and ad libitum (0.17 mmol/L [0.02, 0.31], P = 0.024) trials and increased apoB48 in addition trials (0.12 g/L [0.07, 0.18], P &lt; 0.001).There was evidence of interaction by food source with SSBs increasing postprandial TAG and apoB48 in addition trials and mixed sources increasing postprandial TAG in ad libitum trials. The certainty of the evidence was “moderate” for SSBs increasing TAG in addition trials and mixed sources increasing TAG in ad libitum trials and “low” for all other comparisons.

Conclusions

Food source more than energy control appears to mediate fructose-containing sugars on postprandial lipids. Good evidence suggests that SSBs and mixed sources increase postprandial lipids while evidence is less certain for the lack of effect of other food sources. More high-quality trials of different food sources are needed.

Funding Sources

Primary: Diabetes Canada.

Important Food Sources of Fructose-Containing Sugars and Blood Pressure: A Systematic Review and Meta-Analysis of Controlled Trials

Objectives

Overconsumption of fructose-containing sugars may increase blood pressure. Whether this effect is mediated by the food matrix is unclear. We conducted a systematic review and meta-analysis of controlled feeding trials of the effect of food sources of fructose-containing sugars at different levels of energy control on blood pressure (NCT02716870).

Methods

We searched MEDLINE, Embase and the Cochrane Library through January, 2020 for controlled trials ≥7d. Trial designs were prespecified based on energy control: substitution (energy matched replacement of sugars in the diet); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced in the diet) trials. Outcomes were systolic blood pressure (SBP) and diastolic blood pressure (DBP). Independent reviewers extracted data and assessed risk of bias. Certainty of evidence was assessed by GRADE.

Results

We included 76 trials (121 trial comparisons, N = 4 302) assessing 9 food sources (sugar-sweetened beverages [SSBs], sweetened dairy alternatives, 100% fruit juice, fruit, dried fruit, sweets, added nutritive sweetener, sweetened cereal grains/bars, and mixed sources) across the 4 levels of energy control. Total fructose-containing sugars decreased SBP (mean difference, −2.76 mmHg [95% CI, −4.36, −1.16], P = 0.001) and DBP (−1.26 mmHg [−2.29, −0.23], P = 0.016) in addition trials and the removal of these sugars decreased SBP (−1.79 mmHg [−3.36, −0.21], P = 0.026) in subtraction trials. There was evidence of interaction by food source with fruit decreasing and sweets and mixed sources increasing SBP and DBP in addition trials and the removal of SSBs decreased SBP in subtraction trials. The certainty of evidence was generally moderate to low for all food source-outcome relationships, except for the decreasing-effect of fruit on DBP in addition trials (high).

Conclusions

Food source and energy control appear to mediate the effect of fructose-containing sugars on blood pressure. The evidence provides a good indication that fruit decreases while excess calories from SSBs, sweets and mixed sources increase blood pressure. More high-quality trials of different food sources are needed to improve our estimates.

Funding Sources

Diabetes Canada.

Postprandial Glucose and Insulin Response to a Cookie with or Without Added RS4 Wheat Starch After 3 Days of Pre-Feeding: A Double Blind, Randomized, Controlled Clinical Trial (P08-081-19)

Objectives

Research on the effect of resistant starch on postprandial glucose levels has mainly focused on the attenuation achieved by substituting it for the available carbohydrate (avCarb), few studies have looked at the effect on glucose levels when the resistant starch is added to avCarb. The objective of this study was therefore to investigate the acute effect on postprandial glycemia and insulinemia of a cross-linked RS4 wheat starch (Fibersym® RW) in a test cookie compared to a control cookie matched for available carbohydrate after a 3-day habituation period.

Methods

This study used a double blind, randomized, cross-over design. Nineteen healthy subjects were screened of which 16 were eligible and randomized into the study. A total of 15 subjects completed the study (5M:10F; 32 ± 11y; 24.9 ± 2.5 kg/m2; BP 112/70 mmHg). After 3-day pre-feeding of Control (dietary fiber 1.6 g/d) or Fibersym sugar snap cookies (dietary fiber 29 g/d), the subjects, after an overnight fast, consumed either the respective Control or Fibersym cookie, both meals contained 40 g avCarb. Blood samples were collected over 2 h. Gastrointestinal (GI) symptoms were recorded during the pre-feeding period and during the postprandial visit. Subjective appetite scores were measured at the same time points when blood samples were collected.

Results

The 90-min blood glucose incremental area under the curve (IAUC) was statistically significantly lower after ingesting the Fibersym cookie (71.9 ± 8.5 mmolxmin/L) compared to the Control cookie (86.7 ± 9.3 mmolxmin/L) (P < 0.02). In addition, the peak glucose concentrations at 30 and 45 min after consumption of the Fibersym cookie was significantly lower than the Control cookie (P < 0.05). Insulin levels at 90-min (P < 0.016) and the 2-h (P < 0.02) insulin IAUC's were significantly lower after consumption of the Fibersym cookie compared to the Control cookie. There were no significant differences in GI symptoms over the 3-day pre-feeding period and during the 2 h postprandial visit between the two cookies and neither did the appetite scores differ significantly.

Conclusions

The cross-linked RS4 wheat starch, Fibersym, when formulated into a cookie, is well tolerated and attenuates blood glucose and insulin levels in healthy subjects compared to a Control cookie containing the same amount of available carbohydrate.

Funding Sources

MGP Ingredients, Inc.

Traditional foods and 25(OH)D concentrations in a subarctic First Nations community

Background

Sub-optimal vitamin D status is common worldwide and the condition may be associated with increased risk for various chronic diseases. In particular, low vitamin D status is highly prevalent in indigenous communities in Canada, although limited data are available on the determinants of serum 25-hydroxyvitamin D (25(OH)D) concentrations in this population. The relationship between traditional food consumption and vitamin D status has not been well documented.

Objective

To investigate the determinants of serum 25(OH)D status in a First Nations community in Ontario, Canada, with a focus on the role of traditional food consumption and activities.

Methods

A cross-sectional analysis was conducted within the Sandy Lake Health and Diabetes Project (2003–2005). A total of 445 participants (>12 years of age) were assessed for serum 25(OH)D status, anthropometric and lifestyle variables, including traditional and non-traditional dietary practices and activities. Diet patterns were identified using factor analysis, and multivariate linear regression analysis was used to analyse the determinants of 25(OH)D concentrations.

Results

Mean serum 25(OH)D concentrations were 22.1 nmol/L (16.9, 29.9 nmol/L) in men and 20.5 nmol/L (16.0, 27.3 nmol/L) in women. Multivariate determinants of higher serum 25(OH)D included higher consumption of traditional and healthier market foods, higher wild fish consumption, male gender, spring/summer season of blood collection and more frequent physical activity. Significant negative determinants included hours of TV/day, higher BMI and higher consumption of unhealthy market foods.

Conclusions

Traditional food consumption contributed independently to higher 25(OH)D concentrations in a First Nations community with a high prevalence of sub-optimal vitamin D status.

Butyrate modulates TGF-β1 generation and function: Potential renal benefit for Acacia(sen) SUPERGUM™ (gum arabic)?

Anecdotal evidence suggests that high fibre supplementation of dietary intake may have health benefits in renal disease related to alterations in circulating levels of short-chain fatty acids. The aim of the study was to examine the hypothesis that dietary manipulation may increase serum butyrate and thus have potential beneficial effects in renal disease. We examined the effect of dietary supplementation with a gum arabic sample of standardized molecular characteristics, Acacia(sen) SUPERGUM EM2 (SUPERGUM), on systemic levels of butyrate in normal human subjects. In an in vitro study, we also examined the potential role of butyrate in modifying the generation of the profibrotic cytokine transforming growth factor-beta (TGF-beta1) by renal epithelial cells. Following 8 weeks of dietary supplementation with 25 g/day of SUPERGUM, there was a two-fold increase in serum butyrate (n=7, P=0.03). In vitro work demonstrated that exposure of renal epithelial cells to elevated concentrations of butyrate suppressed both basal and stimulated TGF-beta1 synthesis. The action of butyrate was mediated by suppression of the extracellular signal-regulated kinase/mitogen-activated protein kinase signalling pathway. In addition, butyrate exposures reduced the response of renal epithelial cells to TGF-beta1 as assessed by luciferase activity of a TGF-beta-responsive reporter construct. Attenuation of TGF-beta1 signalling was associated with reduced phosphorylation of Smad 3 and decreased trafficking of TGF-beta1 receptors into signalling, non-lipid raft-associated membrane fractions. In conclusion, the data demonstrate that dietary supplementation with SUPERGU increased serum butyrate, which at least in vitro has beneficial effects on renal pro-fibrotic cytokine generation.

Effect of acarbose on insulin sensitivity in elderly patients with diabetes

OBJECTIVE

To study the effect of acarbose, an alpha-glucosidase inhibitor, on insulin release and insulin sensitivity in elderly patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Elderly patients with type 2 diabetes were randomly treated in a double-blind fashion with placebo (n = 23) or acarbose (n = 22) for 12 months. Before and after randomization, subjects underwent a meal tolerance test and a hyperglycemic glucose clamp study designed to measure insulin release and sensitivity.

RESULTS

After 12 months of therapy there was a significant difference in the change in fasting plasma glucose levels (0.2 +/- 0.3 vs. -0.5 +/- 0.2 mmol/l, placebo vs. acarbose group, respectively; P < 0.05) and in incremental postprandial glucose values (-0.4 +/- 0.6 vs. -3.5 +/- 0.6 mmol/l, placebo vs. acarbose group, P < 0.001) between groups. There was a significant difference in the change in HbA(1c) values in response to treatment (0.4 +/- 0.2 vs. -0.4 +/- 0.1%, placebo vs. acarbose group, P < 0.01). The change in fasting insulin in response to treatment (-2 +/- 2 vs. -13 +/- 4 pmol/l, placebo vs. acarbose group, P < 0.05) and incremental postprandial insulin responses (-89 +/- 26 vs. -271 +/- 59 pmol/l, placebo vs. acarbose group, P < 0.01) was also significantly different between groups. During the hyperglycemic clamps, glucose and insulin values were similar in both groups before and after therapy However, there was a significant difference in the change in insulin sensitivity in response to treatment between the placebo and the acarbose groups (0.001 +/- 0.001 vs. 0.004 +/- 0.001 mg/kg x min(-1) [pmol/l](-1), respectively, P < 0.05)

CONCLUSIONS

Acarbose increases insulin sensitivity but not insulin release in elderly patients with diabetes.

Practical aspects of implementing increased dietary fiber intake

Two hundred twenty dietitians participated in a workshop conference on Health Implications of Dietary Fiber. They were given lectures to increase their knowledge base, and then in group sessions answered questions and wrote concensus opinions. The results are the content of this paper. The topics covered and responses are reported in four categories, diabetes and obesity, hyperlipidemia, hypertension and coronary heart disease, gut function and gastrointestinal disease, and cancer. Specific recommendation for implementing high fiber diets are made in each category. However, the dietitians expressed caution on accepting all of the conclusions expressed in the literature on the value of fiber and believed much education and instruction is needed in order to increase dietary fiber intake.