Harri Sinkko

Protein and fat modify the glycaemic and insulinaemic responses to a mashed potato-based meal

Potatoes, especially mashed potatoes, are known to result in high glycaemic and insulinaemic responses. However, in most meals, potatoes are accompanied by other foods. The objective of the present study was to investigate how glycaemic and insulinaemic responses to a mashed potato meal changed when a high-fat food (rapeseed oil), a high-protein food (chicken breast) and/or salad were added to the meal. Healthy subjects (n 11) ingested the test meals once and the reference food (glucose solution) twice in a random order at 1-week intervals. Capillary blood samples were then drawn for 2 h, and glucose and insulin were analysed. The 2 h glycaemic responses to six mashed potato-containing meals varied more than twofold. The glycaemic index (GI) of pure mashed potato was 108, whereas combined with chicken breast, rapeseed oil and salad, it was only 54. The latter GI also differed considerably from its predicted value of 103, which was based on the individual GI of the components of the meal. The insulinaemic indices of the mashed potato-based meals varied between 94 and 148. Chicken breast in the meal increased the insulinaemic response, and rapeseed oil diminished it. However, the insulinaemic response to mashed potato with chicken breast and rapeseed oil was lower than that to mashed potato alone. In conclusion, the protein, fat and salad contents of a meal exert considerable influence on the glycaemic and insulinaemic responses to mashed potatoes. Furthermore, the estimation of the GI of a mixed meal by calculation is imprecise.

Modifying effects of alcohol on the postprandial glucose and insulin responses in healthy subjects

BACKGROUND Moderate alcohol consumption associates with lower risk of type 2 diabetes, but in postprandial studies, alcohol induced impaired insulin sensitivity. The measurement of the glycemic index (GI) for beer has been considered challenging because of its low carbohydrate content. Therefore, imputed GI values from 36 to 95 on the basis of carbohydrate-rich beverages have been used for beer in epidemiologic studies. OBJECTIVES We investigated the acute effects of alcohol on glucose and insulin responses and measured GIs and insulinemic indexes (IIs) of nonalcoholic and alcoholic beers. DESIGN In a crossover design, 10 healthy volunteers were served beer with 4.5% alcohol by volume, nonalcoholic beer, and a glucose solution with alcohol once and the reference glucose solution twice. Each portion contained 25 g available carbohydrate, and the beer and glucose solution with alcohol contained 21 g alcohol. Capillary blood samples were collected up to 2 h after ingestion, and the incremental AUCs (IAUCs), GIs, and IIs were calculated. RESULTS Compared with the reference glucose solution, the glucose solution with alcohol produced an 18% higher postprandial glucose IAUC (P = 0.03) and had no significant effect on the insulin IAUC. Compared with the reference glucose solution, beer had no significant effect on glucose or insulin IAUCs, and nonalcoholic beer tended to reduce the glucose IAUC (P = 0.06) but not the insulin IAUC. GIs of beer and nonalcoholic beer were 119 and 80, and IIs were 130 and 88, respectively. CONCLUSIONS Alcohol increases the postprandial glucose response, probably through impaired insulin sensitivity. GI values published for alcohol-containing beers have underestimated the true glycemic effects.

Diet and weight gain characteristics of pregnant women with gestational diabetes

Background/Objectives:To determine if women with gestational diabetes (GD) modify their diet and nutrient intake in late pregnancy and gain more weight during pregnancy compared with women without GD.Subjects/Methods:Food and nutrient intake of 3613 pregnant women was studied using food frequency questionnaires from the Type I Diabetes Prediction and Prevention Nutrition Study.Results:GD was reported in 4.8% of the participating women (n=174). Women with GD gained less weight during pregnancy than those unaffected by GD (mean 9.4 vs 12.6 kg, P<0.001). Women with GD consumed more milk products (84 vs 76 g/MJ, P=0.002), cereal products (21 vs 18 g/MJ, P<0.001), vegetables (32 vs 22 g/MJ, P<0.001) and meat (16 vs 14 g/MJ, P<0.001) than unaffected women. The intake of protein (18 vs 16 percent of total daily energy intake, P<0.001) and dietary fibre (3.1 vs 2.4 g/MJ, P<0.001) was higher, whereas the intake of sugars (13.3 vs 15.0 g/MJ, P<0.001) and saturated fatty acids (3.49 vs 3.98 g/MJ, P<0.001) was lower among women with GD. The nutrient density of the diet was higher in women with GD with higher intakes of vitamins A and D, folate and iron.Conclusions:The late pregnancy diet of women with GD differed considerably from that of unaffected women. Women with GD had a higher body weight at the beginning of the pregnancy, but they gained less weight during pregnancy. These findings indicate that abnormal glucose tolerance during pregnancy encourages women to modify their dietary habits towards healthier food choices.

Estimated intake levels for Finnish children of methylmercury from fish

Methylmercury (MeHg) is a well-known neurotoxic agent, and consumption of contaminated fish is the principal environmental source of MeHg exposure in humans. Children are more susceptible to adverse effects than adults. No previous specific data exist for intake by Finnish children of methylmercury from fish. We estimated fish consumption and MeHg intakes from species most commonly consumed by Finnish children aged 1-6 years. The total mercury concentrations were determined in fish species consumed, and age-specific methylmercury intakes were derived. We also examined safety margins and the proportion of children exceeding the tolerable daily intakes set by international expert bodies. The daily intake of MeHg ranged from 0 to 0.33 μg/kg bw. The strictest reference value 0.1 μg/kg bw/day for MeHg, proposed by USEPA, was exceeded by 1-15% of the study population, and FAO/WHO JECFA provisional tolerable weekly intake of 1.6 μg/kg bw was exceeded by 1% of boys and 2.5% of girls aged 6 years. Intakes of 1-year old girls were higher than of boys, whereas for 3-year olds they were the opposite. The highest intakes were observed for 6-year-old boys and girls. There was great variation in the estimated MeHg intakes among Finnish children.

Long-term daily intake estimates of polychlorinated dibenzo-p-dioxins and furans, polychlorinated biphenyls and polybrominated diphenylethers from food in Finnish children: risk assessment implications.

Food is contaminated by polychlorinated dibenzo-p-dioxins and furans (PCDD/F), polychlorinated biphenyls (PCB) and polybrominated diphenylethers (PBDE) worldwide. Previous data show elevated intakes in children. We determined intakes of POPs in Finnish children. Because no children-specific safe limit values exist, we used tolerable daily intakes (TDIs) set for adults by international expert bodies to examine the proportion of the study population that exceed those limits. We utilised dietary monitoring data with food consumption of Finnish boys and girls aged 1–6 years, measured the contaminant concentrations in all the main food items and calculated age-specific contaminant sum and congener-specific long-term daily intake levels. Our food intake and contaminant data correspond to years 2002–2005. The long-term upper-bound dioxin intakes ranged between 0.1 and 12.8 pg WHOPCDD/F-PCB-TEQ/kg bw/d (min and max). An immediate TDI for WHOPCDD/F-PCB-TEQs of 4.0 pg/kg bw/d were exceeded by 2.5%–7.5% of the children. PBDE long-term upper-bound intake was between 0.1 and 5.8 ng/kg bw/d (min and max). Congener-specific analyses indicated a typical Finnish adult exposure pattern of the children to PCDD/Fs, PCBs and PBDEs. The highest POP intakes were observed in children aged 3 years. Long-term daily PCDD/F, PCB and PBDE intakes among Finnish children varied greatly between individuals and ages. In each age group of the study population, there was a proportion of children with their WHOPCDD/F-PCB-TEQ intake exceeding considered safe limits set for adults. Based on the exposure profile reported herein, children should be clearly considered as a specific sub-population in food-mediated contaminant risk assessment.

Dietary acrylamide exposure among Finnish adults and children: the potential effect of reduction measures

A deterministic exposure assessment using the Nusser method that adjusts for within-subject variation and for nuisance effects among Finnish children and adults was carried out. The food consumption data covered 2038 adults (25–74 years old) and 1514 children of 1, 3 and 6 years of age, with the data on foods’ acrylamide content obtained from published Finnish studies. We found that acrylamide exposure was highest among the 3-year-old children (median = 1.01 µg kg−1 bw day−1, 97.5th percentile = 1.95 µg kg−1 bw day−1) and lowest among 65–74-year-old women (median = 0.31 µg kg−1 bw day−1, 97.5th percentile = 0.69 µg kg−1 bw day−1). Among adults, the most important source of acrylamide exposure was coffee, followed by casseroles rich in starch, then rye bread. Among children, the most important sources were casseroles rich in starch and then biscuits and, finally, chips and other fried potatoes. Replacing lightly roasted coffee with dark-roasted, swapping sweet wheat buns for biscuits, and decreasing the acrylamide content of starch-based casseroles and rye bread by 50% would result in a 50% decrease in acrylamide exposure in adults. Among children, substituting boiled potatoes for chips and other friend potatoes and replacing biscuits with sweet wheat buns while lowering the acrylamide content of starch-based casseroles by 50% would lead to acrylamide exposure that is only half of the original exposure. In conclusions, dietary modifications could have a large impact in decreasing acrylamide exposure.

Cow's milk allergy in children: adherence to a therapeutic elimination diet and reintroduction of milk into the diet

Background/Objectives:The basic treatment for cows milk allergy (CMA) is the elimination of all cows milk proteins (CMP) from the diet. This study aimed at characterizing the diet of children with a diagnosis of CMA, to assess the degree of adherence to the elimination diet and to evaluate the factors associated with the adherence and age of recovery.Subjects/Methods:From a birth cohort study, food records of 267 children diagnosed with CMA were studied to define how strictly the elimination diet was adhered to. Subsequent food records were studied to assess the age at reintroduction of milk products in the childs diet.Results:The families adhered to the elimination diet of the child with extreme accuracy in 85% of the cases. Older and monosensitized children had more often small amounts of CMP in their diet, possibly because of the absence of nutritional information by a dietitian/nutritionist. Adherence to the diet was neither related to any other sociodemographic factor studied nor to the age at reintroduction of milk products into the diet.Conclusions:The therapeutic elimination diet of children diagnosed with CMA was well adhered to. Low intakes of vitamin D, calcium, and riboflavin are of concern in children who follow or have followed a cows milk-free diet.

Use of voluntarily fortified foods among adults in Finland

OBJECTIVE To investigate the purchase and use of fortified foods, and to explore and compare background characteristics, food consumption and nutrient intakes among users and non-users of voluntarily fortified foods in Finland. DESIGN A study based on the National FINDIET Survey 2007 (48 h recall), which included also a barcode-based product diary developed to assess the type, amount and users of voluntarily fortified foods. Logistic regression analysis was employed to investigate associations between background characteristics and the use of fortified foods. SETTING Randomly chosen subgroup of 918 adult participants in the National FINDIET 2007 Survey. SUBJECTS Men and women aged 25-64 years from five regions. RESULTS The product group of voluntarily fortified foods purchased in the highest volume was yoghurts (44 % of the weight of all fortified food), followed by fruit drinks (36 %). The only characteristics independently associated with the use of voluntarily fortified foods were age (older people used them less commonly) and the consumption of fruit and vegetables (participants with the highest consumption used them more commonly). Users of fortified foods had higher consumption of yoghurt, juice drinks and ready-to-eat breakfast cereals (women only) than non-users, and lower consumption of boiled potatoes (men only). CONCLUSIONS Use of voluntarily fortified foods is associated with high consumption of fruit and vegetables but not with other health-related behaviours. The use of voluntarily fortified foods does not seem to even out the differences in nutrient intake among Finnish adults.

Impact of overweight and glucose tolerance on postprandial responses to high- and low-glycaemic index meals

The beneficial effects of a low-glycaemic index (GI) meal on postprandial glucose and insulin levels have been demonstrated. However, limited data are available on the impact of overweight and glucose tolerance on postprandial responses to different GI meals. Our aim was to study the effects of physiological characteristics on postprandial glucose, insulin and lipid responses and the relative glycaemic response (RGR) of a low-GI (LGI) and a high-GI (HGI) meal. We recruited twenty-four normal-weight and twenty-four overweight subjects, twelve with normal glucose tolerance (NGT) and twelve with impaired glucose tolerance (IGT) in each group. Both test meals were consumed once and the glucose reference twice. Blood glucose and insulin were measured in the fasting state and over a 2 h period after each study meal, and TAG and NEFA were measured in the fasting state and over a 5 h period. The glucose responses of subjects with IGT differed significantly from those of subjects with NGT. The highest insulin responses to both meals were observed in overweight subjects with IGT. Physiological characteristics did not influence TAG or NEFA responses or the RGR of the meals. The LGI meal resulted in lower glucose (P < 0·001) and insulin (P < 0·001) responses, but higher TAG responses (P < 0·001), compared with the HGI meal. The GI of the meals did not affect the NEFA responses. In conclusion, the LGI meal causes lower glucose and insulin responses, but higher TAG responses, than the HGI meal. The RGR of the meals does not differ between normal-weight and overweight subjects with NGT or IGT.

Modelling the intake of polychlorinated dibenzo-p-dioxins and dibenzofurans: impact of energy under-reporting and number of reporting days in dietary surveys

A probabilistic long-term intake estimation of dioxins was carried out using food consumption data obtained from the National FINDIET 2007 Survey (Paturi et al. 2008). The study population consisted of 606 participants who were first interviewed with a 48-h recall and then filled in a 3-day food record twice. The concentrations of dioxins were obtained from previously published studies. The intake was estimated using a semi-parametric Monte Carlo simulation. The analyses were done separately for the whole study population and for the population excluding energy under-reporters. To diminish the impact of intra-individual variation and nuisance effects, adjustment with software (C-SIDE®) was also done after Monte Carlo simulation. It was found that when C-SIDE® was used, the 95th percentile of intake and its confidence limit was higher with 2 reporting days than with a higher number of days. However, with a crude intake estimation (no adjustment), the confidence intervals of the 95th percentile were also smaller with a higher number of days, but the 95th percentiles were higher with a higher number of reporting days. When under-reporters were excluded the intakes increased, but the impact of energy under-reporting was smaller with 8 reporting days than with 2 days and smaller using C-SIDE® than with a crude estimation. To conclude, adjustment for intra-individual variation and taking energy under-reporting into account are essential for intake estimation of dioxins with food consumption data of a limited number of reporting days.