Alexandra Meynier

Systematic Review and Meta-Analysis of Human Studies to Support a Quantitative Recommendation for Whole Grain Intake in Relation to Type 2 Diabetes.

Background Due to the increasing evidence of their health benefits, whole grains are recommended for consumption worldwide. Such recommendations are, however, rarely quantitative. Our aim was to perform a quantitative evaluation of the relationship between whole grain consumption and the occurrence of type 2 diabetes (T2D) to support a recommendation on the daily consumption of whole grains. Methods and Findings We conducted a systematic review by searching three bibliographic databases. We included human studies addressing the relationship between whole grain consumption and T2D occurrence, and providing quantitative information on daily intake of whole grains. A dose-response meta-regression analysis between whole grain intake and T2D occurrence was performed, using a hierarchical mixed least square linear regression model. Eight observational studies were included (all but one prospective), with a total of 15,573 cases of T2D among 316,051 participants. Quantitative meta-regression demonstrated a significant linear inverse relationship between whole grain intake and T2D occurrence (P<0.0001), with an overall absolute reduction of 0.3% in the T2D rate for each additional 10 g of whole grain ingredient consumed daily. The association persisted when adjusted on sex, age, country, study design, follow up duration, and mode of report of whole grain intakes (as foods or ingredients). Conclusions The meta-regression model made it possible to estimate the decrease in T2D risk corresponding to various changes in whole grain intakes, and the results contribute to setting up quantitative recommendations. For instance, consuming three servings of whole grain foods (45 g of whole grain ingredients) daily would induce a 20% relative reduction in the T2D risk as compared to consuming a half serving (7.5 g of whole grain ingredients). These results should be considered for future recommendations, by considering the actual whole grain intake of the concerned populations. The systematic review protocol was published on the PROSPERO register (CRD42013006925).

Enrichment of biscuits and juice with oat β-glucan enhances postprandial satiety.

Effects of fibre and β-glucan on satiety have been reported in many studies, but no consensus has been reached. The aim of this study was to examine the effects of breakfasts varying in the dose of oat bran (4g or 8g β-glucan). The approach was to study whether the food matrix (solid or liquid) into which the oat bran is incorporated influences postprandial satiety in otherwise similar meal settings. Thirty healthy females were offered four different breakfasts: biscuits+juice (0g β-glucan), enriched biscuits+juice (4g β-glucan), biscuits+enriched juice (4g β-glucan) and enriched biscuits+enriched juice (8g β-glucan) in a random order on separate test days. The sensations associated with hunger and satiety were evaluated using visual analogue scales (VAS) before and after ingesting the test breakfasts and every 30min until 210min. Oat bran addition in breakfasts increased postprandial satiety especially when both juice and biscuits were enriched (8g of β-glucan). Addition of oat bran to juice enhanced satiety and related feelings more effectively than the addition into biscuits.

Cereal Processing Influences Postprandial Glucose Metabolism as Well as the GI Effect

Objective: Technological processes may influence the release of glucose in starch. The aim of this study was to compare the metabolic response and the kinetics of appearance of exogenous glucose from 2 cereal products consumed at breakfast. Methods: Twenty-five healthy men were submitted to a randomized, open, crossover study that was divided into 2 parts: 12 of the 25 subjects were included in the “isotope part,” and the 13 other subjects were included in the “glycemic part.” On test days, subjects received biscuits (low glycemic index [GI], high slowly available glucose [SAG]) or extruded cereals (medium GI, low SAG) as part of a breakfast similar in terms of caloric and macronutrient content. The postprandial phase lasted 270 minutes. Results: The rate of appearance (RaE) of exogenous glucose was significantly lower after consumption of biscuits in the first part of the morning (90–150 minutes) than after consumption of extruded cereals (p ≤ 0.05). Conversely, at 210 minutes, it was significantly higher with biscuits (p ≤ 0.01). For the first 2 hours, plasma glucose and insulin were significantly lower after biscuits during the glycemic part. C-peptide plasma concentrations were significantly lower at 90, 120, and 150 minutes after ingestion of the biscuits (p ≤ 0.05). Conclusion: The consumption of biscuits with a high content of slowly digestible starch reduces the appearance rate of glucose in the first part of the morning and prolongs this release in the late phase of the morning (210 minutes). Our results also emphasize that modulation of glucose availability at breakfast is an important factor for metabolic control throughout the morning in healthy subjects due to the lowering of blood glucose and insulin excursions.

Postprandial glycaemic response: how is it influenced by characteristics of cereal products?

Cereal products exhibit a wide range of glycaemic indexes (GI), but the interaction of their different nutrients and starch digestibility on blood glucose response is not well known. The objective of this analysis was to evaluate how cereal product characteristics can contribute to GI and insulinaemic index and to the parameters describing glycaemic or insulinaemic responses (incremental AUC, maximum concentration and Δpeak). Moreover, interactions between the different cereal products characteristics and glycaemic response parameters were assessed for the first time. Relationships between the cereal products characteristics and the glycaemic response were analysed by partial least square regressions, followed by modelling. A database including 190 cereal products tested by the usual GI methodology was used. The model on glycaemic responses showed that slowly digestible starch (SDS), rapidly digestible starch (RDS) and fat and fibres, and several interactions involving them, significantly explain GI by 53 % and Δpeak of glycaemia by 60 %. Fat and fibres had important contributions to glycaemic response at low and medium SDS contents in cereal products, but this effect disappears at high SDS levels. We showed also for the first time that glycaemic response parameters are dependent on interactions between starch digestibility (interaction between SDS and RDS) and nutritional composition (interaction between fat and fibres) of the cereal products. We also demonstrated the non-linear effect of fat and fibres (significant effect of their quadratic terms). Hence, optimising both the formula and the manufacturing process of cereal products can improve glucose metabolism, which is recognised as strongly influential on human health.

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

Starch digestibility may have an effect on the postprandial blood glucose profile. The aim of this meta-analysis was to analyze the relationship between Slowly Digestible Starch (SDS) levels and plasma glucose appearance and disappearance rates, as well as other parameters of glucose metabolism, after healthy subjects consumed cereal products that differed in SDS content. Three randomized controlled clinical trials that included a total of 79 subjects were identified. Using binary classification for the variables (high versus low levels, more than 12 g of SDS per portion, and less than 1 g of SDS per portion, respectively), we found that there was a 15-fold higher chance of having a low rate of appearance of exogenous glucose (RaE) after consumption of a high-SDS product. A high SDS content was also associated with a 12-fold and 4-fold higher chance of having a low rate of disappearance of exogenous glucose (RdE) and rate of disappearance of total plasma glucose (RdT), respectively. The RaE kinetics were further analyzed by modeling the contribution of SDS content to the different phases of the RaE response. We show that the higher the SDS content per portion of cereal product, the higher its contribution to the incremental area under the curve (iAUC) of the RaE response after 165 min. Using the association rule technique, we found that glycemic iAUC and insulinemic iAUC values vary in the same direction. In conclusion, this meta-analysis confirms the effect of the SDS level in cereal products on the metabolic response, and shows for the first time that the degree to which SDS affects the RaE response differs depending on the SDS content of the food product, as well as the phase of the postprandial period.

Inter-laboratory validation of the starch digestibility method for determination of rapidly digestible and slowly digestible starch

The digestibility of starch in foods, which is influenced by the ingredients, formulation and preparation conditions, is a major determinant of glycaemic response. The terms rapidly digestible starch (RDS) and slowly digestible starch (SDS) along with the associated analytical methodology were developed by Englyst to characterise this nutritionally relevant food attribute. The measurement uncertainty of this starch digestibility method is evaluated here with an inter-laboratory trial. Six laboratories took part in the study testing ten cereal products with mean (range) contents of RDS: 48.4 g/100 g, (23.4-76·9) and, SDS: 10.9 g/100 g, (0.8-24.2). Based on the repeatability and reproducibility measurements, the calculated uncertainty was 3.6 g/100 g for RDS and 1.9 g/100 g for SDS. This trial has demonstrated acceptable measurement uncertainty and confirmed the transferability of the method between laboratories. The SDS content can identify foods rich in slow release carbohydrates with their associated health benefits.

Modulation of Starch Digestibility in Breakfast Cereals Consumed by Subjects with Metabolic Risk: Impact on Markers of Oxidative Stress and Inflammation during Fasting and the Postprandial Period

SCOPE Decreasing postprandial glycaemic excursions may have a beneficial effect on inflammatory and oxidative stress profiles. In this study, we investigated the impact of carbohydrate digestibility modulation per se, as a means of reducing the glycaemic response, on metabolic and inflammatory responses in subjects with metabolic risk factors. METHODS AND RESULTS Twenty healthy subjects with metabolic risk consumed a cereal product either high in Slowly Digestible Starch (HSDS) or low in SDS (LSDS) at breakfast daily for 3 weeks, in a cross-over design. Following each 3-week session, postprandial glycaemia, insulinaemia, the lipid profile, inflammation and oxidative stress markers were assessed and compared to those induced by ingestion of a glucose solution (as a reference). The 2-h glycaemic and insulinaemic responses were significantly lower following the HSDS breakfast compared with the LSDS breakfast or glucose. No significant differences between the products were observed in terms of the lipid profile, C-reactive protein, IL-6 and tumour necrosis factor alpha. We observed a slight increase in fasting lipid peroxidation markers, including an increase in plasma malondialdehyde (MDA) and a decrease in whole blood glutathione (GSH), without significant alteration of urinary F2-isoprostanes or plasma glutathione peroxidase (GPx) activity. CONCLUSION Consumption of HSDS products for 3 weeks significantly altered both postprandial glycaemia and insulinaemia, but was not sufficient to modify the inflammatory profile. Consumption of both cereal products was associated with a slightly higher fasting oxidative stress profile.