Rice intake and risk of type 2 diabetes: the Singapore Chinese Health Study

Dietary manganese intake is positively associated with metabolic dysfunction-associated steatotic liver disease: a multicohort study

BACKGROUND AND AIMS

Manganese (Mn) is an essential nutrient that plays a crucial role in maintaining normal physiological functions of the human body. However, overexposure to Mn often leads to adverse health outcomes and contributes to the development of a variety of diseases. Several studies have explored the relationship between dietary Mn and metabolic dysfunction-associated steatotic liver disease (MASLD) risk. Two UK Biobank (UKB)-based studies suggested that Mn, as a key nutrient, may be associated with a reduced risk of MASLD. Another study found an association between the dietary antioxidant index and the onset of non-alcoholic fatty liver disease (NAFLD), highlighting the importance of nutritional factors (including Mn) in liver health. However, the relationship between dietary Mn intake and MASLD in the Chinese population remains unexplored, and further research is needed to elucidate its underlying mechanisms.

METHODS

This prospective multi-cohort study had 1,137 adults from the Guangzhou Nutrition and Health Study (GNHS) cohort and 17,649 people from the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) cohort. We measured dietary intake using a validated and standardized food frequency questionnaire. Annual abdominal ultrasound was used to diagnose new-onset MASLD. We used multivariable Cox regression models to assess the relationship between dietary Mn intake and the risk of MASLD.

RESULTS

In the TCLSIH cohort, 3640 MASLD cases were observed with a follow-up time of 60,190 person-years. After taking into account possible confounding factors, the multivariable HRs (95% CIs) for MASLD across the quartiles of dietary Mn intake in males were 1.00 (reference), 1.08 (0.96-1.21), 1.12 (0.99-1.26), and 1.16 (1.02-1.31), with a P for trend = 0.02; for females, the HRs (95% CIs) for MASLD across the quartiles of dietary Mn intake were 1.00, 1.11 (0.95-1.31), 1.08 (0.91-1.28), and 0.97 (0.81-1.16), with a P for trend = 0.58. After adjustment for proteins, lipids, and carbohydrates, the HRs (95% CIs) for MASLD across the quartiles of dietary Mn intake in males were 1.00 (reference), 1.11 (0.97-1.26), 1.14 (1.00-1.31), and 1.16 (1.00-1.34), with a P for trend = 0.045. For females, the HRs (95% CIs) for MASLD across the quartiles of dietary Mn intake were 1.00 (reference), 1.08 (0.91-1.30), 1.06 (0.88-1.27), and 0.93 (0.76-1.13), with a P for trend = 0.39. In the GNHS cohort, 624 MASLD cases were observed with a follow-up time of 6454 person-years. After adjusting for relevant confounders, the HRs (95% CIs) for males comparing T3 versus T1 of dietary Mn intake were 1.04 (0.65-1.60); the HRs (95% CIs) for females comparing T3 versus T1 of dietary Mn intake were 1.00 (0.78-1.29).

CONCLUSION

In males, higher dietary Mn intake is associated with a higher incidence of MASLD.

The Influence of Rice Types and Boiling Time on Glycemic Index: An In Vivo Evaluation Using the ISO 2010 Method

Effective blood glucose management is essential for individuals with type 1 diabetes, particularly when dietary adjustments involve staple foods like rice. As a primary carbohydrate worldwide, rice significantly influences the glycemic index (GI) based on its type and cooking method. This study investigated the impact of rice type and boiling duration on the GI in healthy adults using an in vivo approach aligned with ISO 2010 standards. The glycemic response to four rice types (white round-grain, parboiled medium-grain, white long-grain, and whole-grain long-grain) was measured through postprandial blood glucose levels under both standard and extended boiling conditions to assess their implications for dietary glycemic control. Ten healthy participants (mean age 25 years, body mass index (BMI) 23.0 ± 1.6 kg/m2) consumed rice samples containing 50 g of available carbohydrates, prepared under controlled boiling conditions. Postprandial glycemic response was measured at regular intervals over 2 h following ingestion, with glucose solution as a reference food. The GI was calculated based on the incremental area under the glycemic response curve for each rice sample. Extended boiling significantly increased the GI across all rice types. White round-grain rice exhibited the highest relative increase (+15.8%) in the GI, while whole-grain long-grain rice, despite showing a greater percentage increase (+25.4%), maintained the lowest overall GI due to its high amylose and fiber content. Rice types with higher amylopectin content demonstrated faster glycemic responses and higher GI compared to high-amylose types. This study highlights rice type and cooking time as critical factors influencing postprandial glycemic response. Shorter boiling durations may benefit individuals requiring strict glycemic control, particularly those with diabetes, underscoring the importance of personalized dietary guidance for managing glycemic outcomes effectively.

The Consumption of High-Amylose Rice and its Effect on Postprandial Blood Glucose Levels: A Literature Review

Background/Objectives: Rice is a major staple in the diets of East Asian populations. Numerous meta-analyses have shown an association between high white rice consumption and a higher risk of diabetes. High-amylose rice (varieties with over 25% amylose content) is absorbed more slowly in the gut compared to low-amylose rice, and it results in lower levels of postprandial blood glucose. Various intervention studies have investigated the effects of high-amylose rice consumption on postprandial blood glucose and the glycemic index. The quantity of the research suggests that a comprehensive review of these diverse findings is necessary. Methods and Results: We reviewed 17 clinical trials, most of which showed that high-amylose rice ingestion results in lower postprandial blood glucose levels and glycemic index compared to low-amylose rice diets. Although they differed in their sample size, study design, rice type and quantity, and amylose content, most of these studies suggested that there is a reasonable effect of high-amylose rice consumption on postprandial blood glucose. In particular, the effect on blood glucose suppression tended to be related to the amylose content. However, long-term intake studies are still limited and require further investigation. Conclusions: In conclusion, high-amylose rice shows promise for blood glucose management.

Evaluation of the trade-off between variety, processing, and low-GI claim in ready-to-eat rice

An increasing number of consumers demand healthier, more convenient, and sustainable food products, including rice, a staple worldwide. Food manufacturers have responded to this trend by considering food's intrinsic and extrinsic aspects. This study evaluated the importance of variety, processing, and claims on willingness to try ready-to-eat rice (RTE-rice). It also analyses the influence of consumer attitudes on the importance of attributes and willingness to try. The results showed that processing significantly influenced willingness to try RTE-rice, revealing consumers' greater preference for whole grain than milled rice with added bran. Claims had the least relevant importance. However, low glycaemic index had a positive impact, indicating its potential to influence consumer purchasing attitudes and promote healthier rice consumption. Additionally, three groups were created based on attitudinal factors. Naturalness-oriented and convenience-oriented groups were more likely to try RTE-rice. However, the reasons that motivate them may be different; this latter could be the ease of the service offered, while for the group focused on naturalness, they may have perceived through the ingredients and claimed that the product, despite being convenient, can bring benefits, thus perceiving them as natural.

Grains in a Modern Time: A Comprehensive Review of Compositions and Understanding Their Role in Type 2 Diabetes and Cancer

Globally, type 2 diabetes (T2D) and Cancer are the major causes of morbidity and mortality worldwide and are considered to be two of the most significant public health concerns of the 21st century. Over the next two decades, the global burden is expected to increase by approximately 60%. Several observational studies as well as clinical trials have demonstrated the health benefits of consuming whole grains to lower the risk of several chronic non-communicable diseases including T2D and cancer. Cereals grains are the primary source of energy in the human diet. The most widely consumed pseudo cereals include (quinoa, amaranth, and buckwheat) and cereals (wheat, rice, and corn). From a nutritional perspective, both pseudo cereals and cereals are recognized for their complete protein, essential amino acids, dietary fibers, and phenolic acids. The bran layer of the seed contains the majority of these components. Greater intake of whole grains rather than refined grains has been consistently linked to a lower risk of T2D and cancer. Due to their superior nutritional compositions, whole grains make them a preferred choice over refined grains. The modulatory effects of whole grains on T2D and cancer are also likely to be influenced by several mechanisms; some of these effects may be direct while others involve altering the composition of gut microbiota, increasing the abundance of beneficial bacteria, and lowering harmful bacteria, increasing insulin sensitivity, lowering solubility of free bile acids, breaking protein down into peptides and amino acids, producing short-chain fatty acids (SCFAs), and other beneficial metabolites that promote the proliferation in the colon which modulate the antidiabetic and anticancer pathway. Thus, the present review had two aims. First, it summarized the recent knowledge about the nutritional composition and bioactive acids in pseudo cereals (quinoa, amaranth, and buckwheat) and cereals (wheat, rice, and corn); the second section summarized and discussed the progress in recent human studies, such as observational (cross-sectional studies, case-control studies, and cohort studies) and intervention studies to understand their role in T2D and cancer including the potential mechanism. Overall, according to the scientific data, whole grain consumption may reduce the incidence of T2D and cancer. Future studies should carry out randomized controlled trials to validate observational results and establish causality. In addition, the current manuscript encourages researchers to investigate the specific mechanisms by which whole grains exert their beneficial effects on health by examining the effects of different types of specific protein, dietary fibers, and phenolic acids that might help to prevent or treat T2D and cancer.

Exploring Rice Consumption Habits and Determinants of Choice, Aiming for the Development and Promotion of Rice Products with a Low Glycaemic Index

Current consumption drivers, particularly those related to health and wellbeing, have been influencing trends for the lower consumption of cereals, particularly rice, due to their typical high glycaemic index (GIs) and consequent impacts on obesity. To satisfy this consumer concern, more food innovations that promote healthy eating habits are required. Such innovations must be consumer-oriented to succeed, understanding the dynamics of consumer habits and responding to consumer expectations. This study explored these habits, from acquisition to consumption practices, and the expectations of the European market from the perspective of the major European consumer, Portugal, to obtain insights that support the development of low glycaemic index (GI) rice products. A mixed-methods approach was applied. For the first quantitative questionnaire, 256 Portuguese rice consumers aged 18-73 years were recruited. Twenty-four individuals were selected according to their gender and rice consumption profiles for in-depth interviews. The results confirmed that rice was the main side dish for the participants and was mainly consumed at home, cooked from raw milled rice. The drivers of consumption differ according to the provisioning process stage. In the acquisition stage, participants reported benefits from the rice's dynamic market by comparing products on price, brand, and rice types. In the preparation stage, participants reported the adequacy of the recipe and occasion, while in the consumption stage, participants enhanced their sensory preferences, depending on the rice dish. Although the GI concept was unknown to half of the participants, it was perceived as interesting and positive for healthy eating. Consumers showed concern about the taste and naturalness of the product, preferring it to be as close to a homemade dish as possible. The negative perceptions we verified were interpreted to be due to a lack of knowledge about the GI concept. Therefore, awareness actions and informative campaigns are recommended to promote low-GI rice products.

White rice consumption and risk of cardiometabolic and cancer outcomes: A systematic review and dose-response meta-analysis of prospective cohort studies

White rice is the food more than half of the world's population depends on. White rice intake can significantly increase the glycemic load of consumers and bring some adverse health effects. However, the quality of evidence implicating white rice in adverse health outcomes remains unclear. To evaluate the association between white rice consumption and the risk of cardiometabolic and cancer outcomes, a systematic review and dose-response meta-analysis of the relevant publications were performed. Twenty-three articles including 28 unique prospective cohorts with 1,527,198 participants proved eligible after a comprehensive search in four databases. For the risk of type 2 diabetes mellitus (T2DM), the pooled RR was 1.18 (16 more per 1000 persons) for comparing the highest with the lowest category of white rice intake, with moderate certainty evidence. Females presented a higher risk (23 more per 1000 persons) in subgroup analysis. And every additional 150 grams of white rice intake per day was associated with a 6% greater risk of T2DM (5 more per 1000 persons) with a linear positive trend. We found no significant associations between white rice intake and risk of cardiovascular diseases (CVD), CVD mortality, cancer, and metabolic syndrome. In conclusion, moderate certainty evidence demonstrated that white rice intake was associated with T2DM risk, with a linear positive trend. However, low to very low certainty of evidence suggested that no substantial associations were found between white rice intake and other cardiometabolic and cancer outcomes. More cohorts are needed to strength the evidence body.

Effects of Incorporated Emulsifiers Into Noodles on V-amylose Formation, Digestibility, and Structural Characteristics

There is growing interest in developing low glycemic alternatives to starchy foods. In this study, two emulsifiers, namely sodium stearoyl lactylate and egg yolk, were incorporated into the formulation of noodles (EYN and SSLN), and their effects on V-amylose formation, digestibility and structural characteristics of the noodles were investigated. The emulsifiers facilitated V-amylose formation in the noodles, indicated by the complexing indices. The EYN and SSLN exhibited markedly high resistant starch contents compared to the control noodle. The logarithm of slope plot analysis showed that the EYN and SSLN had low first-phase rate constants compared to the control noodles, suggesting a barrier effect to digestive enzymes exerted by V-amylose. The SSLN and EYN displayed a mixture of B- and V-type patterns with higher crystallinities and two distinct spectral features of the bands at 2854 cm- 1 and 1746 cm- 1 compared to the control noodles. Polarized light micrographs of the SSLN and EYN exhibited vague contours of numerous irregularly shaped starch fragments with strong birefringence. These results suggest that forming V-amylose crystals in the SSLN and EYN was responsible for their increased resistance to digestion through reformulating emulsifiers in modifying their nutritional functionalities.

The Glycemic Index of Indica and Japonica Subspecies Parboiled Rice Grown in Italy and the Effect on Glycemic Index of Different Parboiling Processes

Rice is generally considered a high-glycemic index (GI) food, but numerous studies show that parboiling reduces the GI. There are no studies on GI of Indica and Japonica subspecies parboiled rice grown in Italy. The aim of this study was (1) to evaluate GI in different varieties of parboiled rice (ribe, white and brown long B, basmati, black, red, roma, and arborio); (2) to evaluate GI of same variety of rice subjected to different rice parboiling processes (parboiled ribe and parboiled long B with two different methods: flora and conventional method); (3) to evaluate GI of two by-products of parboiled rice: white and brown rice cake. Participants were 10 healthy individuals (20-30 years old, body mass index 18.5-25 kg/m²). Proximate composition and GI were determined by using standard methods. All parboiled rice assessed is low-GI (brown long B 48.1 ± 6.4 by flora method, ribe 52.0 ± 1.8 GI by flora method, black rice 52.3 ± 7.6 by flora method, long B 52.4 ± 3.9 by flora method, long B 53.4 ± 5.1 by conventional method, ribe 54.4 ± 4.3 GI by conventional method, Roma 54.4 ± 7.9 GI by flora method, and arborio 54.4 ± 7.9 GI by flora method), except red rice that is of medium-GI (56.1 ± 7.0 GI), and both classic and brown cakes that are high-GI (respectively, 83.3 ± 8.9 GI and 102.2 ± 5.5 GI). Parboiled rice is low-GI and so is favorable for the dietary management of metabolic disorders and celiac disease. Clinicaltrials.gov (NCT05333081).

Inverse Association of the Adequacy and Balance Scores in the Modified Healthy Eating Index with Type 2 Diabetes in Women

Type 2 diabetes (T2DM) has markedly increased among Asians as their diets and lifestyles become more westernized. We, therefore, investigated the hypothesis that the Korean healthy eating index (KHEI) scores are associated with gender-specific T2DM risk in adults. The hypothesis was tested using the data from the Korea National Health and Nutrition Examination Survey-VI (2013–2017) with a complex sample survey design. Along with the KHEI scores, the modified KHEI (MKHEI) scores for the Korean- (KSD) and Western-style diets (WSD) were used as independent parameters, calculated using a validated semi-quantitative food-frequency questionnaire (SQFFQ). We estimated the association between the KHEI or MKHEI and the T2DM risk using logistic regression after adjusting for T2DM-related covariates. The adults with T2DM were more frequently older men who were less educated, married, on a lower income, and living in rural areas compared to those without T2DM. Not only the fasting serum glucose concentrations but also the waist circumferences and serum triglyceride concentrations were much higher in adults with T2DM than in those without T2DM in both genders. Serum HDL concentrations in the non-T2DM subjects exhibited a greater inverse relationship to serum glucose than in the T2DM group in both genders. Twenty-four-hour recall data revealed that women, but not men, had higher calcium, vitamin C, saturated and monounsaturated fatty acids, retinol, and vitamin B2 intakes than the T2DM group. Furthermore, overall, the KHEI score and the adequacy and balance scores among its components were significantly higher in the non-T2DM group than in the T2DM group, but only in women. The KHEI scores were inversely associated with T2DM only in women. The mixed grain intake score was higher in the non-T2DM than the T2DM group only in men. However, there were no differences between the groups in the MKHEI scores for KSD and WSD. In conclusion, high KHEI scores in the adequacy and balance components might prevent and/or delay T2DM risk, but only in women.

Predicting the Glycemic Index of Biscuits Using Static In Vitro Digestion Protocols

In vitro digestion methods that can accurately predict the estimated GI (eGI) values of complex carbohydrate foods, including biscuits, are worth exploring. In the current study, standard commercial biscuits with varied clinical GI values between 9~30 were digested using both the INFOGEST and single-enzyme digestion protocols. The digestion kinetic parameters were acquired through mathematical fitting by mathematical kinetics models. The results showed that compared with the INFOGEST protocol, the AUR180 deduced from digesting using either porcine pancreatin or α-amylase showed the best potential in predicting the eGI values. Accordingly, mathematical equations were established based on the relations between the AUR180 and the GI values. When digesting using porcine pancreatin, GI= 1.834 + 0.009 ×AUCR180 (R2= 0.952), and when digesting using only α-amylase, GI= 6.101 + 0.009 ×AUCR180 (R2=0.902). The AUR180 represents the area under the curve of the reducing-sugar content normalized to the total carbohydrates versus the digestion time in 180 min. The in vitro method presented enabled the rapid and accurate prediction of the eGI values of biscuits, and the validity of the formula was verified by another batch of biscuits with a known GI, and the error rate of most samples was less than 30%.

The characteristics of postprandial glycemic response patterns to white rice and glucose in healthy adults: Identifying subgroups by clustering analysis

OBJECTIVES

Large interpersonal variability in postprandial glycemic response (PGR) to white rice has been reported, and differences in the PGR patterns during the oral glucose tolerance test (OGTT) have been documented. However, there is scant study on the PGR patterns of white rice. We examined the typical PGR patterns of white rice and glucose and the association between them.

MATERIALS AND METHODS

We analyzed the data of 3-h PGRs to white rice (WR) and glucose (G) of 114 normoglycemic female subjects of similar age, weight status, and same ethnic group. Diverse glycemic parameters, based on the discrete blood glucose values, were calculated over 120 and 180 min. K-means clustering based on glycemic parameters calculated over 180 min was applied to identify subgroups and representative PGR patterns. Principal factor analysis based on the parameters used in the cluster analysis was applied to characterize PGR patterns. Simple correspondence analysis was performed on the clustering categories of WR and G.

RESULTS

More distinct differences were found in glycemic parameters calculated over 180 min compared with that calculated over 120 min, especially in the negative area under the curve and Nadir. We identified four distinct PGR patterns to WR (WR1, WR2, WR3, and WR4) and G (G1, G2, G3, and G4), respectively. There were significant differences among the patterns regard to postprandial hyperglycemia, hypoglycemic, and glycemic variability. The WR1 clusters had significantly lower glycemic index (59 ± 19), while no difference was found among the glycemic index based on the other three clusters. Each given G subgroup presented multiple patterns of PGR to WR, especially in the largest G subgroup (G1), and in subgroup with the greatest glycemic variability (G3).

CONCLUSION

Multiple subgroups could be classified based on the PGR patterns to white rice and glucose even in seemingly homogeneous subjects. Extending the monitoring time to 180 min was conducive to more effective discrimination of PGR patterns. It may not be reliable to extrapolate the patterns of PGR to rice from that to glucose, suggesting a need of combining OGTT and meal tolerance test for individualized glycemic management.

White rice, brown rice and the risk of type 2 diabetes: a systematic review and meta-analysis

OBJECTIVE

Intake of white rice has been associated with elevated risk for type 2 diabetes (T2D), while studies on brown rice are conflicting. To inform dietary guidance, we synthesised the evidence on white rice and brown rice with T2D risk.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, EMBASE and Cochrane databases were searched through November 2021.

ELIGIBILITY CRITERIA

Prospective cohort studies of white and brown rice intake on T2D risk (≥1 year), and randomised controlled trials (RCTs) comparing brown rice with white rice on cardiometabolic risk factors (≥2 weeks).

DATA EXTRACTION AND SYNTHESIS

Data were extracted by the primary reviewer and two additional reviewers. Meta-analyses were conducted using random-effects models and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the Newcastle Ottawa Scale for prospective cohort studies and the Cochrane Risk of Bias Tool for RCTs. Strength of the meta-evidence was assessed using NutriGrade.

RESULTS

Nineteen articles were included: 8 cohort studies providing 18 estimates (white rice: 15 estimates, 25 956 cases, n=5 77 426; brown rice: 3 estimates, 10 507 cases, n=1 97 228) and 11 RCTs (n=1034). In cohort studies, white rice was associated with higher risk of T2D (pooled RR, 1.16; 95% CI: 1.02 to 1.32) comparing extreme categories. At intakes above ~300 g/day, a dose-response was observed (each 158 g/day serving was associated with 13% (11%-15%) higher risk of T2D). Intake of brown rice was associated with lower risk of T2D (pooled RR, 0.89; 95% CI: 0.81 to 0.97) comparing extreme categories. Each 50 g/day serving of brown rice was associated with 13% (6%-20%) lower risk of T2D. Cohort studies were considered to be of good or fair quality. RCTs showed an increase in high-density lipoprotein-cholesterol (0.06 mmol/L; 0.00 to 0.11 mmol/L) in the brown compared with white rice group. No other significant differences in risk factors were observed. The majority of RCTs were found to have some concern for risk of bias. Overall strength of the meta-evidence was moderate for cohort studies and moderate and low for RCTs.

CONCLUSION

Intake of white rice was associated with higher risk of T2D, while intake of brown rice was associated with lower risk. Findings from substitution trials on cardiometabolic risk factors were inconsistent.

PROSPERO REGISTRATION NUMBER

CRD42020158466.

Conceptualization of Rice with Low Glycaemic Index: Perspectives from the Major European Consumers

Rice and cereal consumption has become a concern for consumers due to usually high glycaemic indexes (GI), which is a critical issue for a balanced and healthy diet. Therefore, the development of new products with low GI is an important target of the industry, particularly in countries with high consumption. This study assesses consumers’ perceptions about “rice” and “rice with low GI” and evaluates the effect of consumers’ rice consumption profiles through the application of a free word association technique in a structured self-administered electronic questionnaire with 256 Portuguese consumers (the European market with the highest per capita consumption of rice by far). The frequency of rice consumption was evaluated, and the consumption profile was determined through a hierarchical cluster analysis, with 9% identified as daily consumers. The response words were categorized by the triangulation technique, and the association between the word categories and dimensions, sociodemographic characteristics, and consumption profile were determined. Respondents most frequently associated “rice” with rice dishes, its sensory attributes, and nutrition, highlighting the satisfaction of nutritional and hedonic needs. Consumers revealed positive expectations in relation to the functionality of “rice with low GI”. The consumers’ rice consumption profiles, sex, age, and educational levels influenced their perception towards “rice“ and “rice with low GI”. This study provides important insights for the industry to develop a consumer-oriented, low GI rice product.

Seaweeds as Ingredients to Lower Glycemic Potency of Cereal Foods Synergistically-A Perspective

Seaweeds are traditional food ingredients mainly in seaside regions. Modern food science and nutrition researchers have identified seaweed as a source of functional nutrients, such as dietary soluble and insoluble fibers, proteins, omega-3 fatty acids, prebiotic polysaccharides, polyphenols, and carotenoids. Owing to the rich nutrients, seaweeds and seaweed extract can be used as functional ingredients by modifying the nutrients composition to reduce the proportion of available carbohydrates, delaying the gastric emptying time and the absorption rate of glucose by increasing the digesta viscosity, and attenuating the digesting rate by blocking the activity of digestive enzymes. This review presents the concept of using seaweed as unconventional ingredients that can function synergistically to reduce the glycemic potency of cereal products.

Quantity and variety of food groups consumption and the risk of diabetes in adults: A prospective cohort study

BACKGROUND

Evidence remains inconsistent regarding the association between quantity of food groups and diabetes, and remains scarce regarding the relation of dietary diversity with diabetes.

OBJECTIVE

We aimed to evaluate the prospective relation of variety and quantity of 12 major food groups with new-onset diabetes.

METHODS

A total of 16,117 participants who were free of diabetes at baseline from China Health and Nutrition Survey were included. Dietary intake and variety score were measured by three consecutive 24-h dietary recalls combined with a household food inventory in each survey round. The study outcome was new-onset diabetes, defined as self-reported physician-diagnosed diabetes during the follow-up period. Cox proportional hazards models and restricted cubic spline analysis were used to estimate hazard ratios (HR) and dose-response relation, respectively.

RESULTS

During a median follow-up duration of 9.0 years, a total of 1088 (6.7%) participants developed new-onset diabetes. Overall, there was a significant inverse association between dietary variety score and the risk of new-onset diabetes (per one point increment; HR, 0.85; 95% CI, 0.80-0.90). In addition, there were U-shaped associations of refined grains, whole grains, nuts, red meat, poultry, processed meat, dairy products, and aquatic products intake with diabetes, and L-shaped associations of legumes, vegetables, fruits, and eggs intake with diabetes (all P values for nonlinearity <0.001).

CONCLUSION

Our results suggested that greater variety of food groups consumption was associated with significantly lower risk of new-onset diabetes. Furthermore, when the quantity of food groups intakes was relatively low, there was a negative correlation between the quantity of each different food group consumption and diabetes risk; however, when intake exceeded certain thresholds, the risks of new-onset diabetes increased or reached a plateau.

Prospective Study of Different Staple Diets of Diabetic Indian Population

Background:

Diabetes is a metabolic disorder characterized by chronic hyperglycemia. Its prevention and regulation depends on dietary pattern and lifestyle. There are numerous studies which have been conducted to elucidate the relationship between type of diet consumption and sugar levels. The objective of this study was to enumerate the distribution of the staple food consumed in seven zones across India and their association with sugar levels.

Methodology:

A pan-India multicentered screening, covering the 63 districts, 29 states, and 4 union territories per populations, was undertaken. A specially designed questionnaire was administered for data collection, which comprised specific questions for diet 17,280 sample was analyzed across seven zones of India. Statistical Package for the Social Sciences (SPSS; 21.0) software was used to analyze the data.

Results:

The survey suggested that rice and wheat are the major staple food consumed across different regions of India. In Jammu, North, East, South, and central zones, consumption of rice was more than wheat. However, in North and West zones, consumption of wheat was observed to be more than rice. Mean values of fasting blood sugar (FBS), postprandial blood sugar (PPBS) were high in the group consuming Bajra (128.3 & 160.5). Similarly, FBS mean was less in group consuming rice (114.6), and PPBS was low in group consuming ragi (149.2).

Conclusion:

Staple food has significant effect on FBS, PPBS and glycated haemoglobin cholesterol levels and anthropometric measurements.

Association between intake of white rice and incident type 2 diabetes - An updated meta-analysis

AIMS

Meta-analyses on the association between white rice intake and incident type 2 diabetes (T2D) have been inconsistent. Since the last meta-analysis, more studies have been published with inconsistent results. We aimed to examine the rice-T2D association in Asian populations in an updated meta-analysis.

METHODS

We systematically searched the Medline and Embase databases between January 2012 (the date of the first meta-analysis) and December 2020 for prospective studies examining T2D risk and baseline rice intake. Random-effects models were applied to pool relative risks (RRs). Meta regression analyses were used to evaluate the influence of sex.

RESULTS

Six articles with eleven comparisons in Asian countries were included in the current meta-analysis. A total of 12,395 incident T2D cases were ascertained from 256,818 participants. The pooled RR was 1.25 (95% confidence interval [CI]: 1.17-1.33) comparing extreme categories of rice intake with higher heterogeneity (I² = 88%, P < 0.0001). When stratified by sex, the RR was 1.58 (1.26-1.99) among women and 1.30 (0.85-1.98) among men (P-interaction = 0.42).

CONCLUSIONS

A positive association between rice intake and incident T2D in Asian populations was found, especially among women.

White Rice Intake and Incident Diabetes: A Study of 132,373 Participants in 21 Countries

OBJECTIVE

Previous prospective studies on the association of white rice intake with incident diabetes have shown contradictory results but were conducted in single countries and predominantly in Asia. We report on the association of white rice with risk of diabetes in the multinational Prospective Urban Rural Epidemiology (PURE) study.

RESEARCH DESIGN AND METHODS

Data on 132,373 individuals aged 35-70 years from 21 countries were analyzed. White rice consumption (cooked) was categorized as <150, ≥150 to <300, ≥300 to <450, and ≥450 g/day, based on one cup of cooked rice = 150 g. The primary outcome was incident diabetes. Hazard ratios (HRs) were calculated using a multivariable Cox frailty model.

RESULTS

During a mean follow-up period of 9.5 years, 6,129 individuals without baseline diabetes developed incident diabetes. In the overall cohort, higher intake of white rice (≥450 g/day compared with <150 g/day) was associated with increased risk of diabetes (HR 1.20; 95% CI 1.02-1.40; P for trend = 0.003). However, the highest risk was seen in South Asia (HR 1.61; 95% CI 1.13-2.30; P for trend = 0.02), followed by other regions of the world (which included South East Asia, Middle East, South America, North America, Europe, and Africa) (HR 1.41; 95% CI 1.08-1.86; P for trend = 0.01), while in China there was no significant association (HR 1.04; 95% CI 0.77-1.40; P for trend = 0.38).

CONCLUSIONS

Higher consumption of white rice is associated with an increased risk of incident diabetes with the strongest association being observed in South Asia, while in other regions, a modest, nonsignificant association was seen.

The association of dietary insulin and glycemic indices with the risk of type 2 diabetes

BACKGROUND AND AIM

The aim of this study was to investigate the association of dietary insulin index(II), insulin load(IL), glycemic index(GI), and glycemic load(GL) with risk of developing diabetes among the Tehranian adults.

METHODS

This study was conducted within the framework of the Tehran Lipid and Glucose Study on 1149 subjects, aged ≥30 years, who were followed-up for a mean of 8.04 years. Food frequency questionnaire was used to calculate the dietary GI, GL, II, IL at the baseline. Multivariate Cox proportional hazard regression models, adjusted for the potential confounders, were used to estimate the risk of diabetes based on the dietary indices.

RESULTS

Mean age of the study population was 44.8 ± 10.4 years and 46.3% of them were men. During a mean of 8.04 ± 2.1 years of follow-up, 76 (6.6%) new cases of diabetes were identified. The mean ± SD of the II, IL, GI, and GL of the participants were 52.4 ± 6.5, 234.9 ± 88.8, 61.8 ± 7.9, and 200.6 ± 74.5, respectively. After adjusting for age, sex, smoking, physical activity, daily energy intake, and body mass index, higher dietary scores of the II[HR = 1.33 (95%CIs = 1.06-1.68)], IL[HR = 1.70(95%CIs = 1.10-2.60)], GI[HR = 1.28(95%CIs = 1.03-1.60)], and GL[HR = 1.84 (95%CIs = 1.19-2.84)] were found to be associated with the increased risk of diabetes incidence per each ones SD increment in the scores. Considering the tertiles of the dietary scores, the risk of developing diabetes was increased significantly from tertile 1 into 3 of the GL, and after adjusting for all the potential covariates (p-trend = 0.002); the diabetes risk was 3.40 (95%CI:1.48-7.83) in those with highest tertile of GL compared to those in the lowest tertile of GL.

CONCLUSION

Our findings suggest that the diet with high GL, GI, II, and IL can increase the incidence of diabetes. The glycemic and insulin load can strongly predict the risk of diabetes rather than the glycemic index and insulin index.

Reducing the glycemic impact of carbohydrates on foods and meals: Strategies for the food industry and consumers with special focus on Asia

Type 2 diabetes is increasingly prevalent in Asia, which can be attributed to a carbohydrate-rich diet, consisting of foods in the form of grains, for example, rice, or a food product made from flours or isolated starch, for example, noodles. Carbohydrates become a health issue when they are digested and absorbed rapidly (high glycemic index), and more so when they are consumed in large quantities (high glycemic load). The principal strategies of glycemic control should thus aim to reduce the amount of carbohydrate available for digestion, reduce the rate of digestion of the food, reduce the rate of glucose absorption, and increase the rate of glucose removal from blood. From a food perspective, the composition and structure of the food can be modified to reduce the amount of carbohydrates or alter starch digestibility and glucose absorption rates via using different food ingredients and processing methods. From a human perspective, eating behavior and food choices surrounding a meal can also affect glycemic response. This review therefore identifies actionable strategies and opportunities across foods and meals that can be considered by food manufacturers or consumers. They are (a) using alternative ingredients, (b) adding functional ingredients, and (c) changing processing methods and parameters for foods, and optimizing (a) eating behavior, (b) preloading or co-ingestion of other macronutrients, and (c) meal sequence and history. The effectiveness of a strategy would depend on consumer acceptance, compatibility of the strategy with an existing food product, and whether it is economically or technologically feasible. A combination of two or more strategies is recommended for greater effectiveness and flexibility.

A Dietary Pattern Derived from Reduced Rank Regression and Fatty Acid Biomarkers Is Associated with Lower Risk of Type 2 Diabetes and Coronary Artery Disease in Chinese Adults

BACKGROUND

Combinations of circulating fatty acids may affect the risk of type 2 diabetes (T2D) and coronary artery disease (CAD). No previous studies have identified a dietary pattern predicting fatty acid profiles using reduced rank regression (RRR) and evaluated its associations with the risk of T2D and CAD.

OBJECTIVE

The aim of this study was to derive a dietary pattern to explain variation in plasma fatty acid concentrations using RRR and evaluate these in relation to risk of T2D and CAD.

METHODS

We derived a dietary pattern using fatty acid concentrations from 711 controls of a nested case-control study in the Singapore Chinese Health Study using RRR with 36 food and beverages as predictors and 19 fatty acid biomarkers as responses. Dietary pattern scores were then calculated for the full cohort of men and women (mean age: 56 y). We followed up 45,411 and 58,065 participants for incident T2D and CAD mortality, respectively. Multivariable Cox regression models were used to estimate HRs and 95% CIs.

RESULTS

We identified a dietary pattern high in soy, vegetables, fruits, tea, tomato products, bread, fish, margarine and dairy, and low in rice, red meat, coffee, alcohol, sugar-sweetened beverages, and eggs. This pattern predicted higher circulating n-3 (ω-3) PUFAs (18:3n-3, 20:3n-3, 20:5n-3), odd-chain fatty acids (15:0, 17:0), 18:2n-6 and 20:1, and lower 20:4n-6 and 16:1. During a mean follow-up of 11 y and 19 y, 5207 T2D and 3016 CAD mortality events, respectively, were identified. Higher dietary pattern scores were associated with a lower risk of T2D [multivariable-adjusted HR comparing extreme quintiles, 0.86 (95% CI: 0.79, 0.95); P-trend <0.001] and CAD mortality [HR, 0.76 (95% CI: 0.68, 0.86); P-trend <0.001].

CONCLUSIONS

Dietary patterns reflecting higher circulating n-3 PUFAs, odd-chain fatty acids, and linoleic acid may be associated with lower T2D and CAD risk in Chinese adults. This trial was registered at www.clinicaltrials.gov as NCT03356340.

Rice and Prevention of Type 2 Diabetes: Narrative Review of Epidemiologic Evidene

Inspite that rice is a main staple and heaviliy consumed in most of Asian populations, health effect of rice has been less examined in nutritional epidemiologic studies compared to those of foods such as fruits, vegetables, meats and fish. Some recent meta-analyses that collected prospective cohort studies reported the associations between rice intake and incidence of and mortality from some chronic diseases especially type 2 diabetes. Concerning type 2 diabetes, the results are remarkably different between white (polished) rice and brown (unpolished) rice: the former increased and the latter decreased the risk. This difference may partly be explained by the different types and amounts of dietary fiber and different scores of dietary glycemic index. However, the results on dietary fiber and dietary glycemic index were not necessarily consistent. Indirect effect of rice intake has been examined through the studies on association of dietary patterns and breakfast skipping to type 2 diabetes. However, most of the results were inconclusive. Simple and straightforward judgement on the effect of rice to type 2 diabete should be avoided, and more nutritional epidemiologic studies with high research quality, including basic studies on dietary assessment, are needed, especially in Asian populations.