Selenium - An environmentally friendly micronutrient in agroecosystem in the modern era: An overview of 50-year findings.

Agricultural productivity is constantly being forced to maintain yield stability to feed the enormously growing world population. However, shrinking arable and nutrient-deprived soil and abiotic and biotic stressor (s) in different magnitudes put additional challenges to achieving global food security. Though well-defined, the concept of macro, micronutrients, and beneficial elements is from a plant nutritional perspective. Among various micronutrients, selenium (Se) is essential in small amounts for the life cycle of organisms, including crops. Selenium has the potential to improve soil health, leading to the improvement of productivity and crop quality. However, Se possesses an immense encouraging phenomenon when supplied within the threshold limit, also having wide variations. The supplementation of Se has exhibited promising outcomes in lessening biotic and abiotic stress in various crops. Besides, bulk form, nano-Se, and biogenic-Se also revealed some merits and limitations. Literature suggests that the possibilities of biogenic-Se in stress alleviation and fortifying foods are encouraging. In this article, apart from adopting a combination of a conventional extensive review of the literature and bibliometric analysis, the authors have assessed the journey of Se in the "soil to spoon" perspective in a diverse agroecosystem to highlight the research gap area. There is no doubt that the time has come to seriously consider the tag of beneficial elements associated with Se, especially in the drastic global climate change era.

Multi-Population Analysis for Leaf and Neck Blast Reveals Novel Source of Neck Blast Resistance in Rice.

Rice blast is one of the most devastating biotic stresses that limits rice productivity. The North Eastern Hill (NEH) region of India is considered to be one of the primary centres of diversity for both rice and pathotypes of Magnaporthe grisea. Therefore, the present study was carried out to elucidate the genetic basis of leaf and neck blast resistance under Meghalaya conditions. A set of 80 diverse genotypes (natural population) and 2 F2 populations involving resistant parent, a wildtype landrace, LR 5 (Lal Jangali) and susceptible genotypes Sambha Mahsuri SUB 1 (SMS) and LR 26 (Chakhao Poireiton) were used for association analysis of reported major gene-linked markers with leaf and neck blast resistance to identify major effective genes under local conditions. Genotyping using twenty-five gene-specific markers across diverse genotypes and F2 progenies revealed genes Pi5 and Pi54 to be associated with leaf blast resistance in all three populations. Genes Pib and qPbm showed an association with neck blast resistance in both natural and LR 5 × SMS populations. Additionally, a set of 184 genome-wide polymorphic markers (SSRs and SNPs), when applied to F2-resistant and F2-susceptible DNA bulks derived from LR 5 × LR 26, suggested that Pi20(t) on chromosome 12 is one of the major genes imparting disease resistance. Markers snpOS318, RM1337 and RM7102 and RM247 and snpOS316 were associated with leaf blast and neck blast resistance, respectively. The genotypes, markers and genes will help in marker-assisted selection and development of varieties with durable resistance.

Insight into a region of chickpea (Cicer arietinum L.) Chromosome 2 revealed potential candidate genes linked to Foc4 Fusarium wilt resistance.

Two markers on Chromosome 2 of chickpea (Cicer arietinum ) are reportedly associated with resistance to race 4 Fusarium wilt, and are frequently used in breeding. However, the genes in this region that actually confer wilt resistance are unknown. We aimed to characterise them using both in silico approaches and marker trait association (MTA) analysis. Of the 225 protein-encoding genes in this region, 51 showed significant differential expression in two contrasting chickpea genotypes under wilt, with potential involvement in stress response. From a diverse set of 244 chickpea genotypes, two sets of 40 resistant and 40 susceptible genotypes were selected based on disease incidence and amplification pattern of the TA59 marker. All cultivars were further genotyped with 1238 single nucleotide polymorphisms (SNPs) specific to the 51 genes; only seven SNPs were significantly correlated with disease. SNP Ca2_24099002, specific to the LOC101498008 (Transmembrane protein 87A) gene, accounted for the highest phenotypic variance for disease incidence at 16.30%, whereas SNPs Ca2_25166118 and Ca2_27029215, specific to the LOC101494644 (ß-glucosidase BoGH3B-like) and LOC101505289 (Putative tRNA pseudouridine synthase) genes, explained 10.51% and 10.50% of the variation, respectively, in the sets with contrasting disease susceptibility. Together with the TA59 and TR19 markers, these SNPs can be used in a chickpea breeding scheme to develop wilt resistance.

Time trends of cigarette and waterpipe smoking among a cohort of school children in Irbid, Jordan, 2008-11.

BACKGROUND: Coordinated high-impact interventions and community-level changes in smoking behaviour norms effectively reduced prevalence of smoking among youth in many developed countries. Smoking trends among Jordanian adolescents are likely different than their Western counterparts and must be understood in the context of their daily lives to tailor interventions specifically for adolescents in this setting. METHODS: Between 2008 and 2011, a school-based longitudinal study was conducted in Irbid, Jordan. All seventh-grade students in 19 randomly selected schools (of 60) were surveyed annually for 4 years. Outcomes of interest were time trends in smoking behaviour, age at initiation and change in frequency of smoking. RESULTS: Among 1781 participants, baseline prevalence of current smoking (cigarettes or waterpipe) for boys was 22.9% and 8.7% for girls. Prevalence of ever-smoking and current any smoking, cigarette smoking, waterpipe smoking and dual cigarette/waterpipe smoking was significantly higher in boys than girls each year (P < 0.001). Smoking prevalence increased every year after year 2 for current smoking (P < 0.05) across all methods (any, cigarette, waterpipe and dual). At all time points for both boys and girls, prevalence of waterpipe smoking was higher than that of cigarette smoking (P < 0.001). CONCLUSION: This study shows intensive smoking patterns at early ages among Jordanian youth in Irbid, characterized by a predominance of waterpipe smoking and steeper age-related increase in cigarette smoking. It also points to the possibility of waterpipe being the favourite method for introducing youth to tobacco, as well as being a vehicle for tobacco dependence and cigarette smoking.

Effect of the COVID-19 Pandemic on Place of Death Among Medicaid and Commercially Insured Patients With Cancer in Washington State.

PURPOSE: The COVID-19 pandemic-related disruptions in health care delivery might have affected end-of-life care in patients with cancer. We examined changes in place of death and hospice support for Medicaid and commercially insured patients during the pandemic. PATIENTS AND METHODS: We linked Washington State cancer registry records with claims from Medicaid and two commercial insurers for patients with solid tumor age 18-64 years. The study included 322 Medicaid and 162 commercial patients who died between March 2017 and June 2019 (pre-COVID-19), along with 90 Medicaid and 47 commercial patients who died between March and June 2020 (COVID-19). Place of death was categorized as hospital, hospice (home or nonhospital facility), and home without hospice. Place of death was compared using adjusted multinomial logistic regressions stratified by payer and time period (pre-COVID-19 v COVID-19). The clinical and sociodemographic factors associated with dying at home without hospice were examined, and adjusted marginal effects (ME) are reported. RESULTS: In the adjusted pre-COVID-19 analysis, Medicaid patients were more likely than commercially insured patients to die in hospital (48% v 36%; adjusted ME, 11%; P = .02). In the pre-COVID-19/COVID-19 analysis, Medicaid patients' place of death shifted from hospital (48% v 32%; ME, -16%; P < .01) to home without hospice (19.9% v 38.0%; ME, 16.5%; P < .01). However, there were no statistically significant changes pre-COVID-19/COVID-19 for commercial patients. As a result, during COVID-19, Medicaid patients were more likely than commercial patients to die at home without hospice (38% v 22%; ME, 16%; P = .04) as were male versus female patients (ME, 16%; P < .01). CONCLUSION: The pandemic might have disproportionately worsened the end-of-life experience for Medicaid enrollees with cancer. Attention should be paid to societal and health system factors that decrease access to care for Medicaid patients.

Shoot transcriptome revealed widespread differential expression and potential molecular mechanisms of chickpea (Cicer arietinum L.) against Fusarium wilt.

Introduction: The yield of chickpea is severely hampered by infection wilt caused by several races of Fusarium oxysporum f. sp. ciceris (Foc). Methods: To understand the underlying molecular mechanisms of resistance against Foc4 Fusarium wilt, RNA sequencing-based shoot transcriptome data of two contrasting chickpea genotypes, namely KWR 108 (resistant) and GL 13001 (susceptible), were generated and analyzed. Results and Discussion: The shoot transcriptome data showed 1,103 and 1,221 significant DEGs in chickpea genotypes KWR 108 and GL 13001, respectively. Among these, 495 and 608 genes were significantly down and up-regulated in genotypes KWR 108, and 427 and 794 genes were significantly down and up-regulated in genotype GL 13001. The gene ontology (GO) analysis of significant DEGs was performed and the GO of the top 50 DEGs in two contrasting chickpea genotypes showed the highest cellular components as membrane and nucleus, and molecular functions including nucleotide binding, metal ion binding, transferase, kinase, and oxidoreductase activity involved in biological processes such as phosphorylation, oxidation-reduction, cell redox homeostasis process, and DNA repair. Compared to the susceptible genotype which showed significant up-regulation of genes involved in processes like DNA repair, the significantly up-regulated DEGs of the resistant genotypes were involved in processes like energy metabolism and environmental adaptation, particularly host-pathogen interaction. This indicates an efficient utilization of environmental adaptation pathways, energy homeostasis, and stable DNA molecules as the strategy to cope with Fusarium wilt infection in chickpea. The findings of the study will be useful in targeting the genes in designing gene-based markers for association mapping with the traits of interest in chickpea under Fusarium wilt which could be efficiently utilized in marker-assisted breeding of chickpea, particularly against Foc4 Fusarium wilt.

Morphological characterization and expression analysis of genes for antioxidants enzymes in gamma rays induced M3 mutants of sunflower (Helianthus annuus L.) cultivar TNAUSUF-7.

PURPOSE: Objectives of the present investigation were to investigate the performance of mutant lines (mutant generation 3 (M3) generation) of sunflower obtained through gamma irradiations for yield and yield attributing traits including oil content (%), oil quality in terms of antioxidant activity and to investigate the expression of genes encoding antioxidant enzymes in control and gamma irradiated M3 lines. MATERIALS AND METHODS: Mutant lines (M3 generation) of sunflower variety TNAUSUF-7 obtained from 100 and 130 Gray (Gy) doses of gamma irradiation were evaluated for several traits such as days to 50% flowering, days to maturity, head diameter, number of filled seeds and unfilled seeds per head, fertility %, oil content %, antioxidant activity of oil and expression of genes encoding antioxidant enzymes. All the data were analyzed using different statistical tools. RESULTS: Our results showed that the gamma irradiation dose of 100 and 130 Gy induced significant variations in yield and yield attributing traits especially for days to 50% flowering, days to maturity, fertility %, antioxidant property of sunflower seed oil and expression of genes encoding antioxidant enzymes. CONCLUSIONS: From our results, it can be concluded that the gamma irradiations were effective in creating variations in terms of several traits in sunflower. Many desirable traits like reduced days to 50% flowering and maturity, increased fertility %, increased antioxidant activity of oil were observed in M3 lines. These M3 lines have the potential to be utilized as an inbred line in sunflower hybrid development or it could be used as a source of desirable traits in sunflower breeding programs.

Primary School Educators' Perspectives and Experiences of Nature-Based Play and Learning and Its Benefits, Barriers, and Enablers: A Qualitative Descriptive Study.

Nature-based play and learning is of increasing interest to primary schools and research suggests that it has many potential benefits for children's health and development. However, little is known about educators' perspectives and experiences of nature-based play and learning, particularly the barriers, benefits and enablers, despite their direct relevance to the uptake of nature-based play and learning in schools. A qualitative descriptive methodology was employed to uncover these. Individual, semi-structured interviews were conducted with 12 principals and educators from South Australian public primary schools, recruited via a participant contact list from a previous study. The participants were two principals, eight educators and two individuals with dual principal and educator positions. Metropolitan and rural schools were equally represented. Interviews were audio-taped, transcribed verbatim and analysed using thematic analysis. Analysis identified four overarching themes: the practice, perceived benefits, barriers and enablers of nature-based play and learning. Children's learning, enjoyment, creativity, and a relaxed and flexible environment were clear benefits. Meanwhile educator knowledge and confidence and the crowded curriculum were barriers. Enablers were nature-based play and learning champions and support from school leadership. The findings suggest that schools can help engage students with nature-based play and learning activities by mitigating these barriers and promoting these enablers.

Egg consumption as part of an energy-restricted high-protein diet improves blood lipid and blood glucose profiles in individuals with type 2 diabetes.

The role of dietary cholesterol in people with diabetes has been little studied. We investigated the effect of a hypoenergetic high-protein high-cholesterol (HPHchol) diet compared to a similar amount of animal protein (high-protein low-cholesterol, HPLchol) on plasma lipids, glycaemic control and cardiovascular risk markers in individuals with type 2 diabetes. A total of sixty-five participants with type 2 diabetes or impaired glucose tolerance (age 54·4 (sd 8·2) years; BMI 34·1 (sd 4·8) kg/m2; LDL-cholesterol (LDL-C) 2·67 (sd 0·10) mmol/l) were randomised to either HPHchol or HPLchol. Both hypoenergetic dietary interventions (6-7 MJ; 1·4-1·7 Mcal) and total carbohydrate:protein:fat ratio of 40:30:30 % were similar but differed in cholesterol content (HPHchol, 590 mg cholesterol; HPLchol, 213 mg cholesterol). HPHchol participants consumed two eggs per d, whereas HPHchol participants replaced the eggs with 100 g of lean animal protein. After 12 weeks, weight loss was 6·0 (sd 0·4) kg (P < 0·001). LDL-C and homocysteine remained unchanged. All the subjects reduced total cholesterol ( - 0·3 (sd 0·1) mmol/l, P < 0·001), TAG ( - 0·4 (sd 0·1) mmol/l, P < 0·001), non-HDL-cholesterol (HDL-C, - 0·4 (sd 0·1) mmol/l, P < 0·001), apo-B ( - 0·04 (sd 0·02) mmol/l, P < 0·01), HbA1c ( - 0·6 (sd 0·1) %, P < 0·001), fasting blood glucose ( - 0·5 (sd 0·2) mmol/l, P < 0·01), fasting insulin ( - 1·7 (sd 0·7) mIU/l, P < 0·01), systolic blood pressure ( - 7·6 (sd 1·7) mmHg, P < 0·001) and diastolic blood pressure ( - 4·6 (sd 1·0) mmHg; P < 0·001). Significance was not altered by diet, sex, medication or amount of weight loss. HDL-C increased on HPHchol (+0·02 (sd 0·02) mmol/l) and decreased on HPLchol ( - 0·07 (sd 0·03) mmol/l, P < 0·05). Plasma folate and lutein increased more on HPHchol (P < 0·05). These results suggest that a high-protein energy-restricted diet high in cholesterol from eggs improved glycaemic and lipid profiles, blood pressure and apo-B in individuals with type 2 diabetes.

The Effect of Macronutrients on Reproductive Hormones in Overweight and Obese Men: A Pilot Study.

Hypogonadal obese men find it difficult to lose weight. We investigated whether the modification of macronutrient intake can alter testosterone levels independently of the body mass index. Fasted overweight or obese fertile men were asked to consume meals of polyunsaturated fats (PUFA), monounsaturated fats (MUFA), refined carbohydrates (CHO, orange juice, OJ), whey and egg albumin and mixed meals of PUFA and CHO, PUFA and egg albumin, and CHO and egg albumin. Blood was collected at fasting, then hourly for 5 h and analysed to determine the levels of testosterone and other hormones. We found PUFA and MUFA or a mixed meal of PUFA and CHO significantly reduced serum testosterone production to a similar degree over a 5 h period. PUFA decreased serum testosterone levels by 3.2 nmol/L after 1 h compared to baseline (p = 0.023), with this suppression remaining significant up to 5 h postprandially (2.1 nmol/L; p = 0.012). The net overall testosterone levels were reduced by approximately 10 nmol/L × h by PUFA, MUFA and PUFA combined with CHO. CHO alone had little effect on testosterone levels, whereas egg albumin was able to increase them (7.4 cf 2.0 nmol/L × h). Therefore, for men wishing to optimize their testosterone levels, it may be wise to avoid a high fat intake, drink liquids such as water or OJ or even consider fasting. ANZCTR, Australia; ACTRN12617001034325.

Obesity related metabolic endotoxemia is associated with oxidative stress and impaired sperm DNA integrity.

BACKGROUND: Obesity is known to be associated with inflammation, oxidative stress and a resulting reduction in sperm DNA integrity. Importantly, obesity is also reported to be associated with an increase in intestinal permeability with the passage of intestinal bacteria into the circulation (metabolic endotoxemia) that triggers a systemic state of inflammation and resultant oxidative stress. Therefore, we hypothesised that this obesity related increase in intestinal permeability and resultant metabolic endotoxemia (ME) may activate inflammation within the male reproductive tract, leading to increased reactive oxygen species production, sperm oxidative stress and a decline in DNA integrity. RESULTS: Our pilot study of 37 infertile men confirmed a significant positive correlation between body mass index (BMI), increased intestinal permeability (serum zonulin), metabolic endotoxaemia (LBP), sperm DNA oxidative damage (seminal 8 OhDG) and increasing levels of sperm DNA fragmentation (Halosperm). Metabolic endotoxemia was positively correlated with increasing levels of sperm DNA oxidative damage with this relationship remaining significant, even after adjustment for relevant confounders such as age, BMI and days of abstinence. These observations suggest that metabolic endotoxemia and its associated oxidative stress may be a key driver of sperm DNA damage in obese men. CONCLUSION: This study confirms a link between obesity, increasing intestinal permeability and endotoxin exposure, and oxidative mediated sperm DNA damage. This warrants further investigation to fully understand the effect of metabolic endotoxemia on male reproductive function which could result in the new therapies to improve male fertility potential.

Outcome of Therapeutic Keratoplasty in Hopeless Microbial Keratitis Cases Otherwise Advised Evisceration.

PURPOSE: To study the outcome of therapeutic keratoplasty in severe microbial keratitis cases otherwise advised evisceration. METHODS: A retrospective, single-center clinical audit included 28 patients with severe microbial keratitis presenting from April 2014 to April 2016. Patients with microbial keratitis either affecting more than 2 quadrants of the limbus and/or cases with infections involving more than 180 mm of the cornea who were advised evisceration by more than one ophthalmologist were included. Cases with endophthalmitis were excluded. At 3 months, the outcome was "success" if resolution of infection occurred without recurrence and evisceration was not required. Success was termed "complete" if best vision was 6/24 or better and "partial" otherwise. The outcome was termed a "failure" if infection recurred in the graft or the eye was eviscerated. RESULTS: Mean age of the patients (male:female, 17:11) was 49.5 years, and the mean duration of symptoms before surgery was 28.6 days. Evisceration was required in 2/28 cases. The outcome was "success" in 22/28 cases (78.6%)-complete (10/22); partial (12/22)-and "failure" in 6/28 cases. The outcome was poorer in general in fungal keratitis (n = 16) than bacterial keratitis (n = 7). CONCLUSIONS: Primary evisceration is best avoided in infections limited to the anterior segment. Even in hopeless cases, every eye deserves a fair chance.

Polydrug use among urban adolescent cigarette smokers.

PURPOSE: Adolescent smokers are at increased risk for polydrug use, which is associated with more consequences than use of a single drug. Here we classified subgroups of polydrug use among urban adolescent cigarette-smokers; described the sociodemographic, smoking, and depression correlates; and identified three-year outcomes associated with subgroup membership. METHODS: Adolescent cigarette smokers (N=176; Mage=16.1; 35% male; 27% white) completed surveys assessing drug use, smoking characteristics, demographics, and depressive symptoms at baseline and 12, 24, and 36months follow-up. RESULTS: Almost all participants (96%) reported using, on average, two (SD=0.97) substances (including other tobacco products) in addition to cigarettes. Latent class analysis revealed two distinct classes of polydrug users. "Limited Range Use" (84%) class members reported current use of other tobacco, alcohol, and marijuana, as did "Extended Range Use" class members (16%) who also reported current use of "harder drugs" (i.e., cocaine/crack, hallucinogens, ecstasy, and misused prescriptions). The classes did not differ on demographics or baseline likelihood of marijuana (χ2=0.25; p<0.62) or alcohol use (χ2=3.3; p<0.07). At baseline, a larger proportion of Extended Range Use class members reported both smoking the entire cigarette and symptoms of clinical depression. Extended Range Use class membership at baseline predicted higher mean depression scores at 24 and 36months. CONCLUSION: Adolescent cigarette-smokers who reported extended range use (18%) also reported symptoms of clinical depression at baseline and follow-up. These findings indicate a need for early monitoring of depression symptoms and prevention and cessation interventions targeting this high-risk group.

A 4-week nutrition and therapeutics course in an undergraduate pharmacy program.

OBJECTIVE: To determine the effectiveness of an intensive 4-week nutrition course in increasing the knowledge of undergraduate pharmacy students. DESIGN: A Nutrition and Therapeutics elective course was developed that covered the Australian Guide to Healthy Eating, as well as nutrition labeling, food composition, functional foods, diabetes, cardiovascular disease, nutrition and cancer, osteoporosis, nutrient-drug interactions, nutritional supplements, weight management, and infant feeding. The course was taught using lectures, student-focused tutorials featuring evidence-based practice, problem-based learning exercises, case-based scenarios, media examples, video clips from the lay press, and articles from the professional/scientific literature. ASSESSMENT: A self-administered, validated questionnaire on dietary recommendations, sources of nutrients, choosing everyday foods, and diet-disease relationship was administered prior to and after completion of the course. Students' scores in all 4 areas improved significantly; however, their knowledge of the national dietary recommendations, sources of nutrients, and everyday foods high in nutrients was below that of members of the community. CONCLUSIONS: Nutritional education courses can increase the nutrition knowledge of undergraduate pharmacy students. The need for pharmacists to advise patients regarding nutritional supplements continues to increase the need for incorporating nutrition courses within curriculum.

Continuous glucose monitoring and cognitive performance in type 2 diabetes.

BACKGROUND: Type 2 diabetes is associated with reductions in cognitive function that are associated with glycated hemoglobin (HbA1c) levels, but there is no information on whether cognition is related to postmeal glucose spikes. We explored the relationship of cognition to glucose levels measured by a continuous glucose monitoring system (CGMS) both before and after a weight loss diet. SUBJECTS AND METHODS: Forty-four white subjects with type 2 diabetes (59.0 ± 6.2 years old; body mass index, 32.8 ± 4.2 kg/m(2); HbA1c, 6.9 ± 1.0%) completed an 8-week energy-restricted (approximately 6-7 MJ, 30% deficit) diet. Cognitive functioning (short-term memory, working memory, speed of processing [inspection time], psychomotor speed, and executive function) was assessed during four practice sessions, baseline, and Week 8. Parallel glucose levels were attained using the CGMS in 27 subjects. Outcomes were assessed by fasting blood glucose (FBG), postprandial peak glucose (G(max)), time spent >12 mmol/L (T > 12), and 24-h area under the glucose curve (AUC(24)). RESULTS: Despite a fall in FBG of 0.65 mmol/L after 8 weeks, digits backward results correlated with FBG at both Week 0 and Week 8 (r = -0.43, P < 0.01 and r = -0.32, P < 0.01, respectively). Digits forward results correlated with FBG (r = -0.39, P < 0.01), G(max) (r = -0.46, P < 0.05), and AUC(24) (r = -0.50, P < 0.01) at Week 0 and FBG (r = -0.59, P < 0.001), G(max) (r = 0.37, P = 0.01), AUC(24) (r = -0.41, P < 0.01), and percentage weight loss (r = 0.31, P < 0.01) at Week 8. Cognitive function was not altered by weight loss, gender, baseline lipid levels, or premorbid intelligence levels (National Adult Reading Test). CONCLUSIONS: FBG, G(max,) and AUC(24) were related to cognitive function and an energy-restricted diet for 8 weeks did not alter this relationship.

Effect of carbohydrate distribution on postprandial glucose peaks with the use of continuous glucose monitoring in type 2 diabetes.

BACKGROUND: Large postprandial glucose peaks are associated with increased risk of diabetic complications and cardiovascular disease. OBJECTIVE: We investigated the effect of carbohydrate distribution on postprandial glucose peaks with continuous blood glucose monitoring (CGMS), when consuming a moderate carbohydrate diet in energy balance in subjects with type 2 diabetes. DESIGN: Twenty-three subjects with type 2 diabetes were randomly assigned to each of four 3-d interventions in a crossover design with a 4-d washout period. Identical foods were provided for each treatment with a ratio of total carbohydrate to protein to fat of 40%:34%:26% but differing in carbohydrate content at each meal: even distribution (CARB-E; approximately 70 g carbohydrate), breakfast (CARB-B), lunch (CARB-L), and dinner(CARB-D), each providing approximately 125 g carbohydrate in the loaded meal in a 9-MJ diet. Glucose concentrations were continuously measured with CGMS. Outcomes were assessed by postprandial peak glucose (G(max)), time spent > 12 mmol/L (T > 12), and total area under the glucose curve (AUC(20)). RESULTS: Daily G(max) differed between treatments (P = 0.003) with CARB-L (14.2 +/- 1.0 mmol/L), CARB-E (14.5 +/- 0.9 mmol/L), and CARB-D (14.6 +/- 0.8 mmol/L) being similar but lower than CARB-B (16.5 +/- 0.8 mmol/L). Meal G(max) was weakly related to carbohydrate amount and glycemic load (r = 0.40-0.44). T > 12 differed between treatments (P = 0.014), and a treatment x fasting blood glucose (FBG) interaction (P = 0.003) was observed with CARB-L (184 +/- 74 min) < CARB-B (190 +/- 49 min) < CARB-D (234 +/- 87 min) < CARB-E (262 +/- 91 min). Total AUC(20) was not significantly different between treatments. After adjustment for FBG, treatment became significant (P = 0.006); CARB-L (10 049 +/- 718 mmol/L x 20 h) < CARB-E (10 493 +/- 706 mmol/L x 20 h) < CARB-B (10 603 +/- 642 mmol/L x 20 h) < CARB-D (10 717 +/- 638 mmol/L x 20 h). CONCLUSION: CARB-E did not optimize blood glucose control as assessed by postprandial peaks, whereas CARB-L provided the most favorable postprandial profile.