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The effects of whole-grain compared with refined wheat, rice, and rye on the postprandial blood glucose response: a systematic review and meta-analysis of randomized controlled trials.
Musa-Veloso, K, Poon, T, Harkness, LS, O'Shea, M, Chu, Y
The American journal of clinical nutrition. 2018;(4):759-774
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Abstract
BACKGROUND Whole grains are often referred to collectively, despite differences in their composition, physical structure, processing, and potential health benefits. OBJECTIVE The aim of this study was to compare the postprandial blood glucose response of whole-grain with refined wheat, rice, or rye, while controlling for the food delivery matrix and the processing of the grain (e.g., grinding, germination). DESIGN Eleven electronic databases were systematically searched to identify studies published up to and including November 2017. Randomized controlled trials comparing the effects of whole-grain wheat, rice, or rye with those of each grain's refined counterpart on postprandial blood glucose area under the curve (AUC) were included. Pooled effect sizes were computed by using the difference in the blood glucose AUC after the consumption of the whole compared with the refined grain. RESULTS Twenty publications were included, with 10, 14, and 5 strata (or active-control comparisons) on whole-grain wheat, rice, and rye, respectively. The consumption of ground (wholemeal) wheat, compared with white wheat, was not associated with a significant reduction in blood glucose AUC (-6.7 mmol/L ⋅ min; 95% CI: -25.1, 11.7 mmol/L ⋅ min; P = 0.477). The consumption of wholemeal rye, compared with endosperm rye, was not associated with a significant reduction in blood glucose AUC (-5.5 mmol/L ⋅ min; 95% CI: -24.8, 13.8 mmol/L ⋅ min; P = 0.576). The consumption of intact (whole-grain) rice, compared with white rice, was associated with a significant reduction in blood glucose AUC (-40.5 mmol/L ⋅ min; 95% CI: -59.6, -21.3 mmol/L ⋅ min; P < 0.001). CONCLUSIONS Compared with white rice, whole-grain rice significantly attenuates the postprandial blood glucose response. In most of the studies on wheat and rye, the postprandial blood glucose responses to foods formulated with wholemeal compared with refined flours were compared. Whether reductions in the blood glucose AUC can be achieved with whole-grain (as opposed to wholemeal) wheat and rye requires further investigation.
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High Protein Pasta is Not More Satiating than High Fiber Pasta at a Lunch Meal, Nor Does it Decrease Mid-Afternoon Snacking in Healthy Men and Women.
Korczak, R, Timm, D, Ahnen, R, Thomas, W, Slavin, JL
Journal of food science. 2016;(9):S2240-5
Abstract
This study compared satiety after high protein pasta (16 g protein, 6 g fiber), high fiber pasta (11 g protein, 8 g fiber) or control pasta (11 g protein, 6 g fiber) in a randomized, placebo-controlled, double-blind crossover trial. Participants were 36 healthy and men and women from the University of Minnesota campus. Fasted men and women ate calorie controlled, but macronutrient different pastas at 12:00 pm along with 500 mL of water. The primary outcome was satiety assessed by Visual Analogue Scales at 0, 15, 30, 45, 60, 90, 120, and 180 min daily after consuming the pastas. Secondary outcomes were calories consumed at an ad libitum snack at 3:00 pm, calories from food intake, gastrointestinal tolerance, and palatability. No differences were found among the pasta treatments for satiety, snacking, or gastrointestinal tolerance. Men ate significantly more calories for the rest of the (P = 0.007) after the high protein pasta versus the high fiber pasta (1701 ± 154 compared with 1083 ± 154) with control pasta being intermediate to the other treatments. No significant differences were found for gastrointestinal tolerance, but the palatability ratings showed the high protein pasta was less tasty (P = 0.03) and less pleasant (P = 0.01) than the other 2 pastas. Satisfaction was positively associated with pleasantness and negatively associated with aftertaste. Our results do not support the idea that high protein or high fiber pasta produces a greater satiety response compared to pasta with lower amounts of either nutrient. It is likely that since pasta is already a very satiating food, the subjects were unable to differentiate between the 3 conditions.
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Healthy subjects experience bowel changes on enteral diets: addition of a fiber blend attenuates stool weight and gut bacteria decreases without changes in gas.
Koecher, KJ, Thomas, W, Slavin, JL
JPEN. Journal of parenteral and enteral nutrition. 2015;(3):337-43
Abstract
BACKGROUND Tube-fed patients frequently suffer from abnormal bowel function that affects intestinal bacteria and quality of life. Dietary fiber affects laxation and can be fermented by gut bacteria to metabolites that influence gut health and fecal moisture. The aim of this study was to compare the effects of a fiber-blend fortified enteral formula (FB, 15 g/L), a fiber-free formula (FF), and habitual diet on bowel function, fecal bacteria, and quality of life. MATERIALS AND METHODS In a randomized, double-blind, crossover design, 20 healthy subjects consumed both FF and FB for 14 days with a 4-week washout. A 5-day fecal collection was used to assess stool output, whole-gut transit time (WGTT), total bacteria, bifidobacteria, lactobacilli, clostridia, and bacteroides. Subject gastrointestinal quality of life index (GIQLI) and side effects were also measured. RESULTS On formula diets, 5-day fecal output decreased by >55% from habitual diet, but was 38% higher on FB than FF (P = .0321). WGTT was approximately 1.5 times longer on formula diets than habitual diet (P < .0004). Total bacteria declined from habitual diet on FF (P < .004), but not on FB. Numbers of bifidobacteria and lactobacilli declined from habitual diet on both formula diets, but bifidobacteria was higher on FB compared with FF (P < .0001). Bacteroides and clostridia numbers did not change between diets. GIQLI and incidence of gas symptoms did not differ between formulas. CONCLUSIONS Addition of a fiber blend moderated changes in bowel function and gut bacteria observed in healthy subjects consuming FF. These results support adding mixed fiber sources to enteral nutrition if no contraindication exists.
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[Dry jelly concentrate with vitamins and dietary fiber in patients with IBS with constipation: a comparative controlled study].
Pilipenko, VI, Teplyuk, DA, Shakhovskaya, AK, Isakov, VA, Vorobyova, VM, Vorobyova, IS, Glazkova, IV, Kochetkova, AA, Mikheeva, GA, Yudina, AV
Voprosy pitaniia. 2015;(6):83-91
Abstract
Irritable bowel syndrome (IBS) is highly prevalent functional gastrointestinal disorder associated with decrease in quality of life and a high social cost. Diet is one of several therapeutic options in IBS treatment; therefore the development and clinical evaluation of innovative functional food for IBS patients is useful. Dry jelly concentrate containing 3 g inulin, 10 mg curcumin and 1.8 mg of pyridoxine was developed and clinically evaluated. Fifty patients fulfilling the Rome III criteria for IBS-C were randomly assigned into two groups: one received standard diet plus two jelly drinks a day for 2 weeks and control group received standard diet. Response to therapy was recorded on a daily basis using Likert scale of abdominal pain, bloating and feeling of incomplete bowel emptying, frequency of bowel movement, Bristol stool scale, and quality of life assessed by IBSQoL questionnaire before and after the treatment. Intake of functional food product (jelly) containing inulin and curcumin is associated with a significant positive effect on the stool parameters (from 0.6±0.24 to 1.15±0.65 t/d in stool frequency, p=0.001, from 2.62±1.23 to 3.99±1.27, index Bristol scale, p=0.001), a reduce of the severity of abdominal pain (from 1.69±0.71 to 1.36±0.44 Likert scale points, p=0.001), bloating (from 2.03±0.89 to 1.55±0.81 points of Likert scale, p=0.02) and a sense of incomplete bowel emptying (from 2.25±0.98 to 1.68±0.92 points of Likert scale, p=0.001), as well as an increase in quality of life (from 64.5±13.5 to 81.2±9.1%, р=0.05). Patients in control group have improvement in abdominal pain (from 2.16±0.58 to 1.8±0.61 Likert scale points, p=0.05) and bloating (from 2.42±0.83 to 2.16±0.71 Likert scale points, p=0.05) only. During the treatment period no significant adverse events were found. These results indicate that jelly concentrate containing inulin, curcumin and pyridoxine improves abdominal pain score, Bristol scale index and quality of life in patients with IBS-C.
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The formation of short-chain fatty acids is positively associated with the blood lipid-lowering effect of lupin kernel fiber in moderately hypercholesterolemic adults.
Fechner, A, Kiehntopf, M, Jahreis, G
The Journal of nutrition. 2014;(5):599-607
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Abstract
Lupin kernel fiber beneficially modifies blood lipids because of its bile acid-binding capacity. The aim of this study was to evaluate the preventive effects of a lupin kernel fiber preparation on cardiovascular diseases and to clarify possible mechanisms. In a randomized, double-blind, controlled crossover trial, 60 moderately hypercholesterolemic adults (plasma total cholesterol: >5.2 mmol/L) passed 3 intervention periods in different orders with a 2-wk washout phase between each. Participants consumed either a high-fiber diet containing 25-g/d lupin kernel fiber (LF) or citrus fiber (CF), or a low-fiber control diet (CD) for 4 wk each. Anthropometric, plasma, and fecal variables were assessed at baseline and after the interventions. Contrary to the CF period, total (9%) and LDL (12%) cholesterol as well as triacylglycerols (10%) were lower after the LF period when compared with the CD period [P ≤ 0.02, adjusted for baseline, age, gender, and body mass index (BMI)]. HDL cholesterol remained unchanged. Moreover, the LF period reduced high-sensitivity C-reactive protein (P = 0.02) and systolic blood pressure (P = 0.01) when compared with baseline. Bile acid binding could not be shown because the excretion of total bile acids remained constant after the high-fiber diets. However, the LF period resulted in an enhanced formation of the main short-chain fatty acids in comparison with the CD period. During the CF period, only acetate increased significantly. Both high-fiber diets led to higher satiety and modified nutritional behavior, resulting in significantly lower body weight, BMI, and waist circumference compared with the CD period. The blood lipid-lowering effects of LF are apparently not a result of bile acid binding. Rather, we hypothesize for the first time, to our knowledge, that the blood lipid-lowering effects of LF may be mainly attributed to the formation of short-chain fatty acids, specifically propionate and acetate. This trial was registered at clinicaltrials.gov as NCT01035086.
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Dietary fiber supplementation for fecal incontinence: a randomized clinical trial.
Bliss, DZ, Savik, K, Jung, HJ, Whitebird, R, Lowry, A, Sheng, X
Research in nursing & health. 2014;(5):367-78
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Abstract
Dietary fiber supplements are used to manage fecal incontinence (FI), but little is known about the fiber type to recommend or the level of effectiveness of such supplements, which appears related to the fermentability of the fiber. The aim of this single-blind, randomized controlled trial was to compare the effects of three dietary fiber supplements (carboxymethylcellulose [CMC], gum arabic [GA], or psyllium) with differing levels of fermentability to a placebo in community-living individuals incontinent of loose/liquid feces. The primary outcome was FI frequency; secondary outcomes included FI amount and consistency, supplement intolerance, and quality of life (QoL). Possible mechanisms underlying supplement effects were also examined. After a 14-day baseline, 189 subjects consumed a placebo or 16 g total fiber/day of one of the fiber supplements for 32 days. FI frequency significantly decreased after psyllium supplementation versus placebo, in both intent-to-treat and per-protocol mixed model analyses. CMC increased FI frequency. In intent-to-treat analysis, the number of FI episodes/week after supplementation was estimated to be 5.5 for Placebo, 2.5 for Psyllium, 4.3 for GA, and 6.2 for CMC. Only psyllium consumption resulted in a gel in feces. Supplement intolerance was low. QoL scores did not differ among groups. Patients with FI may experience a reduction in FI frequency after psyllium supplementation, and decreased FI frequency has been shown to be an important personal goal of treatment for patients with FI. Formation of a gel in feces appears to be a mechanism by which residual psyllium improved FI.
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A multi-centre, randomised trial to assess whether increased dietary fibre intake (using a fibre supplement or high-fibre foods) produces healthy bowel performance and reduces laxative requirement in free living patients on peritoneal dialysis.
Sutton, D, Ovington, S, Engel, B
Journal of renal care. 2014;(3):157-63
Abstract
BACKGROUND Constipation is a significant problem for many patients on peritoneal dialysis (PD). Due in part to dietary restrictions it is a common cause of technique failure and poor dialysis efficacy. Both consequences have an economic cost as well as contributing to a poor patient experience. OBJECTIVE This study aimed to investigate whether an appropriate daily bowel habit could be achieved through a higher fibre intake, minimal use of laxatives and with no adverse effect on potassium, phosphate and fluid balance. METHODS One hundred and seven patients who had been on PD for at least three months were recruited from seven renal units. They were asked to record daily bowel habits (Bristol Stool Form Scale: BSFS) and laxative use for four weeks. From this group 41 suitable patients with regular laxative use were identified and invited to enter the Intervention stage, Stage 2. Patients were randomised into one of three intervention arms: high fibre supplement (HFS); high fibre diet (HFD) or placebo. RESULTS During the intervention stage, intake of HFS increased significantly between week 1 and week 4 (p = 0.04) and in the placebo group between week 1 and week 3 (p = 0.02). There was no significant increase in fibre intake for those on the HFD. Laxative dose appeared to decrease in the HFS group (38%) and the HFD group (16%) but these changes were not significant when compared to the placebo. CONCLUSION This study has confirmed the prevalence of laxative use amongst patients on PD and shown that fibre use can confer improvements in bowel function without affecting biochemistry.
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Molecular weight of barley β-glucan does not influence satiety or energy intake in healthy male subjects.
Clegg, ME, Thondre, PS
Appetite. 2014;:167-172
Abstract
Previous studies have shown the ability of high molecular weight barley β-glucan with increased viscosity to attenuate glycemic response, gastric emptying and in vitro starch digestion. The main objective of this study was to investigate the effect of molecular weight of barley β-glucan in a semisolid meal on energy intake and subjective feelings of hunger, fullness, desire to eat and prospective food consumption in healthy male subjects. In a randomised, controlled, crossover trial, 23 healthy male subjects (BMI 24.2 ± 2.5 kg/m²) tested soups equivalent to 25 g available carbohydrate containing high or low molecular weight barley β-glucan (~3 g) as preload after a standard breakfast. The viscosity of soup with high molecular weight β-glucan was 350 Pa·s whereas the soup with low molecular weight β-glucan had a viscosity of 100 Pa·s. Appetite ratings before and for two hours after consumption of β-glucan soups and subsequent ad libitum energy intake at lunch were recorded and compared with a control soup with no β-glucan. There was no significant difference in food intake at the ad libitum meal or for the remainder of the day following consumption of the three test foods (p > 0.05). Similarly, there were no significant differences (p > 0.05) in hunger, fullness, desire to eat or prospective food consumption following β-glucan soups. The current study provides evidence that the molecular weight of barley β-glucan may not impact on perceived feelings of hunger or food intake at the current dose and viscosity.
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A CHO/fibre diet reduces and a MUFA diet increases postprandial lipaemia in type 2 diabetes: no supplementary effects of low-volume physical training.
Bozzetto, L, Annuzzi, G, Costabile, G, Costagliola, L, Giorgini, M, Alderisio, A, Strazzullo, A, Patti, L, Cipriano, P, Mangione, A, et al
Acta diabetologica. 2014;(3):385-93
Abstract
The aim of the study was to evaluate the effects of a supervised physical training added to a healthy diet-rich in either carbohydrate and fibre (CHO/fibre) or monounsaturated fatty acids (MUFA)-on postprandial dyslipidaemia, an independent cardiovascular risk factor particularly relevant in type 2 diabetes (T2D). Participants were forty-five overweight/obese subjects with T2D, of both genders, in good blood glucose control with diet or diet+metformin, with normal fasting plasma lipids. According to a parallel groups 2 × 2 factorial design, participants were randomized to an 8-week isoenergetic intervention with a CHO/fibre or a MUFA diet, with or without a supervised low-volume aerobic training programme. The main outcome of the study was the incremental area under the curve (iAUC) of lipid concentrations in the plasma chylomicron+VLDL lipoprotein fraction, isolated by preparative ultracentrifugation (NCT01025856). Body weight remained stable during the trial in all groups. Physical fitness slightly improved with training (VO2 peak, 16 ± 4 vs. 15 ± 3 ml/kg/min, M ± SD, p < 0.05). Postprandial triglyceride and cholesterol iAUCs in plasma and chylomicron+VLDL fraction decreased after the CHO/fibre diet, but increased after the MUFA diet with a significant effect for diet by two-way ANOVA (p < 0.05). The addition of exercise training to either dietary intervention did not significantly influence postprandial lipid response. A diet rich in carbohydrates and fibre reduced postprandial triglyceride-rich lipoproteins compared with a diet rich in MUFA in patients with T2D. A supervised low-volume physical training did not significantly influence these dietary effects.
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Consumption of buckwheat modulates the post-prandial response of selected gastrointestinal satiety hormones in individuals with type 2 diabetes mellitus.
Stringer, DM, Taylor, CG, Appah, P, Blewett, H, Zahradka, P
Metabolism: clinical and experimental. 2013;(7):1021-31
Abstract
PURPOSE In healthy participants and those with diet-controlled type 2 diabetes (T2DM), to (1) compare the acute 3-hour post-prandial response of glucose, insulin and other gastrointestinal hormones known to influence food intake and glucose metabolism after consumption of a food product made from whole grain buckwheat flour versus rice flour; (2) determine the effect of daily consumption of a food product made from whole grain buckwheat flour on fasting glucose, lipids and apolipoproteins. METHODS Healthy participants or those with T2DM consumed either buckwheat or rice crackers. Blood samples were collected at baseline and 15, 30, 45, 60, 120 and 180minutes after consumption. In a second phase of the study, participants consumed one serving of buckwheat crackers daily for 1week; fasting blood samples from day 1 and day 7 were analyzed. RESULTS Post-prandial plasma glucagon-like peptide-1, glucose-dependent insulinotropic peptide and pancreatic polypeptide were altered after consuming buckwheat versus rice crackers. Interestingly, changes in these hormones did not lead to changes in post-prandial glucose, insulin or C-peptide concentrations. Significant correlations were observed between both fasting concentrations and post-prandial responses of several of the hormones examined. Interestingly, certain correlations were present only in the healthy participant group or the T2DM group. There was no effect of consuming buckwheat for one week on fasting glucose, lipids or apolipoproteins in either the healthy participants or those with T2DM. CONCLUSIONS Although the buckwheat cracker did not modify acute glycemia or insulinemia, it was sufficient to modulate gastrointestinal satiety hormones.