Low-glycemic index diets as an intervention for diabetes: a systematic review and meta-analysis

Macronutrients and cardiovascular diseases: A narrative review of recent scientific literature

BACKGROUND & AIMS

Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. This narrative review explores the relationship between macronutrient intake and CVD risk, focusing on carbohydrates, proteins, and fats. The goal is to examine how specific types of macronutrients influence cardiovascular health and how dietary guidelines, such as those from the World Health Organization (WHO), can reduce the incidence of both fatal and non-fatal cardiovascular events.

METHODS

This narrative review draws upon existing research and WHO dietary guidelines to assess the impact of various macronutrients on cardiovascular outcomes. We searched the relevant literature up to December 2024 using Pubmed and Google Scholar. Key macronutrient groups-carbohydrates (with a focus on glycemic index and glycemic load), proteins (plant-based vs. animal-based), and fats (saturated, trans, polyunsaturated, and monounsaturated)-were analyzed to understand their roles in CVD prevention.

RESULTS

Low glycemic index (GI) and glycemic load (GL) were found to be associated with reduced CVD risk. Protein intake showed no significant direct association with CVD risk, but higher consumption of plant-based proteins was correlated with a reduced risk. Replacing animal proteins with plant-based alternatives led to improved lipid profiles, including reductions in total and low-density lipoprotein (LDL) cholesterol levels. Fats, particularly saturated and trans fats, were strongly linked to increased CVD risk. WHO guidelines recommend limiting these fats and replacing them with healthier alternatives, such as polyunsaturated and monounsaturated fats or slow-digesting carbohydrates, to lower CVD risk.

CONCLUSIONS

Macronutrients play a critical role in cardiovascular health, with specific types of carbohydrates, proteins, and fats having varying impacts on CVD risk. Future research should explore the complex interactions between these macronutrients, dietary patterns, and cultural factors to optimize global dietary guidelines for CVD prevention. Replacing high-GI carbohydrates, saturated fats, and trans fats with healthier alternatives is crucial for reducing cardiovascular risk globally.

Composition and Biological Activity of Colored Rice-A Comprehensive Review

Colored rice (black, purple, red and brown) has been consumed in China for nearly 4000 years. Recent research has focused on exploring its nutritional and metabolomic profiles and associated health benefits. Due to the improvement in detection and quantification techniques for health-promoting compounds and their activities, the number of studies has increased significantly. In this regard, a timely and updated review of research on nutritional composition, phytochemistry, and metabolite content and composition can significantly enhance consumer awareness. Here, we present a detailed and up-to-date understanding and comparison of the nutritional and phytochemical (metabolite) composition of colored rice. While earlier literature reviews focus on either single type of colored rice or briefly present nutritional comparison or bioactivities, here we present more detailed nutrient profile comparison (carbohydrates, fats, proteins, amino acids, minerals, and vitamins), together with the most recent comparative data on phytochemicals/metabolites (flavonoids, anthocyanins, fatty acids, amino acids and derivatives, phenolic acids, organic acids, alkaloids, and others). We discuss how metabolomics has broadened the scope of research by providing an increasing number of detected compounds. Moreover, directions on the improvement in colored rice nutritional quality through breeding are also presented. Finally, we present the health-beneficial activities (antioxidant, anti-inflammatory, antimicrobial, hypoglycemic, neuroprotective, anti-aging, and antitumor activities) of different colored rice varieties, together with examples of the clinical trials, and discuss which bioactive substances are correlated with such activities.

Sex-specific associations between diet quality and mortality in adults with diabetes: findings from NHANES 2001-2018

Objective

To investigate the impact of diet on cardiovascular (CV)/all-cause mortality among individuals with diabetes, and to explore whether this relationship changes by gender.

Methods

We collected data from the National Health and Nutrition Examination Survey (NHANES) database pertaining to 5,875 individuals with diabetes (3,068 males and 2,807 females) and used the Healthy Eating Index (HEI), the Alternative Healthy Eating Index (AHEI), and the alternative Mediterranean Diet (aMED) index to assess diet quality. Multivariate Cox models were used to determine the association between dietary quality scores and CV/all-cause mortality, stratified by genders. Dose-response relationships were assessed using the Restricted Cubic Spline (RCS). As a secondary objective, a further analysis was conducted on the connection between CV/all-cause mortality and different dietary components.

Results

During a median 9.25-year follow-up period, we observed 1,488 all-cause deaths, including 486 CV deaths. Sex-stratified analyses revealed that higher diet quality, as indicated by each standard deviation increase in the score, was significantly associated with a reduced risk of cardiovascular mortality in males (p < 0.05). No significant associations were observed in females (p > 0.05). Among the component scores of the aMED, legume intake was unfavorable for males with diabetes but was remarkably associated with lower CV/all-cause mortality in females.

Conclusion

In the diabetic population, high dietary scores are significantly associated with lower CV/all-cause mortality in males but not in females.

Ketogenic diet and cancer: multidimensional exploration and research

The ketogenic diet (KD) has attracted attention in recent years for its potential anticancer effects. KD is a dietary structure of high fat, moderate protein, and extremely low carbohydrate content. Originally introduced as a treatment for epilepsy, KD has been widely applied in weight loss programs and the management of metabolic diseases. Previous studies have shown that KD can potentially inhibit the growth and spread of cancer by limiting energy supply to tumor cells, thereby inhibiting tumor angiogenesis, reducing oxidative stress in normal cells, and affecting cancer cell signaling and other processes. Moreover, KD has been shown to influence T-cell-mediated immune responses and inflammation by modulating the gut microbiota, enhance the efficacy of standard cancer treatments, and mitigate the complications of chemotherapy. However, controversies and uncertainties remain regarding the specific mechanisms and clinical effects of KD as an adjunctive therapy for cancer. Therefore, this review summarizes the existing research and explores the intricate relationships between KD and cancer treatment.

A Mendelian randomization study to reveal gut-disc axis: causal associations between gut microbiota with intervertebral disc diseases

PURPOSE

Emerging evidence suggests a link between gut microbiota and intervertebral disc diseases (IDDs); however, the causal relationships remain unclear. This study aimed to evaluate the causal effects of gut microbiota on the risk of cervical disc disorders (CDD), other intervertebral disc disorders (OIDD), pyogenic intervertebral disc infections, and discitis, shedding light on the potential "gut-disc axis".

METHODS

Genetic variation data for 202 gut microbiota taxa were obtained from the Dutch Microbiome Project, and disease outcome data were sourced from the FinnGen consortium. A Mendelian Randomization (MR) approach was employed to assess causal relationships, using genetic variants as instrumental variables. Sensitivity analyses, including tests for pleiotropy, heterogeneity, and reverse causation, ensured robust findings.

RESULTS

The study identified 20 gut microbial taxa with significant associations to IDDs. Notably, taxa within the Erysipelotrichaceae family showed consistent protective effects against OIDD after Bonferroni correction (P < 0.05). Associations between several species and specific diseases, such as Alistipes senegalensis with CDD and Ruminococcus lactaris with discitis, were also observed. Sensitivity analyses confirmed no evidence of confounding or reverse causation.

CONCLUSION

This study provides evidence of causal relationships between specific gut microbiota and IDDs, supporting the existence of a "gut-disc axis." The findings suggest that microbial dysbiosis may influence spinal health through systemic inflammation and immune regulation. These insights open new possibilities for microbiota-targeted interventions, such as probiotics or dietary modifications, to prevent or manage IDDs. However, further research is required to validate these therapeutic strategies.

The effectiveness of a community-based online low-glycaemic index diet and lifestyle recommendations intervention for people with type 2 diabetes: a randomized controlled trial

BACKGROUND

The community health workers (CHWs)-led model is an important strategy for managing type 2 diabetes mellitus (T2DM) in China. However, existing community-based dietary and health education interventions in diabetes management are insufficient. Meanwhile, emerging mobile health (mHealth) has emerged as a promising tool for improving disease management. Current evidence on the combined efficacy of mHealth technologies and CHWs strategies remains limited.

OBJECTIVE

This study evaluates the effectiveness of an online dietary and health education intervention delivered through a tertiary hospital's WeChat official account (WOA) for T2DM patients, examining its influence on glycated hemoglobin (HbA1c) levels, body mass index (BMI), serum lipid profiles, and diabetes-specific quality of life (DSQL).

METHODS

This randomized clinical trial was conducted in two community health centers in China, enrolling adults diagnosed with T2DM. Participants were randomly assigned to two groups over 3 months. The control group received standard care, while the intervention group accessed online low glycaemic index (GI) dietary and lifestyle recommendations via the WOA. This group was instructed to monitor blood glucose levels, upload daily dietary photos, review health education notifications, and participate in real-time communication with the diabetes management team via the WOA.

RESULTS

A total of 178 participants were randomized to the control group (mean [SD] age, 57.07 [10.96] years, n = 89) and the intervention group (mean [SD] age, 57.18 [10.61] years, n = 89). After 3 months, significant improvements were observed in the intervention group compared to the control group, with lower HbA1c levels (mean 7.82%, SD 0.43%; p = 0.001), BMI (mean 24.35, SD 1.25 kg/m2; p < 0.001), low-density lipoprotein cholesterol (mean 2.38, SD 0.21 mmol/L; p < 0.001), and DSQL scores (mean 43.24, SD 7.23; P < 0.001), whereas high-density lipoprotein cholesterol (mean 1.35, SD 0.37 mmol/L; p = 0.001) was significantly higher. Subgroup analysis at 3 months showed that age, education, disease duration, comorbidity, and BMI influenced the effectiveness of HbA1c reduction.

CONCLUSION

Overall, the WOA-based intervention effectively engages patients in community diabetes management, leading to improved glycemic control, weight reduction, lipid metabolism optimization, and better quality of life.

TRIAL REGISTRATION

ChiCTR2400081045.

Depolymerization of oyster glycosaminoglycans for the enhancement of α-glucosidase inhibition and its application in hypoglycemic studies

Glycosaminoglycans are a class of naturally occurring macromolecular heteropolysaccharides with α-glucosidase inhibitory effects, which play an essential role in regulating postprandial hyperglycemia. However, the significant molecular weight hinders their inhibitory activity. In this study, oyster glycosaminoglycans were used for purification and depolymerization studies to obtain oyster glycosaminoglycan oligosaccharides (OGAG-Oli) and to study their inhibitory activity against α-glucosidase in vitro and hypoglycemic effect on hyperglycemic zebrafish in vivo. The results showed that the OGAG-Oli with optimal α-glucosidase inhibition obtained by the β-elimination mechanism of chondroitinase ABC had a molecular weight of about 2400 Da with five disaccharide repeating units, and their inhibitory effect on α-glucosidase was significantly enhanced with an IC50 value of 0.12 mg/mL, which was related to the strong binding capacity with α-glucosidase as evidenced by molecular docking. FT-IR and NMR results showed that the conformation of OGAG-Oli was predominantly in the α-configuration, which indicated that its inhibitory effect on α-glucosidase mainly depended on the α-glucosidic bond therein. The enzymatic depolymerization process of glycosaminoglycans was optimized, and the process conditions were determined as phosphate buffer solution pH 8.0, reaction time 3 h, reaction temperature 30 °C, chondroitin enzyme ABC activity 0.5 mU. The hypoglycemic ability of OGAG-Oli was evaluated in diabetic zebrafish, and the results showed that OGAG-Oli at a high-dose (0.12 mg/g, bw/d) could extremely significantly reduce fasting blood glucose in zebrafish, with an effect close to that of acarbose (p > 0.05), and exceptionally significantly (p < 0.01) reduced the elevation of TC, TG, and LDL-C caused by prolonged hyperglycemia, and extremely significantly (p < 0.01) increased the HDL-C level. This study showed that the structurally modified oyster glycosaminoglycans had intense α-glucosidase inhibitory activity, and exhibited biological activity of reducing glucose uptake and consequently improving body weight and lipid metabolism in diabetic zebrafish. As a bioactive ingredient of natural origin, this study provides a theoretical basis for the development and utilization of glycosaminoglycans with hypoglycemic effects in foods and drugs.

Pasta Consumption and Cardiometabolic Risks in Older Adults with Overweight/Obesity: A Longitudinal Analysis

OBJECTIVE

Low Glycemic Index (GI) diets improve cardiometabolic risk (CMR) specifically in those with insulin resistance. However, the prospective association between pasta (a low GI staple) consumption and CMR is unclear. We evaluated the longitudinal association of pasta consumption with CMR (after 2 y: body weight, body mass index (BMI), waist circumference (WC), blood pressure (BP); after 1 y: fasting blood glucose, HbA1c, HDL-cholesterol and triglycerides) in ∼6000 older adults (50% women) at high CMR.

METHODS

Consumption of pasta and other staples were determined as the cumulative average of reported intakes at baseline and annual follow-up visits from food frequency questionnaires and defined as energy-adjusted (residuals) and the number of daily servings. Longitudinal association between pasta consumption and CMR was assessed in PREDIMED-Plus participants (Trail registry number: ISRCTN89898870).

RESULTS

Mean (SD) dry pasta intake was 9(7) g/d at Year 1 and 8(6) g/d at Year 2. In linear regression models, higher pasta intake was associated with greater 2 y decreases in body weight, BMI and WC. When fully adjusted, every additional serving of pasta was associated with significantly greater 2 y decreases in body weight (-2.23(-3.47, -0.98 kg), BMI (-0.86(-1.27, -0.34 kg/m2) and WC (-1.92 (-3.46, -0.38 cm). There was no evidence of association with other outcomes. Additionally, substituting equivalent servings of pasta for white bread or white rice or potato was significantly associated with greater 2 y decreases in body weight and BMI. Replacing white bread with pasta was associated with higher 2 y reductions in WC. Replacing potato with pasta was associated with improvements in diastolic BP and HDL-cholesterol. Conclusions: Equivalent serving substitutions of white bread/white rice/potato with pasta may help reduce CMR in older Mediterranean adults with overweight/obesity. While such substitutions are feasible where pasta consumption aligns with the local gastronomic culture, the feasibility and potential CMR benefit of such interventions should be confirmed in other populations.

The Effect of a Low-Glycemic Index Diet on Postprandial Hypotension in Individuals With Chronic Spinal Cord Injury: Results From a Pilot Study

Background

One in two individuals with spinal cord injury (SCI) experiences postprandial hypotension (PPH), a decline (>20 mm Hg) in systolic blood pressure (SBP) within 2 hours after eating. Consuming meals with a low glycemic index (GI) could prevent or lessen PPH.

Objectives

To determine the effect of a low-GI diet on PPH and postprandial glucose and insulin in individuals with chronic SCI (>1 year postinjury).

Methods

Eleven participants (6 males, 5 females; age 43 ± 11 years) with chronic SCI (C4-C7, 7; T4-T12, 4) took part in a randomized crossover study (low GI vs. high GI). On each occasion, BP, glucose, and insulin were measured in the fasted state and for 2 hours after consuming a breakfast meal (60% carbohydrate, 28% fat, 12% protein) in laboratory-controlled conditions. Participants wore an ambulatory BP monitor and continuous glucose monitor for 3 days at home, and consumed study meals that were macronutrient-matched across conditions.

Results

The maximum decrease in systolic blood pressure (SBP) following the laboratory-controlled breakfast meals tended to be lower in the low-GI (14 ± 12 mm Hg) compared to the high-GI (24 ± 25 mm Hg) diet (d = 0.52, P = .056). Serum glucose (P < .01) and insulin (P = .026) concentrations were lower at 30 minutes in the low-GI diet. In the home setting, peak glucose concentrations were lower after lunch (P = .011) and dinner (P < .01) in the low-GI diet.

Conclusion

A low-GI meal may be an effective solution to reduce the magnitude of PPH and peak glucose concentrations in individuals with chronic SCI.

The Influence of Dietary Patterns on Polycystic Ovary Syndrome Management in Women: A Review of Randomized Controlled Trials with and Without an Isocaloric Dietary Design

Polycystic ovary syndrome (PCOS) is an endocrine disorder that causes cardiometabolic and reproductive disorders in women of reproductive age. Women with PCOS are more likely to have obesity, type 2 diabetes mellitus, and cardiovascular disease. There is an inconclusive consensus on which dietary modification could be most effective in PCOS prevention and treatment. This review aimed to examine the effects of diverse dietary patterns on PCOS in women according to randomized controlled trials (RCTs) with and without an isocaloric dietary design. A literature search was performed in the PubMed®®/MEDLINE®® database up to 14 November 2024. A total of 21 RCTs were reviewed after screening the records, including 15 RCTs with a calorie-restricted dietary design and 6 RCTs with a non-calorie-restricted dietary design. This review found beneficial effects of the calorie-restricted Dietary Approaches to Stop Hypertension (DASH) diet on weight loss and glucose control in women with PCOS in four RCTs with an isocaloric dietary design. The calorie-restricted low-glycemic index (GI) diets from three RCTs and high-protein diets from four RCTs with an isocaloric dietary design showed no significant differences in anthropometric parameters, glucose control, lipids, and gonadal parameters compared with the control diet in women with PCOS. Non-calorie-restricted low-carbohydrate diets from four RCTs with an isocaloric dietary design showed similar results to the calorie-restricted low-GI diets and high-protein diets. However, the existing number of RCTs is insufficient to conclude the association between dietary patterns and PCOS in women. Further, well-designed dietary intervention studies are needed to assess the role of dietary patterns in PCOS beyond calorie restriction.

Effect of dietary glycemic index on insulin resistance in adults without diabetes mellitus: a systematic review and meta-analysis

Low glycemic index (LoGI) diets are associated with decreased insulin resistance and are an effective strategy for patients with diabetes mellitus to control postprandial glucose levels. However, whether these effects on insulin resistance and glucose levels are also observable in those without diabetes mellitus is poorly understood. The present study examined the influence of LoGI diets compared with that of high glycemic index (HiGI) diets on insulin resistance in adults without diabetes mellitus. This meta-analysis included six randomized controlled trials involving 192 participants with a mean age of 52.5 years. A homeostasis model assessment of insulin resistance (HOMA-IR) score was calculated for each trial, and differences in HOMA-IR before and after each dietary intervention were calculated independently. The primary outcome was variations in insulin resistance, which was assessed by proxy as the difference between HOMA-IR scores at the beginning and end of the trials. The results suggested that LoGI diets decrease HOMA-IR scores to a greater extent than HiGI diets (estimate: 0.31; 95% confidence interval [CI], 0.01-0.61; p < 0.001) in individuals without diabetes mellitus. This association remained significant (estimate: 0.16; 95% CI, 0.01-0.31) after excluding one study with a short follow-up time (7 days). In conclusion, LoGI diets lower HOMA-IR scores to a greater extent than HiGI diets in adults without diabetes mellitus.

Systematic review registration

(https://www.crd.york.ac.uk/PROSPERO/).

Can hazelnut flour added to gluten-free corn flour in different amounts cause differences in blood glucose fluctuations?

Aims to find out how adding different amounts of hazelnut to corn flour affects women's blood glucose fluctuations. Women (n = 23) were given loaves of bread containing corn and hazelnut flour (50 g digestible CHO). They were given 50 g of glucose syrup to consume in the first week, normal corn-bread (CB) in the second week, 15 g of corn-bread with hazelnut flour (CB + 15HN) in the third week and 30 g of corn-bread with hazelnut flour (CB + 30HN) in the fourth week. Blood glucose was measured at 0, 15, 30, 30, 45, 60, 90, and 120 min. CB+HN15 AUC values were found to be significantly lower compared to the other breads (p < 0.05). In addition, The GI of CB+HN15 was significantly lower than the GI of the other two breads (p < 0.05). The positive effect on blood glucose fluctuations started to decrease when the addition of hazelnut flour was more than 15 g.

Trial Registration: This study registered under ClinicalTrials.gov (Identifier no. NCT06382506).

A legume-enriched diet improves metabolic health in prediabetes mediated through gut microbiome: a randomized controlled trial

Healthy dietary patterns rich in legumes can improve metabolic health, although their additional benefits in conjunction with calorie restriction have not been well-established. We investigated effects of a calorie-restricted, legume-enriched, multicomponent intervention diet compared with a calorie-restricted control diet in 127 Chinese prediabetes participants, living in Singapore. The study was a 16-week, single-blind, parallel-design, randomized controlled trial (n = 63 intervention group (IG), n = 64 control group (CG); mean ± SD age 62.2 ± 6.3 years, BMI 23.8 ± 2.6 kg/m2). Primary outcomes were markers of glycemia and all measurements were taken at 2 or 4-weekly intervals. At the end of 16 weeks, both groups had significantly lower BMI (q(Time) = 1.92 ×10-42, β  = -0.02) compared with baseline, with minimal difference between groups. The IG had significantly greater reductions in LDL cholesterol (q(Treatment×Time) = 0.01, β  = -0.16), total cholesterol (q(Treatment×Time) = 0.02, β  = -0.3) and HbA1c (q(Treatment×Time) = 0.04, β  = -0.004) compared with CG, alongside increases in fiber degrading species in IG, mediated through metabolites such as bile acids and amino acids. A legume-enriched, multicomponent intervention diet can improve metabolic health in a prediabetes population, in addition to benefits obtained from calorie restriction alone, partially mediated through changes in gut microbial composition and function. Trial registration: Clinical Trials NCT04745702.

Postprandial glycaemic response and pain sensitivity in breast cancer survivors suffering from chronic pain: a double-blind, randomised controlled cross-over pilot experiment

INTRODUCTION

The study's primary goal is to investigate differences in postprandial glycaemic response (PPGR) to beverages with varying glycaemic index (i.e. low and medium) between breast cancer survivors (BCS) with chronic pain and healthy pain-free controls (HC). The secondary goal of the study is to investigate the potential link between PPGR and pain-related outcomes in BCS with chronic pain.

METHODS

In this study, 15 BCS and 15 HC were included. After 12 h of fasting, subjects were randomised between drinking a beverage made with 50 g of sucrose (medium) or isomaltulose (low) within 250 ml water. Blood glucose levels were monitored at fasting as well as at 15, 30, 45, 60, 90 and 120 min following beverage consumption. Furthermore, each participant was evaluated using several experimental pain measurements, including pressure pain thresholds (PPT), electrical detection threshold, electrical pain threshold, temporal summation and electrical offset analgesia (OA).

RESULTS

The BCS group had significantly higher PPGR to sucrose (p = .001) than the HC group. Furthermore, when PPGR to sucrose was compared to PPGR to isomaltulose within the groups, the BCS group showed a considerably larger difference (p = .012). Additionally, correlation analyses indicated both positive and negative associations between PPGR after sucrose intake and specific pain measurements (PPT-tibialis (r = .599), OA (rs = - .549), respectively) in BCS, and a positive association between the difference in PPGR between sucrose and isomaltulose and PPT-tibialis (r = .622).

CONCLUSION

These findings suggest that medium glycaemic index beverage intakes result in significantly higher blood glucose responses (i.e. PPGR) than low-glycaemic index beverage intakes in BCS. Additionally, BCS show an impaired glycaemic response to medium glycaemic index beverage intake and that the impaired glycaemic response might be related to pain sensitivity and endogenous analgesia in BCS. Furthermore, the higher glycaemic response to sucrose and greater difference in the amount of change in PPGR (when isomaltulose was substituted for sucrose) compared to HC highlight the importance of understanding how dietary choices with a lower glycaemic index can alter glycaemic regulation in BCS with chronic pain.

Pre-Type 1 Diabetes in Adolescents and Teens: Screening, Nutritional Interventions, Beta-Cell Preservation, and Psychosocial Impacts

Type 1 Diabetes (T1D) is a progressive autoimmune disease often identified in childhood or adolescence, with early stages detectable through pre-diabetic markers such as autoantibodies and subclinical beta-cell dysfunction. The identification of the pre-T1D stage is critical for preventing complications, such as diabetic ketoacidosis, and for enabling timely interventions that may alter disease progression. This review examines the multifaceted approach to managing T1D risk in adolescents and teens, emphasizing early detection, nutritional interventions, beta-cell preservation strategies, and psychosocial support. Screening for T1D-associated autoantibodies offers predictive insight into disease risk, particularly when combined with education and family resources that promote lifestyle adjustments. Although nutritional interventions alone are not capable of preventing T1D, certain lifestyle interventions, such as weight management and specific nutritional choices, have shown the potential to preserve insulin sensitivity, reduce inflammation, and mitigate metabolic strain. Pharmacological strategies, including immune-modulating drugs like teplizumab, alongside emerging regenerative and cell-based therapies, offer the potential to delay disease onset by protecting beta-cell function. The social and psychological impacts of a T1D risk diagnosis are also significant, affecting adolescents' quality of life, family dynamics, and mental health. Supportive interventions, including counseling, cognitive-behavioral therapy (CBT), and group support, are recommended for managing the emotional burden of pre-diabetes. Future directions call for integrating universal or targeted screening programs within schools or primary care, advancing research into nutrition and psychosocial support, and promoting policies that enhance access to preventive resources. Advocacy for the insurance coverage of screening, nutritional counseling, and mental health services is also crucial to support families in managing T1D risk. By addressing these areas, healthcare systems can promote early intervention, improve beta-cell preservation, and support the overall well-being of adolescents at risk of T1D.

Oxidative Stress and Cardiovascular Complications in Type 2 Diabetes: From Pathophysiology to Lifestyle Modifications

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder that significantly increases the risk of cardiovascular disease, which is the leading cause of morbidity and mortality among diabetic patients. A central pathophysiological mechanism linking T2DM to cardiovascular complications is oxidative stress, defined as an imbalance between reactive oxygen species (ROS) production and the body's antioxidant defenses. Hyperglycemia in T2DM promotes oxidative stress through various pathways, including the formation of advanced glycation end products, the activation of protein kinase C, mitochondrial dysfunction, and the polyol pathway. These processes enhance ROS generation, leading to endothelial dysfunction, vascular inflammation, and the exacerbation of cardiovascular damage. Additionally, oxidative stress disrupts nitric oxide signaling, impairing vasodilation and promoting vasoconstriction, which contributes to vascular complications. This review explores the molecular mechanisms by which oxidative stress contributes to the pathogenesis of cardiovascular disease in T2DM. It also examines the potential of lifestyle modifications, such as dietary changes and physical activity, in reducing oxidative stress and mitigating cardiovascular risks in this high-risk population. Understanding these mechanisms is critical for developing targeted therapeutic strategies to improve cardiovascular outcomes in diabetic patients.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The role of low glycemic index and load diets in medical nutrition therapy for type 2 diabetes: an update

The increasing prevalence of type 2 diabetes mellitus (T2DM) and its microvascular and macrovascular complications necessitate an optimal approach to prevention and management. Medical nutrition therapy serves as the cornerstone of diabetes care, reducing reliance on diabetic medications for glycemic control and mitigating cardiovascular risk. The broadening field of research in the effect of low glycemic index (GI) and/or glycemic load (GL) diets on individuals with T2DM has yielded promising results in the existing literature. Adopting low-GI and GL dietary patterns contributes to minimizing fluctuations in blood glucose levels, thus presenting a good strategy for achieving enhanced glycemic control. Furthermore, the above dietary practices may offer a viable alternative and practical approach to weight management in individuals with T2DM. However, clinical practice guidelines for diabetes dietary management show inconsistency regarding the certainty of evidence supporting the implementation of low-GI/GL nutritional patterns. This review aims to thoroughly evaluate the available data on the effectiveness of low-GI and low-GL diets in managing glycemic control and reducing cardiovascular risk factors.

Emerging roles of ketone bodies in cardiac fibrosis

Cardiac fibrosis, characterized by excessive extracellular matrix (ECM) deposition within the myocardium, poses a significant challenge in cardiovascular health, contributing to various cardiac pathologies. Ketone bodies (KBs), particularly β-hydroxybutyrate (β-OHB), have emerged as subjects of interest due to their potential cardioprotective effects. However, their specific influence on cardiac fibrosis remains underexplored. This literature review comprehensively examines the relationship between KBs and cardiac fibrosis, elucidating potential mechanisms through which KBs modulate fibrotic pathways. A multifaceted interplay exists between KBs and key mediators of cardiac fibrosis. While some studies indicate a profibrotic role for KBs, others highlight their potential to attenuate fibrosis and cardiac remodeling. Mechanistically, KBs may regulate fibrotic pathways through modulation of cellular components such as cardiac fibroblasts, macrophages, and lymphocytes, as well as extracellular matrix proteins. Furthermore, the impact of KBs on cellular processes implicated in fibrosis, including oxidative stress, chemokine and cytokine expression, caspase activation, and inflammasome signaling is explored. While conflicting findings exist regarding the effects of KBs on these processes, emerging evidence suggests a predominantly beneficial role in mitigating inflammation and oxidative stress associated with fibrotic remodeling. Overall, this review underscores the importance of elucidating the complex interplay between KB metabolism and cardiac fibrosis. The insights gained have the potential to inform novel therapeutic strategies for managing cardiac fibrosis and associated cardiovascular disorders, highlighting the need for further research in this area.

The Relationship Between Body Composition Parameters and the Intake of Selected Nutrients, and Serum Anti-Müllerian Hormone (AMH) Levels in the Context of Ovulatory Infertility

Background/Objective: The aim of this study was to outline the relationships between selected parameters connected with lifestyle and serum anti-Müllerian hormone (AMH) levels, i.e., a marker of ovarian reserve. By examining AMH levels in connection with nutrient intake and body composition parameters, this study aimed to provide a preliminary background for further studies focused on establishing dietary and lifestyle recommendations that could lead to improvements in fertility outcomes. Methods: The research involved 28 women, aged 26 to 42-both with and without ovulatory infertility-who were patients of the Reproductive Health Clinic at the Medical University of Białystok. The participants underwent a number of tests consisting of hormonal profiling, including AMH measurements, body composition analyses, and dietary assessments based on a 3-day food diary. Results: The findings of the study indicate that certain lifestyle factors are associated with changes in AMH levels. Most importantly, the multivariate linear regression model designed in the study shows that age, waist-to-hip ratio (WHR), as well as the intake of sucrose, iodine, and erucic acid explain variations in serum AMH levels. These results support the hypothesis that modifiable lifestyle factors can influence AMH levels, and thus ovarian reserve. Conclusions: The study underscores the potential for targeted lifestyle interventions to support fertility and calls for further research in the form of prospective studies performed in larger groups of patients to substantiate these associations and inform fertility care strategies. Based on the preliminary results of this study, certain dietary ideas that could positively influence fertility have been proposed, focused on the normalization of body weight and the reduction in excess fat tissue.

Maternal insulinemic and inflammatory dietary patterns and risk of child neurodevelopmental delay

PURPOSE

Our aim was to assess the risk of higher insulinemic, inflammatory, and hyperglycemia potential in the diet during pregnancy with child neurodevelopmental delay.

METHODS

We enrolled 7,438 pregnant women participating in a prospective cohort study. The food frequency questionnaire was used to evaluate the empirical dietary index for hyperinsulinemia (EDIH), empirical dietary inflammatory pattern (EDIP), glycemic index (GI), and glycemic load (GL) during mid-pregnancy. Child neurodevelopmental assessment was conducted at 6-36 months postpartum using the Denver Developmental Screening Test-II (DDST-II) scale, and the Gesell Developmental Diagnosis Scale (GDDS) was administered to assess children who did not meet the criteria for passing the DDST-II screening.

RESULTS

We documented 540 incident child neurodevelopmental delay cases over 7,438 pregnant women (median follow-up: 2 years). Pregnant women exhibiting the high levels of hyperinsulinemic or proinflammatory components, or GI encountered an elevated risk of child neurodevelopmental delay; HRs (95% CI) comparing highest to lowest dietary index quintiles were EDIH 1.48 (1.07,2.04; P trend = 0.017), EDIP 1.39 (1.05,1.84; P trend = 0.019) and GI 1.36 (1.02,1.81; P trend = 0.038). In sex-stratified analyses, these results remained significant only in boys (P trend = 0.018 for EDIH, P trend = 0.028 for EDIP, P trend = 0.029 for GI). The performance of combined model of EDIH and EDIP for boys is comparable to that of the combined model of EDIH, EDIP, and GI to assess the risk of neurodevelopmental delay (AUC [area under curve] 0.801 vs. AUC 0.830). Both values are higher than the AUC values achieved by models using either set of indicators individually.

CONCLUSION

Our findings suggest that maternal consumption of diets with high insulinemic, inflammatory, or glycemic index properties may be associated with neurodevelopmental delays in children, particularly in boys. Higher insulinemic and inflammatory potentials in maternal diet may forecast neurodevelopmental delay in boys.

Nutritional education on health beliefs, metabolic profiles, and quality of life among high-risk pregnant women for gestational diabetes mellitus: a randomized controlled trial

In recent years, nutrition has become increasingly important in treating and managing gestational diabetes mellitus. The Health Belief Model (HBM) is a conceptual framework in health behavior research used in some medical research. The present study aimed to evaluate the effect of glycemic index training based on the HBM on metabolic indicators and pregnant women's health-related quality of life. In this open-label, parallel-controlled randomized trial, 90 pregnant women from primary health centers in Iran were recruited and randomly assigned to either the intervention group or the control group, using a block randomization method with a block size of six. The intervention group underwent 12 weeks of nutritional education on the glycemic index and load of foodstuff. The control group only received routine health care. Valid and reliable questionnaires included demographic and prenatal information, physical activity, three days of food records, quality of life (SF-12), and HBM constructs. Fasting blood samples were taken at baseline and end of the study, to assess fasting blood glucose (FBS), fasting insulin, hs-CRP, and lipids. Eighty-four pregnant women with an age mean of 30.12 ± 4.35 completed 12 weeks of intervention. At baseline, there were no significant differences between groups in the HBM subscales (P > 0.05). However, within the intervention group, there was an increase in perceived susceptibilities (mean change 1.45 ± 4.21; P = 0.03) and cue to action (mean change: 1.22 ± 3.38; P = 0.02). In the adjusted model, the General Health subscale of Quality of Life showed a significant increase in the comparison between groups (mean change 13.69 ± 29.83 vs. 0.00 ± 29.58; P = 0.04). Additionally, the adjusted model revealed a notable difference between the groups in serum hs-CRP level, (mean change -0.877 ± 3.47 vs. -0.067 ± 3.40; P = 0.01) and triglyceride level (mean change - 55.24 ± 111.21 vs. 40.92 ± 142.01; P = 0.001). However, in the adjusted model, the total cholesterol levels increased between groups (mean change 22.75 ± 66.17 vs. 30.12 ± 61.33; P = 0.01) at the end of the study. There was no significant difference in glycemic indices (P > 0.05). Participation in a nutrition education program might positively impact nutritional beliefs, behaviors, and some biochemical indicators among pregnant women. Future studies with larger sample sizes and longer follow-ups are warranted.Trial registration number: IRCTID: IRCT20190227042858N1. Registration date: 2019-07-18.

Structuring white rice with gellan gum reduces the glycemic response in healthy humans

White rice has a high glycemic index and its consumption has been linked to an increased risk of developing type-2 diabetes mellitus, increased diabetes associated complications and obesity. In recent in vitro studies we have shown that addition of food hydrocolloids, such as low acyl gellan gum (LAGG), when cooking white rice potentially modifies starch digestion kinetics. The impact in vivo remains to be investigated. We aimed to determine the effect of adding LAGG to white rice on postprandial glycemic, gastrointestinal and appetitive responses in humans. Following LAGG in vitro characterisation, 12 healthy adults participated in a randomised, controlled, crossover study. They consumed isoenergetic meals of jasmine white rice (232 kcal) cooked with (Rice + LAGG) and without (Rice control) 3 % w/dry rice w LAGG. Blood glucose, intragastric meal appearance, meal volume and appetite were assessed serially for 2 h. The incremental area under the curve over two hours (iAUC2h) for blood glucose for the Rice + LAGG meal (93 ± 16 mmol/L·min) was significantly lower than that for the Rice control meal (160 ± 18 mmol/L·min), P=0.0007. Blood glucose rose postprandially to a peak at T=30 min, with the Rice control meal peak (7.3 ± 0.2 mmol/L) significantly higher than that for the Rice + LAGG meal (6.5 ± 0.2 mmol/L), P < 0.01. MRI images showed that for Rice + LAGG there were multiple rice boluses persisting intragastrically throughout the digestion time. There were no significant differences in appetite between meals. The addition of LAGG to the cooking process was effective in reducing postprandial blood glucose responses in healthy humans. If confirmed, this could potentially provide a simple and relatively inexpensive intervention to reduce the post prandial glycemic response to white rice.

A collectanea of food insulinaemic index: 2023

BACKGROUND AND AIMS

To systematically update and publish the lnsulinaemic Index (II) value compilation of food/beverages.

METHODS

A literature search identified around 400 scholarly articles published between inception and December 2023. II values were pooled according to the selection criteria of at least 10 healthy, non-diabetic subjects with normal BMI. In addition, the II reported should have been derived from incremental area under the curve (iAUC) calculation of the insulin concentration over time. The reference food used from the pooled articles were either glucose or bread.

RESULTS

The II of 629 food/beverage items were found from 80 distinct articles. This is almost a five-fold increase in the number of entries from a previous compilation in 2011. Furthermore, these articles originated from 32 different countries, and were cleaved into 25 food categories. The II values ranged from 1 to 209. The highest overall recorded II was for a soy milk-based infant formula while the lowest was for both acacia fibre and gin. Upon clustering to single food, the infant formula retained the highest II while both acacia fibre and gin maintained the lowest recording. As for mixed meal, a potato dish served with a beverage recorded the highest II while a type of taco served with a sweetener, vegetable and fruit had the lowest II. Our minimum and maximum II data values replace the entries reported by previous compilations.

CONCLUSION

Acknowledging some limitations, these data would facilitate clinical usage of II for various applications in research, clinical nutrition, clinical medicine, diabetology and precision medicine. Future studies concerning II should investigate standardisation of reference food, including glucose and the test food portion. Although this collectanea adds up new food/beverages II values, priority should be given to populate this database.

Dietary glycemic index and glycemic load predict longitudinal change in glycemic and cardio-metabolic biomarkers among old diabetic adults living in a resource-poor country

This study aims to investigate longitudinal associations between the dietary glycemic index (GI) and glycemic load (GL) and changes in glycemic and cardio-metabolic outcomes. A 28-month retrospective cohort study included 110 Vietnamese diabetic patients, collecting their dietary GI and GL values along with blood biochemical data from baseline 24-h dietary recall and medical records. Latent class growth modelling identified three distinct HbA1c trajectories during the follow-up period, with 51% of patients achieving good glycemic control. The adjusted linear mixed-effect model showed that 1 unit increase in logarithms in dietary GL was associated with a 0.14% increase in the log-HbA1c. Among poorly controlled diabetic patients, baseline GL values were positively correlated with increases in HbA1c; GI showed effects on changes in fasting plasma glucose and the triglyceride-glucose (TyG) index. No significant association was observed in patients with good glycemic control.

Weight Loss Programs: Why Do They Fail? A Multidimensional Approach for Obesity Management

PURPOSE OF REVIEW

Despite the prevalence of weight loss programs, their success rates remain discouraging, with around half of individuals regaining lost weight within two years. The primary objective of this review is to explore the factors contributing to the failure of weight loss programs and to provide insights into effective weight management strategies.

RECENT FINDINGS

Factors contributing to the failure of weight loss programs include the impracticality of restrictive diets, potential metabolic impacts, limited focus on lifestyle changes, genetic predispositions, psychological influences, socioeconomic status, and medical conditions. A holistic approach considering these factors is crucial for safe and sustainable weight loss. Key findings indicate the importance of holistic approaches to weight management, including lifestyle modifications, medical interventions, and behavioral and psychological strategies. Effective weight loss strategies emphasize low-calorie, nutrient-rich diets, regular physical activity, and interventions tailored to individual needs. Combining multiple approaches offers the best chance of successful weight management and improved health outcomes. This review provides insights into the complexities of obesity management and the factors contributing to the failure of weight loss programs. It highlights the necessity of adopting a holistic approach that addresses dietary habits, physical activity, genetic factors, psychological well-being, and socioeconomic influences. Recommendations include implementing lifestyle modifications, medical interventions when necessary, and integrating behavioral and psychological support to achieve sustainable weight loss and mitigate the global health challenge posed by obesity.

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.

Macromolecular, thermal, and nonthermal technologies for reduction of glycemic index in food-A review

Consumers rely on product labels to make healthy choices, especially with regard to the glycemic index (GI) and glycemic load (GL), which identify foods that stabilize blood sugar. Employing both thermal and nonthermal processing techniques can potentially reduce the GI, contributing to improved blood sugar regulation and overall metabolic health. This study concentrates on the most current advances in GI-reduction food processing technologies. Food structure combines fiber, healthy fats, and proteins to slow digestion, reducing GI. The influence of thermal approaches on the physical and chemical modification of starch led to decreased GI. The duration of heating and the availability of moisture also determine the degree of hydrolysis of starch and the glycemic effects on food. At a lower temperature, the parboiling revealed less gelatinization and increased moisture. The internal temperature of the product is raised during thermal and nonthermal treatment, speeds up retrogradation, and reduces the rate of starch breakdown.

Determining key factors affecting coconut sap quality after harvesting

The production of coconut sap beverages faces a challenge with the quality of the incoming coconut sap sourced from farmers. The clarification of pivotal factors influencing the quality of coconut sap after harvesting is of paramount importance for fostering mutual benefit between the involved parties. This research focuses on assessing the quality and degradation of coconut sap during the post-harvest stage. It addresses the shortcomings in evaluating coconut sap quality and improper pick-up conditions. To improve these processes, various experiments were designed, including 1) preliminary experiments that explored microbial count, pH, and soluble solids in harvested coconut sap at varying intervals, and 2) the L9 Taguchi Orthogonal Array method. These approaches identify the optimal levels of factors such as cleaning method, storage temperature, and preservative type. By reducing the number of experiments, costs and time were minimized, 3) the 23 factorial design was implemented, reducing the levels of each factor while measuring coconut sap quality based on pH and total soluble solids (representing sweetness) at different post-harvest intervals. The results from the Taguchi method were then used to design the factorial method experiment. The analysis revealed crucial factors influencing coconut sap quality at the 10-h mark. Storage and transportation temperatures, along with the type of preservative, significantly impacted the pH value. However, the washing method and preservative type showed no statistically significant effect on Total Soluble Solids (TSS) value (p > 0.05). Recommendations include using tap water for container cleaning, opting for Payom wood as a preservative, and adhering to cold chain practices for transportation exceeding 4 h, with temperatures maintained below or equal to 10 °C . Swift sap collection within 4 h post-harvest, coupled with stringent temperature control during transportation (not exceeding 10 °C ), is advised to ensure optimal quality. Integrating pH with TSS values enhances comprehensive quality assessment, aligning with established best practices in coconut sap handling.

Gestational Diabetes Mellitus: What Can Medical Nutrition Therapy Do?

Gestational diabetes mellitus (GDM) is one of the common complications during pregnancy. Numerous studies have shown that GDM is associated with a series of adverse effects on both mothers and offspring. Due to the particularity of pregnancy, medical nutrition treatment is considered to be the first choice for the treatment of GDM. This contribution reviews the research progress of medical nutrition treatment in GDM, summarizes the international recommendations on the intake of various nutrients and the influence of nutrients on the prevalence of GDM, and the improvement effect of nutritional intervention on it, in order to provide references for research in related fields of GDM and the targeted development of enteral nutrition.

Emerging Trends in Bioavailability and Pharma-Nutraceutical Potential of Whey Bioactives

Whey, a component of milk and a useful by-product of the dairy industry's casein and cheese-making, has been used for generations to augment animal feed. It contains a range of proteins, including α-lactalbumin, β-lactoglobulin, bovine serum albumin, heavy and light chain immunoglobulins, lactoferrin, glycomacropeptide, and lactoperoxidase. Whey proteins exhibit great potential as biopolymers for creating bioactive delivery systems owing to their distinct health-enhancing characteristics and the presence of numerous amino acid groups within their structures. Whey has considerable factors such as antitumor, anti-inflammatory, antihypertensive, hypolipidemic, antiviral, and antibacterial properties in addition to chelating. The global market of whey protein stood at USD 5.33 billion in 2021, with a projected compound annual growth rate of 10.48% spanning the interval from 2022 to 2030. The escalating demand for whey protein is intrinsically linked to the amplifying consciousness surrounding healthy lifestyles. Notably, protein supplements are recurrently endorsed by fitness and sports establishments, thereby accentuating the focal point of customers toward whey protein. This review focuses on nutritional composition, whey bioactives, and their bioavailability with potential health benefits.

Effects of purple potato anthocyanins on the in vitro digestive properties of starches of different crystalline types

This study explored the potential of purple potato anthocyanins (PPAs) in regulating the digestive properties of starches of various crystalline types. In vitro digestion experiments indicated that PPAs inhibit the hydrolysis of rice starch (A-type) better than that of garden pea starch (C-type) and potato starch (B-type). Further structural assessment of different PPA-starch systems showed that PPAs and starch likely interact through non-covalent bonds, resulting in structural changes. Microstructural changes observed in the starches were consistent with the in vitro digestion results, and the chain length and proportions of short/long chains in amylopectin molecules affected the binding strengths and interaction modes between PPAs and starch. Hence, the three starches differed in their PPA loading efficiency and digestibility. These discoveries contribute to a deeper understanding of the mechanisms underlying the inhibition of starch digestibility by PPAs. They can aid the formulation of value-added products and low-glycemic-index foods.

[Dietary Management of Obesity]

Obesity is defined as a condition characterized by the abnormal accumulation of fat cells, which results in increased body weight. Worldwide, obesity is progressively on the rise, leading to an increased prevalence of chronic conditions such as cardiovascular disease, type 2 diabetes, and hyperlipidemia. Obesity is a result of the interplay between genetic, metabolic, social, behavioral, and cultural factors, necessitating an interdisciplinary and multimodal management approach. Diet therapy, which includes dietary modifications and nutritional interventions, is a fundamental component of the multifaceted approach to managing obesity. The principle of diet therapy is based on achieving weight loss through a negative energy balance and maintaining weight through an equilibrium of energy intake and expenditure. Strategies for weight loss and control rely on caloric restriction, macronutrient distribution, and dietary patterns such as the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets. Recently, studies have been conducted on weight control using information and communication technology-based interventions, as well as interventions based on intestinal microorganisms which consider inter-individual variability and long-term adherence. In conclusion, diet therapy stands as a pivotal element in the management of obesity, providing a personalized and comprehensive approach to weight control. By combining evidence-based dietary strategies with behavioral modifications and consistent support, healthcare professionals can enable individuals to attain and sustain a healthier weight, thereby reducing related health risks.

Water solubility differentiates the impact of tea polyphenols and rutin on the postprandial glycemic response to cooked maize starch

Postprandial hyperglycemia is an independent risk factor for cardiovascular diseases, and the impact of tea polyphenols (TP) and rutin, representative phenolic compounds with different water solubilities, on the postprandial glycemic response to cooked normal corn starch (CCS) was investigated. Comparatively, TP (DPPH50 = 0.12 mmol L-1) are more potent than rutin (DPPH50 = 0.50 mmol L-1) in scavenging the free radicals of DPPH, but both TP and rutin inhibited the activity of porcine pancreatic α-amylase (PPA), the major enzyme in starch digestion, with an IC50 of 4.09 mmol L-1 and 2.71 mmol L-1, respectively. However, an in vivo study showed that a significant reduction in postprandial blood glucose was only observed in the presence of rutin, and TP had no effect on the glycemic response to CCS. To find out the underlying mechanism, fluorescence spectroscopy and molecular docking were carried out and they showed that, compared to TP, rutin bound to the active site of PPA with higher affinity and a lower free energy (ΔG) driven by hydrogen bonds and π-stacking, and rutin also greatly increased the viscosity of starch. Collectively, water-soluble TP have a higher antioxidant property and a lower potency to inhibit PPA compared to water-insoluble rutin, and the weaker interaction between TP and PPA, and starch as well might synergistically contribute to TP's ineffectiveness in lowering the postprandial glycemic response, and water solubility linking the molecular structures and functions of phenolic compounds might be the fundamental basis for the observed difference in their biological functions, and water solubility can also be used to enrich specific phenolic compounds for desired functions.

Quantitative saccharide release of hydrothermally treated flours by validated salivary/pancreatic on-surface amylolysis (nanoGIT) and high-performance thin-layer chromatography

The susceptibility of hydrothermally treated flour products to amylolysis was studied. The human salivary α-amylase and porcine pancreatin enzyme mixture containing α-amylase were used on-surface to investigate the release of glucose, maltose, and maltotriose. On the same adsorbent surface (all-in-one), their high-performance thin-layer chromatography separation and detection via selective chemical derivatization was performed. For the first time, the all-in-one nanoGIT system was studied quantitatively and validated for the simulated static oral and intestinal on-surface amylolysis of ten different hydrothermally treated flours and soluble starch. Differences were detected in the digestibility of refined and whole flours from wheat, spelt, and rye as well as from einkorn, amaranth, emmer, and oat. Amaranth released the lowest amount of saccharides and spelt the highest in both oral and intestinal digestion systems. The results suggest that consumption of whole grain products may be beneficial because of their lower saccharide release, with particular attention to rye.

Low-Glycemic Load Diets and Thyroid Function: A Narrative Review and Future Perspectives

Nutrition and calorie intake are associated with subtle changes of thyroid function tests in subjects with an intact Hypothalamic-Pituitary-Thyroid axis. Iodine deficiency and extreme fluctuations in calorie intake, such as those that occur during periods of starvation or overfeeding could lead to alterations in thyroid hormones. The dietary macronutrient and micronutrient composition could also influence the thyroid function. Recently, Low-Glycemic Load (LGL) diets have become very popular and are effective in the treatment and/or prevention of several medical conditions, including diabetes, obesity, cardiovascular disease, and epilepsy. In this review, we report on the available data from the literature regarding the association between LGL diets and thyroid function or dysfunction. Several studies conducted in this field to date have yielded inconsistent results.

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.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The Health Effects of Low Glycemic Index and Low Glycemic Load Interventions on Prediabetes and Type 2 Diabetes Mellitus: A Literature Review of RCTs

Diets with a low glycemic index (GI) and a low glycemic load (GL) can improve glycemic control, blood lipids, blood pressure and BMI in prediabetes and type 2 diabetes (T2DM), but evidence regarding other aspects of cardiometabolic health is limited. We searched the literature for RCTs published from 2013 to 2023 and reviewed the evidence on low-GI/GL diets and their effects on different aspects of health in prediabetes and T2DM, aiming to build a report on all relevant outcomes included in the studies. We included 14 RCTs with 1055 participants, who were mostly middle-aged individuals with T2DM. Interventions were mostly low GI and lasted 1-36 months. Low-GI/GL foods and diets showed benefits in terms of short-term glycemic control, weight and adiposity. Longer-term trials would be necessary to determine whether these benefits persist over time and/or lead to lower CVD risk and mortality. Effects on lipid profile were inconsistent. Some studies also reported positive effects of low-GI/GL interventions on blood pressure, inflammatory biomarkers, renal function and gut microbiota composition. Future trials should focus on some of these novel outcome measures, which may provide important insights into the metabolic effects of low-GI diets on individuals with diabetes.

Understanding the health benefits and technological properties of β-glucan for the development of easy-to-swallow gels to guarantee food security among seniors

The world's population is growing rapidly and the number of elderly people with undernutrition and malnutrition is increasing. Common health problems among seniors are cardiovascular, inflammatory, gastrointestinal, and cognitive disorders, cancer, diabetes, psychological and dental problems. The food industry is trying to meet the demands of an aging society, but these efforts are not sufficient. New strategies are needed, and they demand foods development with modified textures that are easy to swallow, such as gels suitable for seniors. Depending on the specific needs of the elderly, bioactive compounds with health benefits should be included in food systems. Novel foods may play an important role in the prevention, maintenance, and treatment of age-related diseases. One of the most studied bioactive compound is β-glucan, a polysaccharide with approved health claims confirmed by clinical trials, such as "β-glucan contributes to the maintenance of normal blood cholesterol levels" and "the consumption of β-glucan from oats or barley contributes to the reduction of postprandial glucose spikes." In this review, the health benefits, and technological properties of β-glucan for the development of senior-friendly ready-to-swallow gels were described. In addition, some patents and studies conducted in connection with the development of the gel systems were collected.

Effectiveness of Chickpeas on Blood Sugar: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Diabetes affects one in eleven adults globally, with rising cases in the past 30 years. Type 1 and type 2 cause blood sugar problems, increasing cardiovascular risks. Dietary control, including chickpeas, is suggested but needs more research. Comprehensive searches were conducted across multiple databases for the randomized controlled trial efficacy of chickpea consumption to lower blood sugar levels to a healthy range, with data extraction and risk of bias assessment performed independently by two researchers. Statistical analysis was performed using RevMan 5.4, expressing continuous data as mean differences and risk ratios with 95% confidence intervals, and a summary of the findings is provided considering the variations in study characteristics. A total of 118 articles were initially identified from seven databases, primarily from Anglo-American countries, resulting in 12 selected studies after the identification and screening processes. These studies involved 182 participants, focusing on healthy or normoglycemic adults, and assessed the effects of chickpeas compared to various foods such as wheat, potatoes, pasta, sauce, cheese, rice, and corn. A meta-analysis involving a subset of studies demonstrated that chickpeas were more effective in reducing blood glucose iAUC compared to potatoes and wheat. Chickpeas offer the potential for blood sugar control through low starch digestibility, high fiber, protein, and hormonal effects. Although insulin benefits are seen, statistical significance varies, supporting their role in diabetic diets focusing on nutrient-rich foods over processed carbs.

Prevalence and determinants of obesity among individuals with diabetes in Indonesia

Background: Obesity and diabetes mellitus (DM), both individually or simultaneously, increase the risk of morbidity and mortality. The present study aimed to determine the prevalence and determinants of obesity among diabetic individuals in Indonesia. Methods: Data were extracted based on 2018 Indonesian Basic Health Survey (Riset Kesehatan Dasar=RISKESDAS). This study involved all individuals with DM and categorized obesity based on body mass index. After data clearing, this study analyzed 3911 DM subjects of the 33.905 subjects acquired from the 2018 RISKESDAS. The study also observed demographic data, diabetes control parameters, history of hypertension, lipid profiles, and food consumption patterns. These variables were involved in a Chi-square test, and related variables were then involved in the Binary logistic regression to define the independent determinants of obesity among DM subjects. Results: Of the 3911 DM subjects included, the study found an obesity prevalence of 32.9%. This study found that female (prevalence odds ratio [POR]=2.15; 95% CI: 1.76-2.62), age 15-44 years (POR=2.46; 95% CI: 1.83-3.33), urban residence (POR=1.49; 95% CI: 1.25-1.77), history of hypertension (POR=1.25; 95% CI: 1.04-1.51), high diastolic blood pressure (POR=1.90; 95% CI: 1.58-2.29), high LDL (POR=1.44; 95% CI: 1.13-1.84), high HDL (POR=0.60; 95% CI: 0.46-0.78, and high triglycerides (POR=1.27; 95% CI: 1.07-1.50) were the risk factor of obesity  among DM subjects; while higher education (POR=0.64; 95% CI: 0.53-0.78) and married (POR=0.73; 95% CI: 0.59-0.90) were protective factors of obesity among DM subjects. Conclusions: The study concluded that almost one-third of DM subjects in Indonesia were obese. Female, age, urban residence, education level, history of hypertension, diastolic blood pressure, and lipid profiles were all associated with obesity among DM subjects in Indonesia. These findings suggest that monitoring and controlling of related determinants is needed to prevent complications caused by the doubled burden of diabetes and obesity.

Determination of glycaemic response to the consumption of two specialised formulas for glycaemic control

To assess the glycaemic response after ingestion of two specialised oral and enteral nutrition formulas for glycaemic control. The participants were sixteen healthy volunteers, aged 21-49 years, with normal glucose tolerance. The volunteers attended the tests fasting for 10 h, for 5 weeks, and consumed the reference food - glucose solution - for 3 weeks, and the two formulas DiamaxO and DiamaxIG in the following weeks, in amounts equivalent to 25 g of available carbohydrates. During the period of 120 min, seven blood samples were taken through capillary blood sampling to determine the glycaemic response. The glycaemic index (GI) was calculated according to the trapezoidal rule, ignoring areas below the fasting line. The glycaemic load (GL) was determined by the formula GL = ((GI(glucose = reference) × 'g' of available carbohydrate per serving]/100. The formulas showed low GI and GL. GI = 37·8 and GL = 6·6 for DiamaxO and GI = 21·5 and GL = 3·5 for DiamaxIG. The peak of the glycaemic response occurred 30 min after ingestion, with a marked difference in blood glucose between the Diamax products in relation to glucose. Differences were also significant at times 15, 45, 60 and 90 min in relation to glucose (ANOVA with post hoc Bonferroni, P < 0·005), but not between the two products. However, the AUC and the GI of DiamaxIG are significantly smaller than that of the DiamaxO second t test (P = 0·0059). The glycaemic response to the products is quite reduced, presenting a curve with a little accentuated shape, without high peak, especially in the modified product.

Effect of low-glycemic index diet advice on pregnant outcomes in women with elevated risk of gestational diabetes mellitus: A meta-analysis of randomized controlled trails

BACKGROUND AND AIMS

The beneficial effect of low-glycemic index (GI) diet on gestational diabetes mellitus (GDM) has been suggested in many observational studies; however, results from intervention trials remain inconsistent. This study aims to estimate the effect of interventions with low-GI dietary advice on pregnant outcomes in women with elevated risk of GDM.

DESIGN

PubMed, Web of Science, Embase, and Cochrane Library databases were searched for randomized clinical trials (RCTs) through March 2022. Studies reporting the effect of low-GI diet advice intervention on maternal and fetal outcomes in pregnant women with increased risks of GDM were included. Random or fixed effects model was used to calculate combined treatment effects. Publication bias was assessed via Begg's and Egger's tests and funnel plot inspection.

RESULTS

Nine RCTs recruiting 3416 participants were included. Low-GI diet advice did not modulate the risk of GDM. Compared with control diets, low-GI diet advice significantly reduced gestational weight gain (GWG) (weighted mean differences, WMD = -0.93 kg, 95% CI: -1.31, -0.55; p < 0.001; n = 7) and the risk of premature birth (RR = 0.55, 95% CI: 0.35, 0.88; p = 0.012; n = 5). In subgroup analyses, the effect of low-GI diet interventions on premature birth was significant only in women with BMI higher than 30 kg/m2 (RR = 0.28, 95% CI: 0.10, 0.77, p = 0.014; n = 3); the significant effect on GWG was not altered by stratification of BMI and the type of GDM risk factors. No significant changes in other maternal and newborn outcomes were found.

CONCLUSIONS

Low-GI diet advice interventions during pregnancy decreased GWG and the risk of premature birth in women with elevated GDM risk; however, the interventions did not significantly prevent GDM development in these women.

Recent Advances in Nutraceuticals for the Treatment of Sarcopenic Obesity

Sarcopenic obesity, low muscle mass, and high body fat are growing health concerns in the aging population. This review highlights the need for standardized criteria and explores nutraceuticals as potential therapeutic agents. Sarcopenic obesity is associated with insulin resistance, inflammation, hormonal changes, and reduced physical activity. These factors lead to impaired muscle activity, intramuscular fat accumulation, and reduced protein synthesis, resulting in muscle catabolism and increased fat mass. Myostatin and irisin are myokines that regulate muscle synthesis and energy expenditure, respectively. Nutritional supplementation with vitamin D and calcium is recommended for increasing muscle mass and reducing body fat content. Testosterone therapy decreases fat mass and improves muscle strength. Vitamin K, specifically menaquinone-4 (MK-4), improves mitochondrial function and reduces muscle damage. Irisin is a hormone secreted during exercise that enhances oxidative metabolism, prevents insulin resistance and obesity, and improves bone quality. Low-glycemic-index diets and green cardamom are potential methods for managing sarcopenic obesity. In conclusion, along with exercise and dietary support, nutraceuticals, such as vitamin D, calcium, vitamin K, and natural agonists of irisin or testosterone, can serve as promising future therapeutic alternatives.

Effect of the Nutritional Intervention Program on Body Weight and Selected Cardiometabolic Factors in Children and Adolescents with Excess Body Weight and Dyslipidemia: Study Protocol and Baseline Data

Excess body weight and associated dyslipidemia in children and adolescents are the main risk factors for cardiovascular diseases in young adults. There is a reasonable need to develop an effective lifestyle modification program that includes various dietary therapies. A low-glycemic index (GI) diet may be recommended in the treatment of obesity. Its use is also recognized as reasonable in cardiovascular diseases, including dyslipidemia. The aim of the presented nutritional intervention program was to evaluate the effectiveness of an energy-balanced diet based on the principal recommendation on Cardiovascular Health Integrated Lifestyle Diet-2 (CHILD-2) and low-GI products (LGI diet) in children and adolescents with excess body weight and dyslipidemia. The study involved 64 children and adolescents (44 boys and 20 girls) aged 8-16 with overweight or obesity and dyslipidemia. For 8 weeks, the participants followed a dietary treatment using two types of diets: one based on products with a low GI, and one standard therapy diet. During this time, they participated in three visits with a dietitian, during which the assessment of their current and habitual food intake was made, and anthropometric measurements and blood pressure were taken. Patients were under the care of a pediatrician who qualified them for the study and ordered lipid profile tests. This article presents the design, protocol of the nutritional intervention program, and baseline data. The collected results will be used to develop practical nutritional recommendations for children and adolescents with excess body weight and dyslipidemia.