Glycemic index of a nutritional supplement designed for people with chronic kidney disease.

The study was carried out to measure the glycemic index (GI) of an oral food supplement for people with CKD as well as on patients on maintenance dialysis. The study was conducted as per international protocols for testing GI, was approved by the local institutional ethics committee, and was registered with the Clinical Trial Registry of India (CTRI). This was a crossover randomized controlled study which enrolled 15 participants between the ages of 18 and 45 years. The participants were randomly allotted to one group that consumed either the reference food (27.5 g of glucose monohydrate) or 118 g of the nutritional supplement which contained 25 g of available carbohydrates. Fasting capillary blood samples as well as blood samples at different time intervals as per the GI protocol, after consumption of either the supplement or the reference food were taken from the participants. Each testing day was separated by a 3-day washout period. GI was calculated from the incremental area under the blood glucose response elicited by the nutritional supplement as a percentage of the response after the consumption of 25 g of glucose (27.5 g of glucose monohydrate) by the same participant using a standard formula. The GI of the nutritional supplement was calculated to be 10.3 ± 2.0 which is considered to be low as per international GI testing standards. The product was created to supplement the diet of people with CKD at different stages and to help prevent the progression from CKD to ESRD as well as the risk for CVD. This product was found to have a low GI which is desirable for people with CKD as well as diabetics in general who are at risk for developing CKD.

Are Unhealthy Diets Contributing to the Rapid Rise of Type 2 Diabetes in India?

The prevalence of diabetes is increasing at an alarming rate globally, particularly in India. In the urban areas, the prevalence of diabetes among adults aged ≥20 y, which was around 2% in the early 1970's, has increased by >20% in 50 y. The rapid nutrition transition due to high economic growth rates increased urbanization and globalization has resulted in higher intakes of processed refined grain staples, mainly white rice in Southern and Eastern India and refined wheat in Northern and Western India. This coupled with inadequate quantity and quality of protein; unhealthy fats; lower intake of vegetables, fruits, and fiber; and a sedentary lifestyle are the main drivers of the diabetes epidemic in India. This review attempts to discuss both the quality and quantity of Indian diets with specific reference to macronutrients. This review also outlines some of the strategies that can be employed to slow down the diabetes epidemic in this region. We believe that the lessons learned from India would be applicable to other developing nations as well, particularly to the South East Asian region.

Higher Intake of Dairy Is Associated with Lower Cardiometabolic Risks and Metabolic Syndrome in Asian Indians.

There is conflicting evidence about the association between dairy products and cardiometabolic risk (CMR). We aimed to assess the association of total dairy intake with CMR factors and to investigate the association of unfermented and fermented dairy intake with CMR in Asian Indians who are known to have greater susceptibility to type 2 diabetes and cardiovascular diseases compared to white Europeans. The study comprised 1033 Asian Indian adults with normal glucose tolerance chosen from the Chennai Urban Rural Epidemiological Study (CURES). Dietary intake was assessed using a validated open-ended semi-quantitative food frequency questionnaire. Metabolic syndrome (MS) was diagnosed based on the new harmonising criteria using central obesity, dyslipidaemia [low high-density lipoprotein cholesterol (HDL) and increased serum triglycerides (TG)], hypertension and glucose intolerance. Increased consumption of dairy (≥5 cups per day of total, ≥4 cups per day of unfermented or ≥2 cups per day of fermented dairy) was associated with a lower risk of high fasting plasma glucose (FPG) [hazards ratio (HR), 95% confidence interval (CI): 0.68, 0.48−0.96 for total dairy; 0.57, 0.34−0.94 for unfermented dairy; and 0.64, 0.46−0.90 for fermented dairy; p < 0.05 for all] compared to a low dairy intake (≤1.4 cups per day of total dairy; ≤1 cup per day of unfermented dairy; and ≤0.1 cup per day of fermented dairy). A total dairy intake of ≥5 cups per day was also protective against high blood pressure (BP) (HR: 0.65, 95% CI: 0.43−0.99, p < 0.05), low HDL (HR: 0.63, 95% CI: 0.43−0.92, p < 0.05) and MS (HR: 0.71, 95% CI: 0.51−0.98, p < 0.05) compared to an intake of ≤1.4 cups per day. A high unfermented dairy intake (≥4 cups per day) was also associated with a lower risk of high body mass index (BMI) (HR: 0.52, 95% CI: 0.31−0.88, p < 0.05) compared to a low intake (≤1 cup per day), while a reduced risk of MS was observed with a fermented dairy intake of ≥2 cups per day (HR: 0.71, 95% CI: 0.51−0.98, p < 0.05) compared to an intake of ≤0.1 cup per day. In summary, increased consumption of dairy was associated with a lower risk of MS and components of CMR.

Carbohydrate profiling & glycaemic indices of selected traditional Indian foods.

Background & objectives: Consumption of high glycaemic index (GI) food is associated with a high risk for diabetes. There is a felt need to understand the GI of common Indian traditional foods using standard GI protocols. The present study was aimed to analyse the carbohydrate profile of common traditional Indian food preparation and to determine their GI using standardized protocols. Methods: Twelve food preparations made of millets, wheat, maize and pulses were evaluated for nutrient composition including detailed carbohydrate profiling and tested for GI in healthy volunteers using standard methodology. Capillary blood glucose responses for the test foods containing 50 g available carbohydrates were recorded and compared to the reference food (50 g glucose). GI was calculated from the incremental area under the curve (IUAC) for the test and reference foods. Results: Available carbohydrate content of the food preparations ranged between 13.6 and 49.4 g per cent. Maize roti showed the highest total dietary fibre (7.5 g%). White chick pea 'sundal' showed highest resistant starch content (3.95 g%). Amongst the 12 test foods, five fell in the high GI category (finger millet balls, sorghum, pearl millet and maize roti), four in the medium GI category (sorghum idli, wheat dosa, methi roti and adai) and three in the low GI category (broken wheat upma, white peas sundal and white chick peas sundal). Interpretation & conclusions: Merely being a whole grain-based food does not qualify for a lower GI. The method of processing, food structural integrity and preparation could influence the GI. The type and quality of fibre are important than the quantity of fibre alone. Judicious planning of accompaniments using low GI legumes may favourably modify the glycaemic response to high GI foods in a meal.

Effect of almond consumption on insulin sensitivity and serum lipids among Asian Indian adults with overweight and obesity- A randomized controlled trial.

Background: Asian Indians have an increased susceptibility to type 2 diabetes and premature coronary artery disease. Nuts, like almonds, are rich in unsaturated fat and micronutrients with known health benefits. Objectives: This study aimed to assess the efficacy of almonds for reduction of insulin resistance and improving lipid profile in overweight Asian Indian adults. Methods: This parallel-arm, randomized, controlled trial was conducted in Chennai, India on 400 participants aged 25-65 years with a body mass index ≥ 23 kg/m2. The intervention group received 43 g of almonds/day for 12 weeks, while the control group was advised to consume a customary diet but to avoid nuts. Anthropometric, clinical, and dietary data were assessed at periodic intervals. Glucose tolerance, serum insulin, glycated hemoglobin, C-peptide and lipid profile were assessed at baseline and end of the study. Insulin resistance (homeostasis assessment model-HOMA IR) and oral insulin disposition index (DIo) were calculated. Results: A total of 352 participants completed the study. Significant improvement was seen in DIo [mean (95% CI) = + 0.7 mmol/L (0.1, 1.3); p = 0.03], HOMA IR (-0.4 (-0.7, -0.04; p = 0.03) and total cholesterol (-5.4 mg/dl (-10.2, -0.6); p = 0.03) in the intervention group compared to the control group. Incremental area under the curve (IAUC) and mean amplitude of glycemic excursion (MAGE) assessed using continuous glucose monitoring systems were also significantly lower in the intervention group. Dietary 24-h recalls showed a higher significant reduction in carbohydrate and increase in mono unsaturated fatty acid (MUFA) and polyunsaturated fatty acids (PUFA) intake in the intervention group compared to the control group. Conclusion: Daily consumption of almonds increased the intake of MUFA with decrease in carbohydrate calories and decreases insulin resistance, improves insulin sensitivity and lowers serum cholesterol in Asian Indians with overweight/obesity. These effects in the long run could aid in reducing the risk of diabetes and other cardiometabolic disease.

Glycemic index of pulses and pulse-based products: a review.

Pulses are a major source for plant-based proteins, with over 173 countries producing and exporting over 50 million tons annually. Pulses provide many of the essential nutrients and vitamins for a balanced and healthy diet, hence are health beneficial. Pulses have been known to lower glycemic index (GI), as they elicit lower post prandial glycemic responses, and can prevent insulin resistance, Type 2 diabetes and associated complications. This study reviews the GI values (determined by in vivo methodology) reported in 48 articles during the year 1992-2018 for various pulse type preparations consumed by humans. The GI ranges (glucose and bread as a reference respectively) for each pulse type were: broad bean (40 ± 5 to 94 ± 4, 75 to 93), chickpea (5 ± 1 to 45 ± 1, 14 ± 3 to 96 ± 21), common bean (9 ± 1 to 75 ± 8, 18 ± 2 to 99 ± 11), cowpea (6 ± 1 to 56 ± 0.2, 38 ± 19 to 66 ± 7), lentil (10 ± 3 to 66 ± 6, 37 to 87 ± 6), mung bean (11 ± 2 to 90 ± 9, 28 ± 1 to 44 ± 6), peas (9 ± 2 to 57 ± 2, 45 ± 8 to 93 ± 9), pigeon peas (7 ± 1 to 54 ± 1, 31 ± 4), and mixed pulses (35 ± 5 to 66 ± 23, 69 ± 42 to 98 ± 29). It was found that the method of preparation, processing and heat applications tended to affect the GI of pulses. In addition, removal of the hull, blending, grinding, milling and pureeing, reduced particle size, contributed to an increased surface area and exposure of starch granules to the amylolytic enzymes. This was subsequently associated with rapid digestion and absorption of pulse carbohydrates, resulting in a higher GI. High or increased heat applications to pulses were associated with extensive starch gelatinization, also leading to a higher GI. The type of reference food used (glucose or white bread) and the other nutrients present in the meal also affected the GI.

Assessment of quality of minor millets available in the south Indian market & glycaemic index of cooked unpolished little & foxtail millet.

BACKGROUND & OBJECTIVES: : Millets are widely marketed as healthier alternatives to white rice (WR). This study was conducted with two aims: firstly, to look at the nature and quality of minor millets available in the Chennai market and secondly, to estimate the glycaemic index (GI) of unpolished forms of the two most widely available minor millets, i.e. little (LM) and foxtail millet (FXM). METHODS: : A market survey was conducted of 100 food stores in four zones of Chennai, south India. Morphological features of market millet samples were compared with that of unpolished millets under stereo-zoom microscope, and the claims declared on the pack were evaluated. A consumer perception survey was conducted among 20 minor millet-consuming female homemakers. Finally, the GI of unpolished LM and FXM was evaluated using a validated protocol in 12 healthy volunteers. RESULTS: : Forty eight brands of minor millets were available, with LM and FXM being the most common. Most of the millet samples were identified as highly polished grains using stereo-zoom microscope. The product labels were misleading and showed no scientific backing for claims mentioned on the label. Most participants (12 of 20) were unaware of the fact that millets can also be polished like rice. Both LM and FXM exhibited high GI (88.6±5.7 and 88.6±8.7, respectively). INTERPRETATION & CONCLUSIONS: The availability and knowledge regarding unpolished millets was low. Both LM and FXM exhibited high GI. Hence, substituting millets for WR might be of limited benefit considering the glycaemic property in the prevention and management of chronic non-communicable diseases such as T2DM.

Cashew Nut Consumption Increases HDL Cholesterol and Reduces Systolic Blood Pressure in Asian Indians with Type 2 Diabetes: A 12-Week Randomized Controlled Trial.

Background: There is increasing evidence that nut consumption decreases the risk of cardiovascular disease. However, there are few data on the health effects of cashew nuts among adults with type 2 diabetes (T2DM). Objective: The study aimed to investigate the effects of cashew nut supplementation on glycemia, body weight, blood pressure, and lipid profile in Asian Indians with T2DM. Methods: In a parallel-arm, randomized controlled trial, 300 adults with T2DM [mean ± SD age: 51 ± 9.3 y; body mass index (BMI; in kg/m2): 26.0 ± 3.4; 55% male] were randomly assigned to receive advice to follow a standard diabetic diet (control) or similar advice plus 30 g cashew nuts/d (intervention) for 12 wk. The macronutrient composition of the prescribed diabetic diet was 60-65% energy from carbohydrates, 15-25% from fat, and the rest from protein. Differences between groups in changes in anthropometric and biochemical variables were analyzed using linear models with robust variance estimation under an assumed independence working correlation. Results: Participants in the intervention group had a greater decrease in systolic blood pressure from baseline to 12 wk than did controls (-4.9 ± 13.7 compared with -1.7 ± 11.6 mm Hg; P = 0.04) and a greater increase in plasma HDL cholesterol compared with controls (+1.7 ± 5.6 compared with +0.1 ± 4.6 mg/dL; P = 0.01). There were no differences between the groups with respect to changes in body weight, BMI, blood lipid, and glycemic variables. Plasma oleic acid concentrations and self-reported dietary intake of nuts, oleic acid, and monounsaturated fatty acids suggested excellent compliance with the nut consumption. Conclusion: Cashew nut supplementation in Asian Indians with T2DM reduced systolic blood pressure and increased HDL cholesterol concentrations with no deleterious effects on body weight, glycemia, or other lipid variables. This study was registered at the clinical trial registry of India as CTRI/2017/07/009022.

Development and evaluation of nutritional, sensory and glycemic properties of finger millet (Eleusine coracana L.) based food products.

BACKGROUND AND OBJECTIVES: Finger millet (Eleusine coracana L.) (FM) is rich in dietary fibre and is therefore expected to elicit a lower glycemic response compared to other grains. However, there is little data on the glycemic properties of FM-based products. We evaluated the nutritional, sensory and glycemic properties of decorticated millet with lower polish (DFM-LDP), flakes (FMF), vermicelli (FMV) and extruded snack (FMES) (both FMV and FMES with 7-8% added soluble fibre). METHODS AND STUDY DESIGN: The nutrient contents of the FM products were evaluated by standard AOAC (Association of Official Analytical Chemists) and AACC (American Association of Cereal Chemists) methods. Sensory evaluation was conducted monadically using a 9-point hedonic scale using untrained panel members. GI testing was conducted using a standardized validated protocol. The study was conducted according to the guidelines laid down by the Declaration of Helsinki, and was approved by the Ethics Committee of the Madras Diabetes Research Foundation. RESULTS: The products had dietary fibre (DF) content between 5.8-15.6 g%. FMES was unique in having a very low fat content (0.17%). Evaluation of sensory perception revealed moderate acceptance of millet based products. The glycemic indices (GI) (mean±SEM) of the products were 84.7±7.7%, 82.3±6.4%, 65.5±5.1% and 65.0±6.6% for DFM-LDP, FMF, FMV and FMES respectively. CONCLUSIONS: DFM-LDP and FMF (purely finger millet based products) elicited higher glycemic responses. Comparatively, FMV and FMES (with added functional ingredients) exhibited medium GI values and, are healthier dietary options. It is possible to prepare FM products with lower GI by utilizing functional ingredients.

Even minimal polishing of an Indian parboiled brown rice variety leads to increased glycemic responses.

BACKGROUND AND OBJECTIVES: To evaluate the effect of polishing on the glycemic properties of Indian parboiled brown rice. METHODS AND STUDY DESIGN: We evaluated the effect of different degrees of polishing on the glycemic and insulinemic responses of Bapatla (BPT-5204), Indian parboiled Indica rice variety. Brown rice (BR), under milled rice (UMR) and white rice (WR) with 2.3% and 9.7% degree of polishing (DOP), respectively, were prepared and evaluated for the glycemic properties. Incremental Area Under the Curves (IAUC) were estimated for both glycemic index (GI) in 12 healthy participants (6 men, 6 women) and 24 hr glycemic response studies in 13 overweight participants (5 men, 8 women) using continuous glucose monitoring (CGM) system with ≈2000 kcal/day rice diets. Differences in pre and post meal insulin (Δ) were assessed. RESULTS: The GI of WR (GI=79.6) and UMR (GI=73) were significantly higher than BR (GI=57.6) (p<0.01). Similar results were obtained for 24 hr glycemic responses [IAUC: WR=58.4, UMR=55.5, BR=34.7 mg*5 min/dL, respectively]. The Δ Insulin responses were lower with BR meals compared with UMR and WR (p=0.025; p=0.003). CONCLUSIONS: Both UMR and WR had a high GI while BR had a medium GI. This could have influenced the 24 h glycaemic and insulinemic responses of BR which had the lowest responses as compared with UMR and WR, and the latter two had similar higher responses. Thus any degree of polishing leads to higher glycaemic responses.

Glycemic Index of a Novel High-Fiber White Rice Variety Developed in India--A Randomized Control Trial Study.

BACKGROUND: White rice, a common Indian staple, has a high glycemic response and is associated with high risk of type 2 diabetes. The aim of this study was to compare the Glycemic Index (GI) of a newly developed high-fiber white rice (HFWR) with that of commercial white rice (WR). MATERIALS AND METHODS: HFWR was developed using biochemical screening approaches and classical plant breeding techniques. The GI of HFWR was determined using a validated protocol in 30 healthy participants in the year 2013 and repeated in a subsample of 15 participants in the year 2014; the results were compared with the value for WR. The incremental area under the curve was calculated geometrically by applying the trapezoid rule for both reference food (glucose) and the test foods (HFWR and WR). Proximate principles along with dietary fiber, resistant starch, and amylose content were analyzed using standardized methods. RESULTS: The dietary fiber content of HFWR was fivefold higher (8.0 ± 0.1 vs. 1.58 ± 0.17 g%), resistant starch content was 6.5-fold higher (3.9 ± 0.2 vs. 0.6 ± 0.03 g%) (P < 0.001), and amylose content was significantly higher (32.8 ± 1.1 vs. 26.0 ± 0.2 g%) (P < 0.001), compared with WR. HFWR was found to be of medium GI (61.3 ± 2.8), whereas WR was of high GI (79.2 ± 4.8). Overall, HFWR had 23% lower GI compared with WR (P = 0.002). CONCLUSIONS: The new HFWR variety can be considered as a potentially healthier alternative to commercial WR in rice-eating populations, on account of its lower GI and high fiber content.

Amelioration of hyperglycaemia and its associated complications by finger millet ( Eleusine coracana L.) seed coat matter in streptozotocin-induced diabetic rats.

Finger millet (Eleusine coracana) is extensively cultivated and consumed in India and Africa. The millet seed coat is a rich source of dietary fibre and phenolic compounds. The effect of feeding a diet containing 20% finger millet seed coat matter (SCM) was examined in streptozotocin-induced diabetic rats. Diabetic rats maintained on the millet SCM diet (diabetic experimental (DE) group) for 6 weeks exhibited a lesser degree of fasting hyperglycaemia and partial reversal of abnormalities in serum albumin, urea and creatinine compared with the diabetic control (DC) group. The DE group of rats excreted comparatively lesser amounts of glucose, protein, urea and creatinine and was accompanied by improved body weights compared with their corresponding controls. Hypercholesterolaemia and hypertriacylglycerolaemia associated with diabetes were also notably reversed in the DE group. Slit lamp examination of the eye lens revealed an immature subcapsular cataract with mild lenticular opacity in the DE group of rats compared to the mature cataract with significant lenticular opacity and corneal vascularisation in the DC group. Lower activity of lens aldose reductase, serum advanced glycation end products and blood glycosylated Hb levels were observed in the DE group. The millet SCM feeding showed pronounced ameliorating effects on kidney pathology as reflected by near normal glomerular and tubular structures and lower glomerular filtration rate compared with the shrunken glomerulus, tubular vacuolations in the DC group. Thus, the present animal study evidenced the hypoglycaemic, hypocholesterolaemic, nephroprotective and anti-cataractogenic properties of finger millet SCM, suggesting its utility as a functional ingredient in diets for diabetics.

Glycemic response of rice, wheat and finger millet based diabetic food formulations in normoglycemic subjects.

Food formulations suitable as dietary supplements to diabetic subjects based on wheat, decorticated finger millet, popped (aralu) and expanded (puri) rice each blended separately with legumes, non-fat dry milk, vegetable oils, spices and a few hypoglycemic ingredients were formulated. The formulations contained 13.0-18.3% protein, 11.3-11.8% fat, 59.9-67.5% starch and 13.2-18.0% dietary fiber. A 50-g equivalent carbohydrate portion of the foods in the form of thick porridge was provided to eight healthy adult subjects and the postprandial blood glucose response was determined. The Glycemic Index (GI) values were 55.4+/-9, 93.4+/-7, 105+/-6 and 109+/-8 for wheat-based, millet-based, aralu-based and puri-based formulations. The variations in the GI could be attributed to the nature of available as well as non-available (non-starchy polysaccharides) carbohydrates in the foods besides the processing undergone by the cereal ingredients. The higher GI of rice formulations could be due to the easily digestible nature of starches and also their lower dietary fiber contents. The study revealed the suitability of wheat-based formulation as a food supplement or as meal replacer in diabetic subjects but the unsuitability of rice-based formulations.